renal calculi

  1. 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
  2. Influential factors
    • fluids
    • infections
    • diet- purine, uric acid
    • immobility- stasis
    • foreign body- foley cath.
    • inc risk of stone formation
    • dehydration- concentrated urine
  3. 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-
  4. patho
    • saturation theory- stones form when environment supersaturated with components
    • urine is sitting and compotents saturate
  5. renal calculi-diet think **
    • *** calcium (Oxalate, phosphate or mixture)
    • - possible causes: hypercalcuria, dehydration, diet
    • oxalate: rhubarb, spinach, blueberries, beets, beer (avoid food)
  6. 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
  7. 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
  8. dx test
    • good assessment
    • ** KUB or CT
    • U/A, C&S- r/o infection
    • Ca
    • uric acid
    • * get stone to test it
  9. 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
  10. 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
  11. rebak calculi complication
    • hydronephrosis
    • pyelonephritis- urinary stasis
    • infections-
    • local tissue irritation and inflammation
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. polycystic kidney disease dx
    • s/s PE
    • family hx- autosomal dominant
    • CT/MRI- definite dx
    • BUN/Cr, UA
  18. 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
  19. polycystic kidney disease- renal transplantation
    • potential donors
    • living related
    • - best donor is sibling
    • cadaver
    • - brain death
    • primary limiting factor is availability
Author
Prittyrick
ID
330606
Card Set
renal calculi
Description
kidneys stones
Updated