Post RN 1st year 2nd semester

Group – 3

Sana Mushtaque, Shagufta Mushtaque,

Shaheen Akhter, Shahzadi, Sidra Gull, Sidra
Noureen, Sumera Asghar, Uzair Jamal,
Waseema Kouser, Maria Huma, Zareena
George, Zarish Fazil
Renal calculus
 Objectives
At the end of this presentation students will be able
to.
• Explain the factors in environment, which
contribute to produce changes in physiological
process of the body.
• Discuss the relationship of normal body function
with altered physiological mechanism in disease
process.
• Integrate the knowledge of basic principles of
pathophysiology and pharmacology with the
disease process.
 The Kidneys Functions
• The main purpose of the kidney is to separate
urea, minerals, salts, toxins, and other waste
products from the blood.
• They also do the job of conserving water, salts,
and electrolytes.
• At least one kidney must function properly for
life to be maintained.
 Factors in environment
• Physical activity
• The more active you are, the more you are likely to
perspire.
• While exercise is an excellent way to maintain or
reach your goal body weight, improve cardiovascular
function and increase muscle and bone mass, it may
also lead to dehydration and overly concentrated
urine if you do not replace fluids. The more you
sweat, the more fluids you should drink.
 Factors in environment
Physical activity continue………….

• If you are very inactive, you may be losing

bone strength, which could result in loss of
calcium from bone. That calcium is filtered by
the kidneys and a large amount of calcium
may not be able to be reabsorbed. Instead,
excessive calcium gets excreted in the urine,
where it can lead to stone formation.
 Factors in environment
• Work environment
• If you work in high temperatures, such as in hot
weather or in certain types of manufacturing or
processing where high temperatures are the norm,
you may be predisposed to dehydration and
concentrated urine.
• Restricted fluid intake will cause your urine to be
concentrated and increase the chance of forming
kidney stones.
 Factors in environment
• Nutrition
• Lack of fluids
• Too much sodium
• Too much meat from beef, poultry, fish, and seafood
• Too little or too much calcium
• Too much oxalate absorbed
• Too few fruits and vegetables
 Factors in environment
Body mass
• Body weight is an increased risk for kidney stones,
especially for women.
• Waist circumference is also associated with increased
risk for stones. The larger your waist size, the more
likely you are to form stones.
 Factors in environment
• Gender
• Men generally have a higher incidence of stone formation.
• An increase in stone formation among women has been
observed over the last couple of decades. Pregnancy increases
the risk for stone formation among women, but the incidence is
quite low (one in 1,500 pregnancies).

• Age
• The risk of stone formation appears to increase with age up to
about 50 years. The majority of kidney stones occur in people
between 20 and 60 years of age. At about 60 years, the overall
incidence of kidney stones slowly declines with age.
.
 Factors in environment

• Ethnicity
• Among Americans, Caucasians have the highest
incidence of kidney stones, followed by Mexican-
Americans. African-Americans have the lowest risk.

• Geographic location
• the hotter weather may lead to dehydration, which
may cause urine to become too concentrated
 Relationship of normal body function with
altered physiological mechanism in Renal
calculus
• The term renal calculi and nephrolithiasis refers
to kidney stones.
• The most common cause of upper urinary tract
obstruction is urinary calculi.
• Stones can form in any part of urinary tract, most
develop in kidneys.
• Urinary stones are third most common disorder
of urinary tract after UTI’s and prostate disorders.
• Men are two to three times likely to develop
calculus than women.
 Pathophysiology
• Kidney stones are • Calcium (oxalate and
crystalline structures phosphate), magnesium,
made up of the material ammonium phosphate,
that the kidneys normally uric acid and cysteine.
excrete in the urine.
• Stones require a nidus to • The matrix theory
form and urinary proposes that organic
environment that materials such as
supports continued epithelial cells that lines
crystallization of stone the tubules (mucopolysaccrides)
components. act as nidus.
 Pathophysiology Continue
• The development of stone
component is influenced by
the concentration of stone
components in the urine, the
ability of the stone
components to complex and
form stone, and the ability of
substances that inhibit stone
formation
• Proteins produced by kidney
inhibit all phases of
crystallization.
• The persons who have
deficiency of inhibiter protein
are at risk of calculus.
• Kidney cells produce at least
three proteins that are
thought to slow down the
calcium oxalate crystallization
(nephro calcine, mucoprotein,
and uroprotein.
 Kidney’s Proteins
Organic inhibitors
• Nephrocalcine • Nucleation,
aggregation, and
growth of calcium
oxalate stone.
• Tamm Horsfall
mucoprotein • Exerts a minor effect on
crystal aggregation.

