Urolithiasis

Urolithiasis

1. Calcifications that form in the urinary system

   • Nephrolithiasis (Kidney
   • Ureterolithiasis (Ureters)
   • Cystolithiasis (Bladder)
   • AKA: Renal Calculi: salt and mineral accumulation in the urinary system
     • Calcium Oxalate
     • Cystine
     • Uric Acid
     • Ammonium magnesium phosphate

2. Pathophysiology

   • Any factor that reduces urinary flow or causes obstruction results in urinary stasis
   • Reduced urine output due to dehydration or reduced fluid intake

3. Treatment

   • Hydration
   • Analgesia
   • Pass in 48 hours usually
     • size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone
       • A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance
         • surgical intervention, shock wave lithotripsy.
     • Pt may be asked to urinate in a strainer so the calculi may be examined
   • Antibiotics if r/t recurrent UTIs

4. S&S: dependent on size and location of calculi

   • Sudden Onset pain: caused by peristaltic waves in ureters
     • radiating from the back, down the flank, and into the groin
       • colicky (intermittent), not improved by changes in position,
   • Dysuria
   • Hematuria
   • Urinary Retention
   • Nauses & Vomitting
   • May be asymptomatic & discovered incidentally

5. Diagnosis

   • Urinalysis
   • Renal imaging via CT Scan
   • Blood tests
   • Physical Examination
   • Medical history
   • radiographic study

6. Risk Factors

   • Medical History
     • HTN, Family hx, Gout, Cystinuria, Hyperparathyroidism, immobility, IBD, intestinal surgery........ETC
   • Environmental
     • Water supply w/ high mineral content
   • Diet
     • Fluid restriction/dehydration
     • high in sodium, oxalate, fat, protein, sugar, unrefined carbohydrates, and ascorbic acid (vitamin C)
   • Medications
     • Meds that cause hyperuricemia (high uric acid)
     • ephedrine, guaifenesin, thiazide, indinavir, and allopurinol