Introduction to Renal

Calculi
Renal calculi, also known as kidney stones, are
hard mineral deposits that form in the kidneys.
These painful conditions can cause severe
discomfort and potentially lead to serious
complications if left untreated. Understanding the
underlying causes and management strategies is
crucial for effective patient care.

by Elsy Mayjo
Risk Factors and Predisposing
Conditions
• Family history: Individuals with a family history of
kidney stones have a higher risk of developing the
condition.
• Dietary factors: Excessive intake of sodium, animal
protein, and high-fructose foods can increase the risk
of stone formation.
• Dehydration: Insufficient fluid intake can lead to the
concentration of minerals in the urine, promoting
stone development.
 Pathophysiology of Renal Calculi
Renal calculi, or kidney stones, form when there is an imbalance in the normal composition of urine.
This can occur due to factors such as dehydration, excess intake of certain minerals, or underlying
metabolic disorders. The buildup of crystallized substances, like calcium, oxalate, or uric acid, leads
to the gradual formation of hard, stone-like deposits within the kidneys.
Pathophysiology of Renal Calculi
Types of Renal Calculi and Staghorn Stones

Common Stone Uncommon Staghorn Stones Composition

Types Stones Analysis

The most common Rarer stone types Staghorn calculi are Determining the
types of kidney stones include struvite (or large, branched stones mineral composition
are calcium oxalate, infection) stones and that fill the entire renal of a stone is key to
uric acid, and cystine drug-induced stones, pelvis and collecting identifying the
stones. Each type which can develop system. They are often underlying cause and
forms due to different from certain caused by urinary tract developing an
imbalances in the medications or infections and require appropriate treatment
body's chemical supplements. complex surgical plan.
composition. treatment.
The main types of stones are
1.calcium stones
2.cystine stones
3.struvite
4.uric acid
Calcium stones:
These are compounds of calcium compounds mostly calcium oxalate, incidence
rate is 70-80% and most commonly occur in men , Sometimes other minerals like
calcium phosphate may also form stones (incidence rate 15%).Calcium stones may
be caused by high calcium level such as in hyperparathyroidism. High oxalate
level can also cause increased risk of calcium stones.
Cystine stones:
These occur due to an inherited defect in amino acid transport, manifests as recurrent
stones in young patients.
Uric acid stones:
Uric acid stones are formed due to low urine output, excessive intake of proteins
especially red meat, alcohol intake, inflammatory bowel disease, gout .these form in acidic
urine and are not visible in a plain X-ray.
Struvite:
These type of stones are usually associated with urinary infection .they can grow very
rapidly forming cast in the urinary tract .left untreated stones may cause chronic infection
and permanent kidney damage.
STAGHORN
STONES:
The renal pelvis is
filled with a large
stone that is shaped
to its contours,
resembling the horns
of a stag.
 CLINICAL MANIFESTATIONS

Patient may not have symptoms until the

stones move down the tubes (ureters)
through which urine empties into the
bladder. When this happens, the stones
can block the flow of urine out of the
kidneys.
The main symptom is severe pain that starts and stops suddenly:

 Pain may be felt in the belly area or side of the back.

 As a stone nears the UVJ, pain moves around toward the abdomen and down toward the lower quadrant.
Pain may move to the groin area (groin pain), testicles (testicle pain) in men, and labia (vaginal pain) in
women.

 If the obstruction is in a calyx or at the UPJ, the patient may have cost vertebral flank pain or colic pain.

 Other symptoms include: dizziness, abnormal urine color, hematuria, pyuria, chills, fever, nausea,
vomiting, diarrhea, abdominal discomfort and manifestations of UTI.
Diagnosis

Patients with renal calculi often experience severe,

colicky flank pain that radiates to the groin.
Hematuria (blood in urine), nausea, and vomiting
are common symptoms. Diagnosis involves a
comprehensive medical history, physical
examination, and imaging tests such as CT scans
or ultrasounds to locate and characterize the stone.
Medical Management of Renal Calculi
Lifestyle Modifications Pharmacological Therapy
Increasing fluid intake, reducing sodium and Medications like thiazide diuretics, citrate
animal protein intake, and maintaining a healthy supplements, and allopurinol may be prescribed to
BMI can help prevent stone formation. reduce stone-forming substances in the urine.

Dietary Recommendations Monitoring and Follow-up

A low-oxalate, low-sodium diet with adequate Regular checkups, urine testing, and imaging
calcium intake can help minimize the risk of studies are crucial to assess treatment
recurrent stone formation. effectiveness and detect any new stone
development.
For some types of stones, your provider may prescribe medicine to prevent stones
from forming or help break down and remove the material that is causing the stone.
These medicines can include:

Allopurinol (for uric acid stones)

Antibiotics (for struvite stones)

Diuretics (water pills)

Phosphate solutions

Sodium bicarbonate or sodium citrate

Water pills (thiazide diuretics)

Tamsulosin to relax the ureter and help the stone pass

SURGICAL MANAGEMENT
1.ENDO UROLOGICAL PROCEDURE
2.LITHOTRIPSY
A)LASER LTHOTRIPSY
B)EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
3.OPEN SURGICAL PROCEDURE
4.PARTIAL / OR TOTAL NEPHRECTOMY
 1.ENDO UROLOGICAL PROCEDURE

