Download RENAL CALCULI

RENAL CALCULI
What are Renal Calculi ?
• Urine passes away from the kidneys,
down a tube on each side called the
ureter, and into the bladder. From
here, the urine is discharged through
the urethra
• If there is too much of certain waste
products in the urine, these
substances form crystals
• Crystals can then combine to form
stones.
• The stones may lie in the kidney, and
often do not cause symptoms there.
• However, when they pass down the
ureter on their way to the bladder, pain
usually occurs
• If a stone gets stuck on its way down
the ureter, pain usually occurs in the
form of renal colic.
• This is a griping pain which can be
very severe.
• Blood may be passed as well, due to
the irritation of the lining of the ureter by
the sharp-edged stone.
• As the stone is being passed, the pain
may be felt in the penis (males) or in the
vaginal area (in females).
•Once the stone has passed, the
bleeding and pain stop quite abruptly.
Symptoms
• Sudden severe and excruciating back pain
which may come and go and often radiates
from the back across the abdomen and into
the genital area or inner thighs
• may be associated with nausea, vomiting,
abdominal bloating, possible blood in urine,
pain during urination and chills and fever.
• Stones in the urinary tract can be one of
the most painful conditions known to
humankind.
How do Renal Calculi occur ?
• Very concentrated urine
• Hot climates
• Increase in the concentration of
certain waste product.
Types of calculi
1. Calcium stones occur when there is too
much calcium in the urine.
This may happen if there is too much calcium
in the diet from milk, cheese or bread.
Some people seem to absorb more calcium
from the gut and there is nowhere for it to go
other than into the urine.
Other people may have an overactive
parathyroid gland (hyperparathyroidism). This
results in calcium being leached out of the
bones and again it has nowhere else to go but
the urine.
2. Oxalate stones can occur if there is
too much oxalate in the diet (e.g
spinach, chocolates and certain nuts).
They are more likely to occur in people
who have a bowel problem in which fat
is not being absorbed properly.
3. Uric acid stones form when there is
too much uric acid in the urine.
This comes as a direct result of too
much uric acid in the blood.
This is particularly likely in people who
are prone to the condition of gout.
High concentration of uric acid usually
occurs in people who consume food
rich in proteins.
4. Cystine stones are an uncommon problem
where the kidneys leak high quantities
of the amino acid cystine.
Why do Renal Calculi occur ?
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Inherited tendency
Infections
Low urine flow.
Kidney stones form when a change
occurs in the normal balance of
water, salts, minerals, and other
things found in urine.
• The most common cause of kidney
stones is not drinking enough water.
Tests to diagnose kidney stones
• CT scan
(spiral computed tomography ) of the
ureters and kidneys, but the scanner
moves in a circle as you move through
the machine.
• Intravenous pyelogram (IVP)
The doctor injects a special dye into
the patient. A technician will then take
x-rays as the dye enters the kidneys
and travels down the urinary tract.
Spiral CT scan
Urine Tests
• Urine samples are required to
evaluate features of the urine,
including its acidity and the presence
of:
• Red or white blood cells
• Infection
• Crystals
• High or low levels of chemicals that
inhibit or promote stone formation
Microscopic Examination
• The kidney stones obtained from the
urine sample are examined under a
microscope.
• The crystal formations are often
specific enough so that the doctor is
able to identify the substance
causing the stone.
Testing the Acidity of Urine
• Testing whether urine is acidic or
alkaline helps to identify the specific
type of stone:
• A pH value of 7.0 is neutral.
• A solution with a low pH (below 7.0) is
acidic. (A low pH favors uric acid and
cystine stones.)
• A solution with a high pH is alkaline. (A
high pH favors calcium phosphate
stones.)
Testing for Blood in the Urine
• AA dipstick test for blood in the urine
(called hematuria) is typically
performed when patients appear in
the emergency room with flank pain
(the primary symptom of kidney
stones).
• About a third of kidney stone
patients, however, do not show
blood in the urine, so other tests
may be needed.
Blood Tests
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Blood Tests for Stone Factors
Parathyroid Tests
Tests for Infection
Tests for Metabolic Problems