• Uroprotein
• Uroprotein inhibits the
growth of calcium
oxalate crystals.
 Non organic inhibitors
• Some non organic substances also can act as
inhibitors of stone formation. For example,
citrate is a key factor affecting development of
calcium stones.
 Types of stones
• There are four basic types of kidney stones
• Oxalate and phosphate
• Magnesium ammonium phosphate( struvite)
• Uric acid (urate)
• Cystine
 Clinical manifestations
• Renal colic due to obstruction and distention.
• Flank pain
• Hematuria
• Pyuria
 Manifestations
Pain of two types depending on location

Renal colic Noncolicky renal pain

• Describes the colicky pain
accompanies stretching of the
collecting system or ureters
• Excruciating pain in flank and
upper outer quadrant of the
abdomen on affected side.
• 1-5 mm in diameter that can
move into the ureter and
obstruct the flow.
• Skin may be cool and clammy.
• Nausea and vomiting are
common
• Caused by stone that
produce distension of renal
calices or renal pelvis.
• Usually dull pain, deep ache
in flanks or back.
• Can be mild to sever.
• Often exaggerates by
drinking large amount of
fluid
 Diagnosis
• Diagnosis of kidney stones is best accomplished using an
ultrasound, intravenous pyelography (IVP), or a CT
scan. Other tests include:
• Urinalysis
• blood tests for calcium, phosphorus, uric acid, and
electrolytes. blood urea nitrogen (BUN) and creatinine to
assess kidney functioning.
•
Most kidney stones will pass through the ureter to the
bladder on their own with time. Treatment includes pain-
control medications and, in some cases, medications to
facilitate the passage of urine.
Type of stone Contributing Factors
Calcium (oxalate and Hypercalcemia and hyper
phosphate) calciuria Immobilization
Hyperparathiroidism
Vitamin D intoxication,
defused bone disease, Renal
tubular acidosis
Hyperoxaluria
Treatment
Treatment of underlying
conditions increased fluid
intake
Thiazide diuretics
Dietary restriction of foods
high in oxalate

Magnesium ammonium Urinary tract infection Treatment of UTI

phosphate (struvite) Acidification of urine
Increased fluid intake

Uric Acid Formed in acid urine with pH Increased fluid intake

of approximately 5.5 Allopurinol for hyperuricuria
Gout Alkalinazation of urine
High purine diet

Cystine Cystineuria (inherited Alkalinazation of urine

disorder of amino acid Increased fluid intake
metabolism
 Pharmacology
• Treatment of underlying conditions.
• Thiazide diuretics
• Allopurinol for hyperuricuria
• Alkalinization of urine by administration of intravenous
sodium bicarbonate to produce urine with a pH ≥7.5.
(normal urine PH is 6.0)
• One treatment option is lithotripsy.
This treatment uses shock waves to break up
the kidney stones into small pieces. After
the treatment, the small pieces of the kidney
stone will pass through your urinary tract and out of
your body with your urine.
 Allopurinol

• Brand Name: Aloprim, Apo-Allopurinol (CAN),

Purinol (CAN), Zyloprim
• Classification: Antigout drug
• Vomiting
• Diarrhea
• Drowsiness
• Headache
• Muscle pain
• Changes in sense or taste
 Thiazide diuretics

• dizziness and lightheadedness,

• blurred vision,
• loss of appetite,
• itching,
• stomach upset,
• headache, and.
• weakness.
 Bicarbonate

• Frequent urge to urinate, headache (continuing), loss of

appetite (continuing),mood or mental changes, muscle pain
or twitching, nausea or vomiting, nervousness or
restlessness. slow breathing. Respiratory drive may be
suppressed after bicarbonate administration due to
increased venous C02 concentration.
• Without adequate ventilation, worsened systemic acidosis
could develop Rare cases of sodium bicarbonate abuse
have been associated with features of Munchausen
syndrome
• Metabolic side effects have included metabolic alkalosis.
• Hypernatremia and hypokalemia
 Pharmacological nursing implications
• Encourage fluid intake to also help with
excretion, as well as reduce kidney stone
formation.
• Monitor for joint pain and swelling and
educate the patient regarding taking
additional pain medication when experiencing
acute gout flare-ups. This can happen
frequently in the first few months of
allopurinol therapy.
 Nursing considerations
• Assess the client’s fluid balance throughout the therapy. Including
intake and output, daily weight, edema and lung sounds.
• Monitor the client’s serum calcium, sodium, potassium, bicarbonate
concentrations, acid-base balance and renal function throughout
the therapy.
• Symptoms of fluid overload should be reported such as
hypertension, edema, difficulty breathing or dyspnea, crackles and
frothy sputum.
• Sigs of acidosis should be assessed such as disorientation,
headache, weakness, dyspnea and hyperventilation.
• Assess for alkalosis by monitoring the client for confusion,
irritability, paresthesia, tetany and altered breathing pattern.
• Hypernatremia clinical manifestations should be assessed and
monitored which includes: edema, weight gain, hypertension,
tachycardia, fever, flushed skin and mental irritability.
 Nursing considerations
• Hypokalemia should also be assessed by monitoring signs and
symptoms such as: weakness, fatigue, U wave on ECG, arrhythmias,
polyuria and polydipsia.

• IV sites should be observed closely. Extravasation should be avoided

as tissue irritation or cellulitis may occur when taking sodium
bicarbonate.
• If infiltration occurs, the physician should be notified immediately.
Confer with the doctor or other health care staff regarding warm
compresses and infiltration site with lidocaine or hyaluronidase.
• Tablets must be taken with a full glass of water.
• For clients taking the medication as a treatment for peptic ulcers it
may be administered 1 and 3 hours after meals and at bedtime
 Refrences
• Concepts of altered health states
seventh edition by Carol Matison
• Research report:
https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C3826902/