Renal Stone Diseases.pptx.....defination

A number of medical conditions have high association with kidney stone disease. Any type of chronic diarrhea state (such as Crohn's disease, gastric bypass, inflammatory bowel disorder), primary hyperparathyroidism, obesity, gout, and even diabetes have all been linked to increased risk of kidney stone disease.

1. Renal Stone Diseases M.Hudaib 202086

2. Learning objectives Introduction and Etiology of renal stone diseases History taking Examination Differentials Management

3. Renal Calculi Called nephrolithiasis or urolithiasis Most commonly develop in the renal pelvis but can be anywhere in the urinary tract May stay in kidney or urinary tract May stay in kidney or travel to the ureter May cause hydronephrosis

4. Types of stones

5. Etiology of Renal Stone Diseases

6. Etiology (continued) Idiopathic calcium urolithiasis Unexplained hypercalciuria Normal serum calcium Can be renal or Absorptive 70 percent of urinary tract stones

7. Etiology (continued) Hypercalcemic disorders Primary Hyperparathyroidism Due to parathyroid Adenoma Increased production of 1,25 dihydroxycholecalciferol Increased intestinal and renal Ca2+ tubular reabsorption < 5 percent of people with radio-opaque stones

8. Prolonged Immobilization Hypercalcemia and hypercalciuria from bone resorption Milk – Alkali Syndrome Ingestion of large quantities of Ca2+, Vitamin D and Alkali results in hypercalcemia , alkalosis and possible renal impairment Compromised renal excretion of Ca2+ promoting soft tissue calcification 4. Sarcoidosis Non – Caseating granulomata produce 1,25 dihydroxycholecalciferol

9. Etiology ( continued) Renal Tubular Acidosis (RTA) 3 types of RTA , which is due to hypercalciuria and low urinary citrate Stones consist of Calcium Phosphate Cystinuria - Defect in renal transport of COAL. Stones are very hard and radio-opaque

10. Etiology (continued) Uric acid stones 5-10 percent of urinary tract stones Due to excess amount of uric acid excretion or uric acid in insoluble form Enzyme Disorders Primary Hyperoxaluria Xanthuria 2,8 Dihydroadeninuria Secondary Urolithiasis Secondary Hyperoxaluria Dietary Excess Infection Obstruction and Stasis

11. History taking Age – mostly between 30 and 50 years Sex – More common in men than in women Season – Summer. Why ? Symptoms : Pain Hematuria dysuria Symptoms of acute pyelonephritis symptoms associated with uraemia in severe cases such as headaches, restlessness, twitching, fits, convulsions, drowsiness and coma Past medical history : UTI, gout, parathyroidism , IBD Family History : gout and parathyroidism Personal History : Water intake, Foods high in Oxalates, High Na+ and Ca+

12. Examination Abdominal examination Costovertebral angle tenderness Differential Diagnosis Acute Pyelonephritis Renal cell carcinoma

13. Management of Stones in emergency setting CT scan Stones in the distal ureter treated expectantly, medical expulsive treatment maybe considered NSAIDs eg : diclofenac Monitor vitals and WBC count eGFR measurement For urgent pain : In situ ESWL Cystoscopy and inserting stent Primary ureteroscopic stone retrieval , lasertripsy

14. Management in elective setting ESWL ( Extracorporeal shockwave Lithotropsy ) Shockwaves generated outside the body Needs to be coordinated with ECG Prophylactic antibodies are given Cystine stones are relatively resistant Can result in hematuria

15. Management in Elective setting Ureteroscopy Used for endoscopic examination and visualization Stones then retrieved by wire retrieval baskets

16. Management in Elective setting Percutaneous Nephrolithotomy (PCNL) Used to treat larger stones in the renal pelvis or calyces or proximal ureter Tract is established into the renal collecting system Series of dilators is used through which stone is visualised and fragmented ( using ultrasound, laser or lithocast )

17. Thank You