Prevention of urolithiasis recurrence.pptx

Informative presentation about the kinds of stones involved in urolithiasis and ways to prevent or protect against each of them.

1. UROLOGY Prevention of recurrence of urolithiasis Educational presentation of preventative strategies.

2. Introduction Urolithiasis is a recurrent disease. The management includes: treatment of the stone, etiological investigation and preventive measures to reduce the risk of recurrence. Understanding the significant impact of urolithiasis on patients highlights the importance of effective prevention strategies.

3. Major Risk Factors Dehydration Diet (Hight-protein, High-Salt) Hereditary

4. General Advice for almost all adults/children to prevent kidney stones An increase in fluid intake is recommended. Therefore, an increase in urine output to more than 1.5L/m2/day is the single most important aspect of stone prevention. Reducing salt intake to less than 2-3g/day is helpful for most children especially those at risk for calcium, oxalate or uric acid stones. Regular exercise. Monitor body weight

5. Dietary choices can affect kidney stone development , outpatients or previous urolithiasis patients may need to change certain eating habits , such as drinking more fluids and modifying their favorable diet. The best way to prevent or treat kidney stones is by understanding the type of different stones and their underlying causes:

6. Hypercalciuria Hypocitraturia Hyperoxaluria Uric Acid Lithiasis Cystinuria

7. Hypercalciuria Hypocitraturia Sodium Restricted Diet. Patients should avoid vitamin C, A and D supplements. Citrate supplementation. Hight protein intake increases calcium secretion; so all patients should receive the recommended dietary allowance of protein for age. Any unusual excess of calcium intake should be curtailed. Calcium or protein restriction is not recommended because of risk of osteopenia and increased intestinal oxalate retention. Potassium depletion increases calciuria , therefore patients should receive adequate dietary Potassium , particularly if they are taking diuretics. Calcium Stone

8. Dietary Hyperoxaluria Calcium-Oxalate Stones Normal people absorb <5% of dietary oxalate. Foods rich in oxalate increase absorption by 20-50%. Low calcium diets increase urinary oxalate excretion. Vitamin B6 supplementation is of limited value. Orthophosphate supplementation may help.

9. Limiting or avoiding high oxalate foods: Foods Leafy Greens : Spinach, Swiss chard, beet greens, and collard greens. Nuts and Seeds : Almonds, cashews, peanuts, and sesame seeds. Fruits : Rhubarb, berries (especially blackberries and raspberries), and kiwi. Vegetables : Beets, okra, and sweet potatoes. Grains : Wheat bran and oatmeal. Chocolate : Dark chocolate and cocoa powder. Tea : Black tea and certain herbal teas. Drinks Certain Fruit Juices : Such as those made from rhubarb or beets. Tea : Particularly black and green teas.  Limiting these foods and drinks can help reduce oxalate levels and lower the risk of kidney stone formation, especially for those prone to calcium oxalate stones.

10. Uric Acid Lithiasis Urate Stones Hydration is always essential. Limiting dietary sodium intake may decrease urinary uric acid (and calcium) excretion. If these measures fail or if the patients have recurrent symptoms, base supplementation with citrate or bicarbonate may be indicated. Dietary purine restriction is of limited value ; Most children do not consume significant quantities of purine-rich animal-protein foods, such as: mushrooms, meats, anchovies, mussels, goose, brain, kidney, liver cauliflower and asparagus . If the patient with a low urinary pH or confirmed hyperuricosuria , dietary restriction of protein, purine and sodium is indicated. Allopurinol is of limited value .

11. Cystinuria Cystine Stones Prevention and Treatment of Cystine Stone include: Encouragement to drink lots of fluids to help move the stone alone. Extra potassium citrate (Citrus Fruits). Creating abundant urinary flow and urinary alkalinization. In children, a regular diet to support growth is recommended. Low-methionine diet (essentially a low-protein diet) sometimes recommended in severe cases.

12. Struvite Stones Prevention of struvite stones rests on prevention of Urinary Tract Infections. Encouragement to drink lots of fluids to create good urinary flow to move stone predisposition or nucleus itself.

13. Evaluation of patient with first episode History : medications, occupation, family history of stones or other kidney disease, inflammatory bowel Disease (e.g., Crohn's disease). Diet : intake of protein, purines, sodium, fluids, oxalate and calcium Laboratory tests : electrolyte, blood urea nitrogen, creatinine, calcium, phosphate and uric acid levels, urinalysis, urine culture if indicated, stone analysis if available (if not, consider qualitative cystine screening). Radiology : plain radiographs, ultrasonography and/or intravenous pyelography (or helical computed tomography) to find more stones, radiolucent stones or anatomic abnormalities.

14. Evaluation of patient with recurrent stone formatiom (and all children) Twenty-four–hour urine collection : volume, pH, levels of calcium, phosphorus, sodium, uric acid, oxalate, citrate, creatinine, calcium oxalate (supersaturation), calcium phosphate and uric acid. Repeat as necessary: 24-hour urine collection and analysis to monitor response to dietary changes and effectiveness of treatment. Infrared spectroscopy analysis of the stone to have an idea about the chemical composition.

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