Dr Kushma Nand Renal Physician Kidney stones Dr Kushma Nand Renal Physician

General aspects of stone formation Biomineralisation of urinary stones are multifactorial Socio-economic Genetic Constitutional factors such as diet, pharmacologic treatment and metabolic abnormalities might act in concert

Super saturation of urine Prerequisite Solubility of different stone components depends on urinary pH and excretion of other urine constituents

General Aspects of Urinary stone formation Age sex Profession Mentality Nutrition constitution Climate race Inheritance Abnormal Renal morphology Disturbed urine flow Urinary tract infection Metabolic abnormalities Genetic factors Increased Decreased Excretion of stone forming constituents Excretion of Crystallization promoters Excretion of Crystallization inhibitors Urinary volume Physico-chemical change in the state of super saturation Abnormal crystalluria Crystal aggregation Crystal growth URINARY STONE

Ammonium urate Uric acid cystine solubility phosphate 8 5 6 7 Urinary pH

Location and form of urinary stones 97 % of all stones are localized in the Parenchyma Papilla Calyces Pelvis Pelvis and calices Ureter Only 3 % in the bladder and urethra

Location and form of urinary stones Major Constituent in % of the cases The only mineral in % of the cases Calcium oxalate Uric acid Struvite Carbonate apatitie,whitlockite Brushite Cystine Ammonium urate Protein No major constituent 70.4 11 6 4.8 1.0 0.4 0.5 0.8 5.1 20.8 8.0 2.1 1.1 1.0 0.4 0.1 -

The emergency stone Treatment of patients with acute renal colic Treatment and care of patients with urinary stones Biochemical investigations Urine and blood Imaging

Stone episodes Medical history Current age and age at first stone Profession Stone disease in relatives Associated diseases Disturbances of the metabolism of calcium HPT, RTA, Wilson's disease, MSK sarcoidosis Disturbances of the metabolism of oxalate Primary hyperoxalouria, Enteric hyperoxalouria Disturbance of the metabolism of uric acid As a result of cell death cytotoxics As a result of enzyme deficiency Gout Lesch-Nyhan syndrome As a result of alteration in excretion of uric acid Metabolic acidosis Infections Medications