If the stone is in the bladder, a cystoscopy is done to remove

small stones. For larger stones, a transurethral or percutaneous
suprapubic cystolitholapaxy is done .in this procedure,
ultrasonic or laser energy or an instrument called a lithotrite
(stone crusher) is used to break up the stone. The bladder is
then irrigated, and the crushed stones washed out.
A cystoscopy lithotripsy uses ultrasonic waves to break up stones
 PERCUTANOUES NEPHROLITHOTOMY

A nephroscope is inserted into the kidney pelvis through a track (using a

sheath) in the skin. The track is created in the patients back. The kidney
stones can be fragmented using ultrasound, electrohydraulic or laser
lithotripsy .the stone fragments are removed, and the pelvis is the
irrigated .a percutaneous nephrostomy tube can be left in place to make sure
that the ureter stays unobstructed.
 LITHOTRIPSY

Lithotripsy is a procedure used to break up stones, thus allowing them to pass from the urinary tract.
Lithotripsy techniques include
1. Laser lithotripsy
2. Extracorporeal shock – wave lithotripsy ( ESWL )
3. Ultrasonic lithotripsy
4. Electrohydraulic lithotripsy

1. LASER LITHOTRIPSY:
It is used to shatter urethral and large bladder stones .to access stones, a urethroscope is used to get close
to the stone. A small fiber is inserted up the scope so that the tip (which emits the laser energy) can come
in contact with the stone .a holmium laser in direct contact with the stone is often used. The intense
energy breaks the stone into small pieces. The pieces are then extracted or flushed out. This minimally
invasive treatment usually requires general anesthesia.
1. EXTRACORPOREAL SHOCK – WAVE
LITHOTRIPSY (ESWL)
The patient is anesthetized (spinal or general) to
ensure they stay in the same position during the
procedure. In this procedure uses fluoroscopy or
ultrasound to focus the lithotripter over the stone.
Then, a high – voltage spark generator produces
high – energy acoustic shock waves that shatters
the stone. The small pieces of stone are then
excreted in the urine.
 3. ULTRASONIC LITHOTRIPSY
High frequency sound waves are used to break
the stone into sand like particles. The patient
receives general or spinal anesthesia.

4. ELECTROHYDRAULIC LITHOTRIPSY
Electrical shock waves are used to break the stone
into small fragments. The patient needs general
anesthesia.
Surgical Management and Pre- and Post-
Operative Measures
1 PRE-OPERATIVE PREPARATION
Comprehensive medical evaluation, imaging studies, and laboratory
tests to assess stone size, location, and composition. Patients may
receive medications to relax the urinary tract and manage pain.

2 SURGICAL INTERVENTIONS
Depending on stone characteristics, various minimally invasive
procedures may be performed, such as extracorporeal shock wave
lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy
(PCNL).

3 POST-OPERATIVE CARE
Patients receive close monitoring, pain management, and hydration to
facilitate stone passage and prevent complications. Follow-up
imaging and urine analysis ensure complete stone removal and guide
further preventive measures.
Nursing Management and Patient Education

Comprehensive Patient Education Pain Management Hydration and

Nursing Care and Empowerment Strategies Fluid Management
Nurses play a crucial
role in managing Nurses educate patients Nurses implement Ensuring adequate
patients with renal on the causes, effective pain hydration is a critical
calculi, providing pain prevention, and management nursing intervention, as
relief, monitoring fluid treatment of kidney techniques, such as it helps dilute urine and
intake, and stones, empowering administering promote the passage of
coordinating with the them to make lifestyle analgesics, providing stones. Nurses closely
medical team to ensure changes and adhere to comfort measures, and monitor fluid intake
optimal outcomes. the prescribed medical teaching patients and output.
regimen. coping strategies to
alleviate the discomfort
associated with renal
calculi.
Prevention and Lifestyle Modifications

Increase Fluid Intake

Drink at least 8 glasses of water per day to dilute urine and flush out
1 stone-forming substances.

Dietary Changes
Limit sodium, animal protein, and high-fructose foods while
2
increasing intake of fruits, vegetables, and dairy products.

Maintain Healthy Weight

Achieving and maintaining a healthy body mass
3
index can reduce the risk of stone formation.

Proactive prevention is key to managing renal calculi. By making simple lifestyle modifications, such as staying
well-hydrated, adjusting dietary habits, and maintaining a healthy weight, individuals can significantly reduce their
risk of developing kidney stones and minimize the likelihood of recurrence.
Conclusion and Key Takeaways
Comprehensive Management Patient Education and Empowerment
Effective treatment of renal calculi requires a
multifaceted approach, combining lifestyle Educating patients on the causes, prevention,
modifications, pharmacological interventions, and management of kidney stones empowers
and, when necessary, specialized surgical them to take an active role in their health and
procedures. reduce the risk of recurrence.

Ongoing Monitoring and Preventive Interprofessional Collaboration

Care
Effective management of renal calculi requires a
Regular follow-up, imaging, and laboratory tests team-based approach, with healthcare
are crucial to ensure complete stone removal and professionals, including physicians, nurses, and
guide long-term preventive strategies, such as dietitians, working together to provide
dietary modifications and lifestyle changes. comprehensive and coordinated care.