Nephrolithiasis is a condition that causes formation of crystalline stones in kidneys or urinary tract.
Stones form from mineral salts and substances in urine. Most renal calculi are made of calcium to cause pain through ureteral obstruction-induced dilation, stretching, and spasm.
Acute renal colic is incredibly painful for patient. Unexpected pain surpasses childbirth, fractures, gunshots, burns, and surgeries severity.
While nephrolithiasis is rare, those with preexisting azotemia and solitary kidneys are at higher risk of renal damage.
Kidney stone formation starts with urine supersaturation, nucleation, and crystallization. Urine inhibitors prevent stone formation, but in nephrolithiasis it allows crystal stones.
Risk Factors are:
Dehydration
Diet
Family History
Medical Conditions
Epidemiology
Approximately 11% of men and 7% of women develop nephrolithiasis. In children it is increases up to 6 to 10%.
Approximately 30 million people are at risk in the United States. Around 30 million Americans are at risk while about 2 million patients experience stone disease yearly.
Research suggests that higher rates of kidney stones in US linked to patient’s socioeconomic status.
Lower economic status linked to lower renal stone risk. Regions with lower living standards have less kidney stones but more bladder stones.
Anatomy
Pathophysiology
Foreign bodies or crystals can act as nidi for crystalline structures. Most kidney stones are made of calcium, with a smaller portion made of uric acid or other substances.
Urine supersaturation causes uric and cystine stones, while calcium stones have multifactorial origins.
Renal colic causes upper midback pain starting at costovertebral angle. More proximal peristalsis in the ureter increases pain perception with intrinsic pacemakers.
Moving ureter stone causes more pain than motionless stone due to intermittent obstruction.
Etiology
The causes of Nephrolithiasis:
Calcium stones
Uric acid stones
Struvite stones
Cystine stones
Genetics
Prognostic Factors
Around 20% of patients need hospitalization due to persistent pain, fluid retention issues, infection, or obstruction.
Minimally invasive stone removal modalities are generally successful in managing calculi.
Metabolic evaluation and treatment should be considered for high-risk patients with multiple stones or a history of stone formation.
High fluid intake is important for effective medical therapy to delay stone formation and maintain high urinary volume.
Clinical History
Clinical History:
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Physical Examination
Genitourinary Examination
Abdominal Examination
Back Examination
Cardiovascular and Respiratory Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Nausea and Vomiting
Hematuria
Dysuria and Urinary Urgency
Chronic symptoms are:
Asymptomatic Stones
Chronic Hematuria
Chronic Kidney Damage
Differential Diagnoses
Biliary Colic
Acute Cholecystitis
Diverticulitis
Gallstones
Inflammatory Bowel Disease
Large-Bowel Obstruction
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
IV hydration essential to reduce nephrotoxic effects of contrast.
Management of nephrolithiasis includes emergency care for renal colic, surgeries, and medical treatment.
Observation and acetaminophen for mild hydronephrosis stones. Severe cases need stent or percutaneous nephrostomy for pain relief.
Medical therapy for stone disease focuses on short-term methods to dissolve or pass stones and long-term prevention of future stones.
Treatment of renal colic patient in ED involves IV access for fluids, analgesics, antiemetics.
Pain relief and medical measures help stones pass without infection. Infections are treated with antimicrobial therapy when obstruction is absent.
Uric acid stone patients can dissolve stones with alkalized urine when not urgent surgical intervention needed.
Potassium citrate therapy is recommended for patients with recurrent calcium stones and low urinary citrate.
There are various surgical options available including, Anatrophic nephrolithotomy, Percutaneous nephrostolithotomy, Extracorporeal shockwave lithotripsy, Percutaneous nephrostomy, and Stent placement.
use-of-phases-in-managing-nephrolithiasis
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids, calcium channel blockers, xanthine oxidase inhibitors, analgesics, antibiotic agent and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
Initial dose: 800mg/day orally divided a day thrice
Based on the quantity necessary to lower urine cystine concentration to below its solubility limit (often less than 250 mg/L), the dose should be prescribed
Maintenance dose: 1000mg/day orally divided a day thrice
Take 10 to 30 ml of the diluted solution in a maximum of 6 ounces of water or juice orally after meals and at bedtime as needed.
Drink more water if necessary
Indicated for the prevention of calcium nephrolithiasis
12.5-25 mg orally once daily; after many weeks, titrate the dose based on the urinary calcium response and tolerance of 100 mg once daily
Keep the usual effective dose to 25-50 mg once each day
≥20kg: 15mg/kg/day orally divided thrice daily. Do not exceed 50mg/kg/day
Modify dosage to limit urine cystine levels to around 250 mg/L.
