Urolithiasis


Urolithiasis (Kidney Stones, Calculi)

Pathophysiology

■ Urinary stasis or chemical environment that → precipitation and crystallization of minerals. Stones form, which obstruct the ureter and result in hydroureter and hydronephrosis
■ Components of calculi vary: Calcium with phosphorous or oxalate (75%),
uric acid (10%), struvite (15%), or cystine (1%)
■ Stones can recur


Risk Factors


■ 30-50yr, male gender, dehydration, diet with ↑dairy and vitamin D

■ ↑UTIs (struvite), hyperparathyroidism (calcium), gout and myeloprolific disease increase uric acid Signs and Symptoms
■ Pain; depending on stone location, may have little or no pain ranging to
severe pain radiating from flank to bladder or genitals
■ N&V, hematuria, pallor, diaphoresis, UTI


Treatment


■ Opioids, NSAIDs, hydration
■ Lithotripsy (extracorporeal shock wave, percutaneous ultrasonic, or laser)

■ Calcium stones: ammonium chloride to acidify urine, thiazide diuretics

■ Uric acid stones: allopurinol, ↑urine pH
■ Diet based on stone composition

Nursing Management

■ Monitor S&S, strain urine, ↑fluids to 3-4L daily
■ Control pain
■ Calcium stones: Acid ash diet with ↓dairy, protein, and sodium intake

■ Uric acid stones: Alkaline ash diet with ↓purine (organ meat) intake

■ Oxalate stones: ↓Tea, spinach, nuts, chocolate, and rhubarb intake
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