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Kidney stones Dr Kushma Nand Kidney stones Dr Kushma Nand

Kidney stones Dr Kushma Nand - PowerPoint Presentation

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Uploaded On 2018-10-27

Kidney stones Dr Kushma Nand - PPT Presentation

Renal Physician General aspects of stone formation Biomineralisation of urinary stones are multifactorial Socioeconomic Genetic Constitutional factors such as diet pharmacologic treatment and metabolic abnormalities might act in concert ID: 698276

stone urinary excretion stones urinary stone stones excretion uric urine acid renal age result metabolism treatment pelvis abnormal cases constituents hyperoxalouria profession

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Presentation Transcript

Slide1

Kidney stones

Dr Kushma Nand

Renal PhysicianSlide2

General aspects of stone formation

Biomineralisation of urinary stones are multifactorial

Socio-economic

Genetic

Constitutional factors such as diet, pharmacologic treatment and metabolic abnormalities might act in concertSlide3

Super saturation of urine

Prerequisite

Solubility of different stone components depends on urinary pH and excretion of other urine constituentsSlide4

General Aspects of Urinary stone formation

Age

sex

Profession

Mentality

Nutrition

constitution

Climate

race

Inheritance

Abnormal Renal

morphology

Disturbed

urine flow

Urinary tract

infection

Metabolic

abnormalities

Genetic

factors

Excretion of stone forming

constituents

Excretion of

Crystallization

promoters

Increased

Excretion of

Crystallization

inhibitors

Urinary volume

Decreased

Physico-chemical change in the state of

super saturation

Abnormal crystalluria

Crystal aggregation

Crystal growth

URINARY STONESlide5

5

6

7

8

Urinary pH

solubility

Ammonium

urate

phosphate

Uric acid

cystineSlide6

Location and form of urinary stones

97 % of all stones are localized in the

Parenchyma

Papilla

Calyces

Pelvis

Pelvis and calices

Ureter

Only 3 % in the bladder and urethraSlide7

Location and form of urinary stones

Major Constituent

in % of the cases

The only mineral in

% of the cases

Calcium oxalate

Uric acid

Struvite

Carbonate apatitie,whitlockite

Brushite

Cystine

Ammonium urate

Protein

No major constituent

70.4

11

6

4.81.00.40.5

0.85.1 20.8

8.02.11.11.00.40.1

0.1-Slide8

The emergency stone

Treatment of patients with acute renal colic

Treatment and care of patients with urinary stones

Biochemical investigations

Urine and blood

ImagingSlide9

Stone episodes

Medical history

Current age and age at first stone

Profession

Stone disease in relatives

Associated diseases

Disturbances of the metabolism of calcium

HPT, RTA, Wilson's disease, MSK sarcoidosis

Disturbances of the metabolism of oxalate

Primary hyperoxalouria, Enteric hyperoxalouria

Disturbance of the metabolism of uric acid

As a result of cell death

cytotoxics

As a result of enzyme deficiency

Gout Lesch-Nyhan syndrome

As a result of alteration in excretion of uric acidMetabolic acidosis

Infections

Medications