UROLITHIASIS (KIDNEY STONES) IN ENGLISH

                                               

                          UROLITHIASIS (KIDNEY STONES) IN ENGLISH

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UROLITHIASIS-

Ø  Urolithiasis and nephrolithiasis refer to stones (calculi) in the urinary tract. Stones may be formed anywhere in urinary tract. It may be in kidney, ureter or even urinary bladder.

CAUSES-

Ø  Causes of stone formation is not clearly understood, and there are a number of theories about their causes. One theory is that there is a deficiency of substances that normally prevent crystallization in the urine, such as citrate, magnesium, nephrocalcin, and uropontin

Ø  Another theory relates to fluid volume status of the patient. As per this theory chances of tones formation are increased in the person with low fluid intake.

Ø  Stones may also be formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase

Ø  Other factors which favor the formation of stones include infection, urinary stasis, and periods of immobility and all factors which slow renal drainage and alter calcium metabolism.

Ø  Uric acid stones (5% to 10% of all stones) may be seen in patients with gout or myeloproliferative disorders.

Ø  Urinary stone formation can occur in patients with inflammatory bowel disease and in those with an ileostomy or bowel resection because these patients absorb more oxalate.

Ø  Some medications may cause stones in some patients such as antacids, acetazolamide, vitamin D, laxatives, and high doses of aspirin.

CLINICAL MANIFESTATIONS-

Ø  Signs and symptoms of stones in the urinary system depend on the presence of obstruction, infection, and edema.

Ø  Stones in the renal pelvis may be associated with an intense, deep ache in the costovertebral region.

Ø  Hematuria is often present

Ø  Pyruria may be present

Ø  tenderness over the costovertebral area

Ø  Diarrhea and abdominal discomfort may occur

Ø  Stones lodged in the ureter (ureteral obstruction) cause acute, excruciating, colicky, wavelike pain.

Ø  Stones lodged in the bladder usually produce symptoms of irritation (burning pain during micturition) and may be associated with UTI and hematuria.

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of urinary stones)

Ø  X-ray (KUB).

Ø  Ultra sonography.

Ø   IV urography.

Ø  Retrograde pyelography.

Ø  Urine (routine) and CBC.

TREATMENT

Ø  Medical management - The immediate objective of treatment of renal or ureteral colic is to relieve the pain until its cause can be eliminated.

Ø  Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating renal stone pain and  reducing swelling and facilitating passage of the stone with urine flow.

Ø  Hot baths or moist heat to the flank areas may also be helpful.

Ø  fluids are encouraged. This increases the hydrostatic pressure behind the stone, assisting it in its downward passage.

Ø  If the stone does not pass spontaneously or if complications occur, common interventions include endoscopic or other procedures. For example, ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), or endourologic (percutaneous) stone removal may be necessary.

Ø  Surgery may be done but rarely needed

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  Pain assessment is very important in the assessment of patients with urinary stones.

Ø  Opioid analgesic agents  may be prescribed and administered to provide rapid relief along with  NSAID.

Ø  The patient is encouraged and assisted to assume a position of comfort. If activity brings pain relief, the patient is assisted to ambulate.

Ø  Increased fluid intake is encouraged to prevent dehydration and increase hydrostatic pressure within the urinary tract to promote passage of the stone

Ø  All urine is strained through gauze because uric acid stones may crumble. Any blood clots passed in the urine should be crushed and the sides of the urinal and bed pan inspected for clinging stones.

Ø  Patients with calculi require frequent nursing observation to detect the spontaneous passage of a stone

Ø  Vital signs, including temperature, are monitored closely to detect early signs of infection. UTIs may be associated with renal stones due to an obstruction from the stone

Ø  The risk of recurring renal stones is high, So nurse provides health education about the causes of kidney stones and methods to prevent their recurrence

Ø  If lithotripsy, percutaneous stone removal, ureteroscopy, or other surgical procedures for stone removal have been performed, proper pre and post procedure/ operative care is provided.

Ø  Patient is closely monitored for complications.

Ø  During discharge planning the patient is instructed to take medications as prescribed and return for follow up if needed.