Stone formation is typically silent that takes weeks-months to reach detectable size. Can remain asymptomatically in kidney for yrs and
Second, crystals or foreign bodies can act as nidi, upon which ions from the supersaturated urine form microscopic crystalline structures such as: Calcium oxalate/phosphate, Struvite (Magnesium, ammonium phosphate)
Allopurinal can be considered, esp. w/ gout
Nephrolithiasis is the formation of kidney stones in the urinary tract. Kidney stones are small, hard deposits of calcium oxalate or calcium phosphate, or occasionally, other salts. They are a common cause of blood in the urine or pain in the abdomen, flank, or groin, and 10% of people are affected by kidney stones at some point in their life.
Treatment is focused on pain control using pain relief medications during an acute stone event. Pain medications may include NSAIDs or opioids.
The medical term for kidney stones is renal calculi.
Magnesium ammonia phosphate stones (also called struvite stones) Comprise 10-15% of all kidney stones, caused by urea-splitting bacteria associated with a urine infection.
Suspicion of kidney stones or Nephrolithiasis is diagnosed with the onset of the pattern of symptoms. Diagnostic test procedures are the following:
Nephrolithiasis is characterized by the formation of crystalline material in the kidney and the urinary tract. Nephrolithiasis is also known as kidney stones and is formed as a result of a decrease in the volume of urine or an increase in the substances in urine that can form stones in the kidney or in the urinary tract.
The location and quality of pain are relative to the position on of the stone within the urinary tract while the severity is dependent on the degree of obstruction brought by the formation of kidney stones. Nausea and vomiting usually accompany the rapid and excruciating pain. Painful urination is also experienced and is accompanied by ...
Pain is the most common and initial symptom of kidney stones. The onset of pain is characterized as rapid and excruciating. The pain may be felt in the lower back and radiates to the sides, groin and the abdomen. The pain is also characterized as colicky pain which cannot be relieved with a change in the body position.
Imaging tests are done to confirm the formation of kidney stones. A helical CT scan is the imaging test of choice that is usually done without contrast materials. This imaging test can identify stones and obstruction within the urinary tract.
Most kidney stones usually resolve within 48 hours with sufficient amount of fluid intake to help wash away the stone through the urine. Small stones that have minimal symptoms can be treated with the following: Increase fluid intake. Pain relieving medications.
The symptoms of Nephrolithiasis usually occur when the stones move within the kidney and passes through the ureter. Kidney stones generally originate from the kidney and extend distally and lodge in narrow areas adjacent to the kidney. When symptoms occur this may include the following: Pain is the most common and initial symptom of kidney stones.
The lifetime risk of nephrolithiasis is 7% to 13%. The majority of crystals are composed of calcium (>80%) complexed with oxalate or phosphate. Other stones are composed of uric acid, magnesium ammonium phosphate (struvite), or cystine, either alone or in combination. The mean age at onset of symptomatic stone disease is 45 years for men and 41 years for women, and the overall male-female ratio is 1.7:1. In addition to age and gender, race, geography, and body mass index are factors in the prevalence of kidney stones, with sun exposure and obesity significant risk factors.
The lifetime risk of nephrolithiasis is about 19% in men and 9% in women. In men, the first episode of renal colic is most likely to occur after age 30, but it can occur earlier. The incidence for men who have never had a stone is about 0.3% per year between the ages of 30 and 60 years, and it decreases thereafter with age. For women, the rate is about 0.25% per year between the ages of 20 and 30 years, and then declines to 0.15% for the next 4 decades.
The management of kidney stones can be divided into the management of the acute stone episode and, if the stone is nonobstructing, management of the prevalent stone medically and/or surgically, with an additional focus on prevention of further stones. Management of the acute stone episode rests on optimal pain control using parenteral narcotic agents, hydration, and urologic consultation for potential removal of an obstructing stone. Medical management of a nonobstructing stone requires increasing fluid intake to cause a urine output of >2 L/day, modification in diet, treatment targeted at changing urinary pH, and strategies to prevent further stones from forming. Surgical management depends on the size, location, and number of stones. Surgical options include extracorporeal shock wave lithotripsy (ESWL) and percutaneous or transurethral lithotripsy. General rules are that cystine stones, calcium oxalate monohydrate stones, are generally poorly broken up by ESWL and percutaneous or transurethral lithotripsy for removal are favored. However, other calcium oxalate stones, struvite and uric acid stones, are generally amenable to ESWL and either percutaneous or transurethral routes for removal depending on the size and location of the stones.
