Renal Problems – Renal Calculi
Renal Calculi also called kidney stones or renal lithiasis are found in the inner surfaces of the kidney, they usually contain mineral and acid salts.
Pathophysiology:
Renal stones are formed when the urine is not able to dissolve the minerals that comes along with the excretion of the body. Those minerals crystallizes and solidifies until it may block the passageway.
Types of calculi based on composition:
1. Calcium stones – the most common form of renal stone, it is due to accumulation of oxalate that comes from the diet that’s rich in vitamin D.
2. Struvite Stone – this is common in women since they are more prone to have urinary tract infections. They are described as staghorn shaped because they usually collect themselves on the urine collecting space of the kidney.
3. Uric Acid Stone – this is the result of high-protein diet.
4. Cystine Stones – this is a genetic disorder wherein the kidneys excrete excessively high amounts of amino acids (cystinuria).
Complications:
1. Kidney damage
2. Bleeding
3. Infection
Clinical Manifestations:
- acute, sharp, intermittent pain (ureteral colic)
- dull, tender ache in the flank
- nausea and vomiting accompanying severe pain
- fever and chills
- hematuria
- abdominal distention
- pyuria
Diagnostic Evaluation:
- Kidneys, ureters and bladder radiography reveals visible calculi.
- Stone analysis detects mineral content calculi
- Intravenous pyelography determines size and location of the calculi
- Renal ultrasonography reveals obstructive changes, such as hydronephrosis.
Medical Management:
- For severe infections antibiotic therapy is indicated.
- Supportive therapy is given for fever, pain control and hydration.
Surgical Management:
- Crucial decision in removing the kidney to relieve the obstruction.
- Nephrectomy
- Hand-assisted laparoscopic nephrectomy
Nursing Management:
- Assess for ability to tolerate oral fluids and food.
- Obtain urologic history that could suggest recurrent infections or urinary tract infections
- Give prescribed analgesics to relieve pain
- Administer oral and intravenous fluids as ordered to reduce concentration of urinary crystalloids and ensure adequate urine output.
- Explain preventive measures including good fluid intake, personal hygiene measures and healthy voiding habits.
Photo credits: www.homeopathictreatment4u.com
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