If there has been a history of severe toxicity to d-penicillamine, start with a lower dosage
<2 years: As per physician's recommendation
≥2 years: Take 5 to 15 ml of the diluted solution in 30 to 90 ml of water or juice orally after meals and at bedtime as needed
Drink more water if necessary
Nephrolithiasis is a condition that causes formation of crystalline stones in kidneys or urinary tract.
Stones form from mineral salts and substances in urine. Most renal calculi are made of calcium to cause pain through ureteral obstruction-induced dilation, stretching, and spasm.
Acute renal colic is incredibly painful for patient. Unexpected pain surpasses childbirth, fractures, gunshots, burns, and surgeries severity.
While nephrolithiasis is rare, those with preexisting azotemia and solitary kidneys are at higher risk of renal damage.
Kidney stone formation starts with urine supersaturation, nucleation, and crystallization. Urine inhibitors prevent stone formation, but in nephrolithiasis it allows crystal stones.
Risk Factors are:
Dehydration
Diet
Family History
Medical Conditions
Approximately 11% of men and 7% of women develop nephrolithiasis. In children it is increases up to 6 to 10%.
Approximately 30 million people are at risk in the United States. Around 30 million Americans are at risk while about 2 million patients experience stone disease yearly.
Research suggests that higher rates of kidney stones in US linked to patient’s socioeconomic status.
Lower economic status linked to lower renal stone risk. Regions with lower living standards have less kidney stones but more bladder stones.
Foreign bodies or crystals can act as nidi for crystalline structures. Most kidney stones are made of calcium, with a smaller portion made of uric acid or other substances.
Urine supersaturation causes uric and cystine stones, while calcium stones have multifactorial origins.
Renal colic causes upper midback pain starting at costovertebral angle. More proximal peristalsis in the ureter increases pain perception with intrinsic pacemakers.
Moving ureter stone causes more pain than motionless stone due to intermittent obstruction.
The causes of Nephrolithiasis:
Calcium stones
Uric acid stones
Struvite stones
Cystine stones
Around 20% of patients need hospitalization due to persistent pain, fluid retention issues, infection, or obstruction.
Minimally invasive stone removal modalities are generally successful in managing calculi.
Metabolic evaluation and treatment should be considered for high-risk patients with multiple stones or a history of stone formation.
High fluid intake is important for effective medical therapy to delay stone formation and maintain high urinary volume.
Clinical History:
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Genitourinary Examination
Abdominal Examination
Back Examination
Cardiovascular and Respiratory Examination
Acute symptoms are:
Nausea and Vomiting
Hematuria
Dysuria and Urinary Urgency
Chronic symptoms are:
Asymptomatic Stones
Chronic Hematuria
Chronic Kidney Damage
Biliary Colic
Acute Cholecystitis
Diverticulitis
Gallstones
Inflammatory Bowel Disease
Large-Bowel Obstruction
IV hydration essential to reduce nephrotoxic effects of contrast.
Management of nephrolithiasis includes emergency care for renal colic, surgeries, and medical treatment.
Observation and acetaminophen for mild hydronephrosis stones. Severe cases need stent or percutaneous nephrostomy for pain relief.
Medical therapy for stone disease focuses on short-term methods to dissolve or pass stones and long-term prevention of future stones.
Treatment of renal colic patient in ED involves IV access for fluids, analgesics, antiemetics.
Pain relief and medical measures help stones pass without infection. Infections are treated with antimicrobial therapy when obstruction is absent.
Uric acid stone patients can dissolve stones with alkalized urine when not urgent surgical intervention needed.
Potassium citrate therapy is recommended for patients with recurrent calcium stones and low urinary citrate.
Urology
Patient should regularly maintain hydration level to reduce the risk of kidney stones.
Follow regular exercise routine to improve overall kidney function and health.
Start taking low-sodium diet to manage hypertension and avoid high-protein diet to reduce the workload on the kidneys.
Proper education and awareness about nephrolithiasis should be provided and its related causes with management strategies.
Appointments with a urologist and preventing recurrence of disorder is an ongoing life-long effort.
Urology
Butorphanol:
It is used to reduce moderate to severe pain and less smooth muscle spasm.
Nalbuphine:
It stimulates kappa opioid receptor in the CNS that cause inhibition of ascending pain.
It inhibits DNA gyrase in susceptible organisms to promote breakage of double-stranded DNA.
Urology
There are various surgical options available including, Anatrophic nephrolithotomy, Percutaneous nephrostolithotomy, Extracorporeal shockwave lithotripsy, Percutaneous nephrostomy, and Stent placement.