The combination of loin pain with hematuria syndrome (LPHS) in the absence of renal stones is a poorly understood condition that must always be considered in the differential diagnosis of patients presenting with the clinical manifestations of nephrolithiasis. This diagnosis is reached by exclusion when the patients, often young to middle-aged females, present with loin pain and persistent microscopic or intermittent macroscopic hematuria. Careful evaluation is required to exclude small stones, tumor, and urinary tract infection as a cause of the pain. Inconsistent angiographic abnormalities implying intrarenal vasospasm or occlusion have been reported, as have renal biopsy abnormalities typified by deposition of complement C3 in arteriolar walls. Denervation of the kidney by autotransplantation is rarely successful, and although nephrectomy has been attempted, often the pain recurs promptly in the contralateral kidney.
Frequency, urgency, and dysuria can result from stone impaction at the ureterovesical junction and/or associated UTI.
Kidney stones form when urine becomes supersaturated with respect to the specific components of the stone. Saturation is dependent on chemical free ion activities of the stone constituents. Factors that affect chemical free ion activity include urinary ion concentration, pH, and the combination of the constituent ion with other substances. For example, an increase in the urinary calcium concentration or a decrease in urine volume increases the free ion activity of calcium ions in the urine. Urinary pH can also modify chemical free ion activity. A low urinary pH increases the free ion activity of uric acid ions. However, a high urine pH promotes the complexation of calcium with phosphorus, which decreases the free ion activity of both calcium and phosphorus. Citrate combines with calcium ions to form soluble complexes and will decrease the free ion activity of unbound citrate and calcium. When the chemical free ion activities are increased, the urine becomes supersaturated (also termed oversaturated ). In this setting, new stones may form and established stones may grow. In the event of decreased free ion activity, urine becomes undersaturated, and stones do not grow and can even dissolve. The equilibrium solubility product is the chemical free ion activity of the stone components in a solution at which the stone neither grows nor dissolves.
Renal stones are urinary calculi originating in the kidney (i.e., nephrolithiasis), usually in the renal pelvis. The stones develop as the result of growth of crystalline components in supersaturated urine and are dependent on pH, ionic strength, and solute concentration.
renal pelvis. to the urethra. Risk factors. include low fluid intake, high-sodium, high-. purine. , and low-potassium diets, which can raise the calcium,
Stones usually form in the. collecting ducts. of the kidneys but may be deposited along the entire urogenital tract from the. renal pelvis. to the urethra. Their localization and size determine the specific symptoms. Small kidney stones may also be asymptomatic and detected incidentally. [10]
cystine. . Nephrolithiasis manifests as sudden onset colicky flank pain that may radiate to the groin, testes. , or labia (renal/ureteric colic) and is usually associated with. hematuria. . Diagnostics include noncontrast spiral CT of the abdomen and pelvis or. ultrasound.
C0019202. Disease or Syndrome. Wilson disease is a disorder of copper metabolism that can present with hepatic, neurologic, or psychiatric disturbances, or a combination of these, in individuals ranging from age three years to older than 50 years; symptoms vary among and within families.
The three major features of alkaptonuria are dark urine or urine that turns dark on standing, ochronosis (bluish-black pigmentation in connective tissue), and arthritis of the spine and larger joints. Ochronosis generally occurs after age 30 years; arthritis often begins in the third decade.
HPRT1 disorders, caused by deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGprt), are typically associated with clinical evidence for overproduction of uric acid (hyperuricemia, nephrolithiasis, and/or gouty arthritis) and varying degrees of neurologic and/or behavioral problems.
BWS is considered a clinical spectrum, in which affected individuals may have many of these features or may have only one or two clinical features. Early death may occur from complications of prematurity, hypoglycemia, cardiomyopathy, macroglossia, or tumors.
Hypomagnesuria is Associated With Nephrolithiasis in Patients With Asymptomatic Primary Hyperparathyroidism.
Familial hypocalciuric hypercalcemia type II (HHC2) is an autosomal dominant disorder characterized by lifelong elevations of serum calcium concentrations with low urinary calcium excretion and normal circulating parathyroid hormone concentrations in most patients. Patients are generally asymptomatic, although pancreatitis or chondrocalcinosis may develop in some affected adults (summary by Nesbit et al., 2013). For a general phenotypic description and a discussion of genetic heterogeneity of hypocalciuric hypercalcemia, see HHC1 (145980).
Stone formation is typically silent that takes weeks-months to reach detectable size. Can remain asymptomatically in kidney for yrs and
Second, crystals or foreign bodies can act as nidi, upon which ions from the supersaturated urine form microscopic crystalline structures such as: Calcium oxalate/phosphate, Struvite (Magnesium, ammonium phosphate)
Allopurinal can be considered, esp. w/ gout