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Renal Calculi
- most common cause of intrinsic urinary tract obstruction
- primarily in kidney (nephrolithiasis- kidney stone) can migrate towards ureters & bladder
- more common in men, caucasians, ages 30-50, previous calculi
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Influential factors
- fluids
- infections
- diet- purine, uric acid
- immobility- stasis
- foreign body- foley cath.
- inc risk of stone formation
- dehydration- concentrated urine
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renal calculi Primary prevention
- frequent turning of immobile pts- help move stone
- high fluid intake
- decr sodium intake
- Na + Ca- compete for reabsorption in kidney- you want more Ca to absorb-
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patho
- saturation theory- stones form when environment supersaturated with components
- urine is sitting and compotents saturate
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renal calculi-diet think **
- *** calcium (Oxalate, phosphate or mixture)
- - possible causes: hypercalcuria, dehydration, diet
- oxalate: rhubarb, spinach, blueberries, beets, beer (avoid food)
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renal calculi- diet 2
- struvite (mg ammonium phosphate)
- - possible causes: proteus infection, alkaline urine)- avoid foods w/high phosphate, diary, meats
- Uric Acid-
- - possible causes: gout, high uric acid levels, diet
- diet: purines- liver, kidney, asparagus, shellfish, organ meat, red wine
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manifestations- renal calculi
- nephrolithiasis- asumptomatic or dull pain, constant pain at CV angle
- ureteral- excruciating pain, desire to void w/little urine
- bladder- s&s infection, irritating pain
- urethra- colicky, excruciating pain
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dx test
- good assessment
- ** KUB or CT
- U/A, C&S- r/o infection
- Ca
- uric acid
- * get stone to test it
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medical management
- for stone < 6mm spontaneously pass
- pain managment- opioids 24-36 hrs then NSAIDS
- warm, moist packs, warm baths
- encourage amb
- ** force fluilds if tolerated 3-4L/d will put on IV if can't tolerate it.
- monitor for s&s infection, dec renal fxn (i&o- did stone get stuck)
- diet management and education
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surgical management
- ESWL (extracorporeal shock wave lithotripsy)
- laser lithotripsy- percutaneous
- - may need nephrostomy tube x 1-5d
- - enc fluids, monitor for infection
- Cytoscopy- to dislodge or manipulate stone
- nephrolithotomy, pyelolithotomy, ureterolithotomy- open surgical
- inc pain
- stone doesn't past in a month
- inc BUN, crt
- read 397-398 ATI- read varies procedures that occur FYI
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rebak calculi complication
- hydronephrosis
- pyelonephritis- urinary stasis
- infections-
- local tissue irritation and inflammation
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hydronephrosis
- calculus (stone) kink in ureter may cause obstruction
- urine production contines, urine trapped
- retained urine exerts pressure destroy nephrons
- it destroys renal cell which destroys renal function
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hydronephrosis management
- relieve obstruction, prevent infection
- watch F&E, dehydration after obstruction relieved- VS q 30mins x 4 then q 2hr
- (initial watch for FVD)
- monitor u/o closely
- wt qd
- may not be any s&s until you see KUB
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polycystic kidney disease
- congenital disorder- grape like cyst in the nephrons
- autosomal dominant
- affect both kidneys
- may affect other organs
- - cyst in intestines
- cyst grow in renal pelvis
- grow btw 20-30lbs
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polycystic kidney disease- patho
- slowly progressive invasion of cysts which get filled with fluid, pus, blood & urine
- enlarge up to 10x normal volume
- cysts rupture causing infection & scar tissue
- problems w/perfusion to tissue- ischemia, necrosis, sepsis, seath
- can lead to renal failure
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polycystic kidney disease- manifestations
- ** palpable bilateral masses
- ** dull lumbar, flank, abd/back pain
- ** hematuria- secondary to cyst rupture
- HTN
- - secondary to renal failure
- pain
- ESRD
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polycystic kidney disease dx
- s/s PE
- family hx- autosomal dominant
- CT/MRI- definite dx
- BUN/Cr, UA
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polycystic kidney disease management
- pain management
- bedrest- dec metabolic demands
- control htn
- prevent infection
- dialysis or renal transplant(can cure it)- last resort
- teach s&s of UTI
- genetic counseling
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polycystic kidney disease- renal transplantation
- potential donors
- living related
- - best donor is sibling
- cadaver
- - brain death
- primary limiting factor is availability
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