Download Urolithiasis

Urolithiasis
Renal stone
Nephrocalcinosis
Predisposig Factors
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1. Age (20- 40 yr)
2. Sex (M>F)
3. Enviromental Factors
4. Genetic Factors
5. Dietary Habits (specially for
bladder stone)
Renal stone
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Ca-oxalate, ca-phosphate (the most
common)
Struvite, uric acid, cystine, xanthin,
etc.
Bladder stone:
- ca-oxalate, Amonium urate, Uric acid
Mechanism of stone formation
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Supersaturation
Infection
Retension of crystals
Foreign body
Urine PH
Inhibitors
Citrate, Mg, Pyrophosphate, Zn,
glucosaminoglycan, nephrocalcin,
THF protein
Major causes of nephrocalcinosis
RTA
- Hyperoxaluria
- Hypercalciuria
Stone + Nephrocalcinosis: usually =
DRTA
-
Hypocitraturia (15-63%)
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Primary
Secondary (acidosis, ↑protein intake,
severe exercise, ↑Na intake, ↓urine
Mg, UTI, chronic diarrhea, thiazides)
Clinical manifestations:
Asymptomatic, unless with
displacement, obstruction or UTI.
 Symptoms due to crystaluria
 Symptoms due to stone
- Stone passing, renal colic (15%),
hematuria abdominal pain, FTT,
lower urinary tract symptoms
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Bladder stone symptoms
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Lower UT symptoms
Erection
Urinary retension
Rectal prolapse
↓pain in supine position
Diagnosis
KUB
Sono
CT scan
IVP
Secondary Signs on CT…
Hydroureter
Hydronephrosis
Hydronephrosis in right kidney (long ar
and tiny right renal calculus (short arro
Dilated renal pelvis (arrowhead) with minimal
surrounding fat-tissue stranding
Left kidney is normal.
(Catalano)
(McDonald)
Plain Film Radiography…
For evaluating initial episodes of suspected
urolithiasis, the KUB’s sensitivity for detecting
stones is low (58%- 62%) (ACR)
KUB will detect:
calcium stones
struvite
cystine stones
KUB will miss:
uric acid stones
small stones
stones obscured by bones
Radiograph of left kidney shows
a large stone (arrow) (Susah).
Metabolic evaluations
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Indicated in all children
Serum (ca, P, alk. Phosphatase, uric
acid, K, Na, AG, creatinine)
Fasting urine (U/A, U/C, Ca/Cr,
Cystine, PH)
24hr urine (Ca, P, Uric acid, Oxalate,
Citrate, Mg)
Treatment
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Pain control
Hydration
Control of UTI
Medical, surgical or ESWL
Prevention
Medical treatment
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Non-pharmacological medical
therapy in all children
Pharmacological therapy in children
with multiple stones at presentation
or recurrence of stone during one
year.
Special indications for drug therapy
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Hypercalciuria (the most common)
RTA
Cystinuria
Hyperuricosuria
Hypocitraturia
Non-pharmacological
Non-surgical therapy
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↑Water intake
Prevention of heavy exercise
↓Na intake
↓Protein intake (↓urine Ca, ↑Urine PH,
↓Urine uric acid)
Ca-intake (regular or even ↑)
↓Lipid intake
↓Intake of tea, Coffee, bean, sea
foods, …