•Factors involved in the development of urinary tract calculi include metabolic, dietary, genetic, climatic, lifestyle, and occupational influences. Other factors are obstruction with urinary stasis and urinary tract infection.
- •The five major categories of stones (lithiasis) are (1) calcium phosphate, (2) calcium oxalate, (3) uric acid, (4) cystine, and (5) struvite.
- -If urine is too alkaline: calcium and phosphate are less soluble
- -Acidic environment: uric and cystine are less soluble
- -Struvite more llikely to form in alkaline uine due to urea splitting bacteria (proteus, klebsiella, psudomonas)
•Urinary stones cause clinical manifestations when they obstruct urinary flow. Common sites of complete obstruction are at the ureteropelvic junction (UPJ), the point where the ureter crosses the iliac vessels, and at the ureterovesical junction.
severe abdominal or flank pain, hematuria, and renal colic. A common symptom of renal colic (the pain that results from stretchig, dilation, and spasm of the ureter in response to the obstructing stone. N/V may occur also) is that patients cannot remain still. They sit, then stand, then lie down and then repeat the process "kidney Stone Dance".
- => diagnostic:
- CT/KUB for renal colic
- -complete urinalysis helps confirm diagnosis of stone: assess for hematuria, crystalluria, and urinary pH
• Management of a patient with renal lithiasis consists of treating the symptoms of pain, infection, or obstruction.
• Lithotripsy is the use of high-energy shock waves to fragment and disintegrate kidney stones. It is used to eliminate calculi from the urinary tract. Outcome for lithotripsy is based on stone size, stone location, and stone composition.
• The goals are that the patient with urinary tract calculi will have relief of pain, no urinary, tract obstruction, and an understanding of measures to prevent further recurrence of stones
.• To prevent stone recurrence the patient should consume an adequate fluid intake to produce a urine output of approximately 2 L/day. Additional preventive measures focus on lifestyle and dietary changes or medications, depending on the type of stone involved.