Urology
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids, calcium channel blockers, xanthine oxidase inhibitors, analgesics, antibiotic agent and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
Nephrolithiasis is a condition that causes formation of crystalline stones in kidneys or urinary tract.
Stones form from mineral salts and substances in urine. Most renal calculi are made of calcium to cause pain through ureteral obstruction-induced dilation, stretching, and spasm.
Acute renal colic is incredibly painful for patient. Unexpected pain surpasses childbirth, fractures, gunshots, burns, and surgeries severity.
While nephrolithiasis is rare, those with preexisting azotemia and solitary kidneys are at higher risk of renal damage.
Kidney stone formation starts with urine supersaturation, nucleation, and crystallization. Urine inhibitors prevent stone formation, but in nephrolithiasis it allows crystal stones.
Risk Factors are:
Dehydration
Diet
Family History
Medical Conditions
Approximately 11% of men and 7% of women develop nephrolithiasis. In children it is increases up to 6 to 10%.
Approximately 30 million people are at risk in the United States. Around 30 million Americans are at risk while about 2 million patients experience stone disease yearly.
Research suggests that higher rates of kidney stones in US linked to patient’s socioeconomic status.
Lower economic status linked to lower renal stone risk. Regions with lower living standards have less kidney stones but more bladder stones.
Foreign bodies or crystals can act as nidi for crystalline structures. Most kidney stones are made of calcium, with a smaller portion made of uric acid or other substances.
Urine supersaturation causes uric and cystine stones, while calcium stones have multifactorial origins.
Renal colic causes upper midback pain starting at costovertebral angle. More proximal peristalsis in the ureter increases pain perception with intrinsic pacemakers.
Moving ureter stone causes more pain than motionless stone due to intermittent obstruction.
The causes of Nephrolithiasis:
Calcium stones
Uric acid stones
Struvite stones
Cystine stones
Around 20% of patients need hospitalization due to persistent pain, fluid retention issues, infection, or obstruction.
Minimally invasive stone removal modalities are generally successful in managing calculi.
Metabolic evaluation and treatment should be considered for high-risk patients with multiple stones or a history of stone formation.
High fluid intake is important for effective medical therapy to delay stone formation and maintain high urinary volume.
Clinical History:
Collect details including chief complaint, history of present illness, and medical history to understand clinical history of patient.
Genitourinary Examination
Abdominal Examination
Back Examination
Cardiovascular and Respiratory Examination
Acute symptoms are:
Nausea and Vomiting
Hematuria
Dysuria and Urinary Urgency
Chronic symptoms are:
Asymptomatic Stones
Chronic Hematuria
Chronic Kidney Damage
Biliary Colic
Acute Cholecystitis
Diverticulitis
Gallstones
Inflammatory Bowel Disease
Large-Bowel Obstruction
IV hydration essential to reduce nephrotoxic effects of contrast.
Management of nephrolithiasis includes emergency care for renal colic, surgeries, and medical treatment.
Observation and acetaminophen for mild hydronephrosis stones. Severe cases need stent or percutaneous nephrostomy for pain relief.
Medical therapy for stone disease focuses on short-term methods to dissolve or pass stones and long-term prevention of future stones.
Treatment of renal colic patient in ED involves IV access for fluids, analgesics, antiemetics.
Pain relief and medical measures help stones pass without infection. Infections are treated with antimicrobial therapy when obstruction is absent.
Uric acid stone patients can dissolve stones with alkalized urine when not urgent surgical intervention needed.
Potassium citrate therapy is recommended for patients with recurrent calcium stones and low urinary citrate.
Urology
Patient should regularly maintain hydration level to reduce the risk of kidney stones.
Follow regular exercise routine to improve overall kidney function and health.
Start taking low-sodium diet to manage hypertension and avoid high-protein diet to reduce the workload on the kidneys.
Proper education and awareness about nephrolithiasis should be provided and its related causes with management strategies.
Appointments with a urologist and preventing recurrence of disorder is an ongoing life-long effort.
Urology
Butorphanol:
It is used to reduce moderate to severe pain and less smooth muscle spasm.
Nalbuphine:
It stimulates kappa opioid receptor in the CNS that cause inhibition of ascending pain.
It inhibits DNA gyrase in susceptible organisms to promote breakage of double-stranded DNA.
Urology
There are various surgical options available including, Anatrophic nephrolithotomy, Percutaneous nephrostolithotomy, Extracorporeal shockwave lithotripsy, Percutaneous nephrostomy, and Stent placement.
Urology
In the initial diagnosis phase, evaluation of medical history, physical examination and imaging studies to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of corticosteroids, calcium channel blockers, xanthine oxidase inhibitors, analgesics, antibiotic agent and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with urologist are schedule to check the improvement of patients along with treatment response.
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
