1. Urinary track calculi (Kidney stone) Hanjong Park, PhD, RN

2. Urinary track calculi  요로결석은 신장요로계 어디나 형성 가능  신장 : most common site (renal calculi=kidney stones)  남 > 여  남 : Urinary track calculi (except for struvite stones) are more common in men  여 : Struvite stones with urinary track infection are more common in women than in men 2 김금순 외 (2012), Lewis et al.(2014)

3. Urinary track calculi: etiology1  Metabolic  Abnormalities resulting in increased urine level of calcium, oxaluric acid( 옥살산 ), uric acid( 요산 ), or citric acid( 구연산 )  Climate  Warm climates causing increased fluid loss, low urine volume, increased solute concentration in urine 3 김금순 외 (2012), Lewis et al.(2014)

4. Urinary track calculi: etiology2  Diet  Large intake of dietary proteins increasing uric acid excretion  Excessive amounts of tea or fruit juices elevating urinary oxalate level  Large intake of calcium/ Vit C 과량복용  oxalate( 수산염 )↑  Low fluid intake increasing urinary concentration  Genetic factors  Family history of stone formation,, cystinuria( 시스틴뇨증 ), gout( 통풍 ), renal acidosis  Lifestyle  Sedentary occupation, immobility 4 김금순 외 (2012), Lewis et al.(2014)

5. Urinary track calculi: Diagnostic studies  KUB  Abdominal X-ray  IVP( 정맥내신우촬영술 )  BUN/Cr  CBC  Urinalysis  Urine culture  24hr urine collection for checking calcium, oxalate, phosphorus, uric acid  Serum calcium, phosphorus, protein, electrolytes, uric acid 5 김금순 외 (2012), Lewis et al.(2014)

6. Urinary track calculi: Clinical manifestations  Pain  usually severe, sharp pain(renal colic)  sites: flank are, back, or lower abdomen  sudden onset  nausea, vomiting may occur due to severe pain  Hematuria: 95% 6 김금순 외 (2012), Lewis et al.(2014)

7. Urinary track calculi: Clinical manifestations  Common sites of obstruction:  UPJ(where the renal pelvis narrows into the ureter)  UVJ(ureterovesical junction) 7 김금순 외 (2012), Lewis et al.(2014)

8. Types of urinary track calculi 8 김금순 외 (2012), Lewis et al.(2014) Calcium oxalate( 수산화칼슘 결석 ) Calcium phosphate( 인산칼슘 결석 ) Struvite(Magnesium Ammonium Phosphate) Uric acid( 요산 결석 ) Cystine( 시스틴결석 )

9. Urinary track calculi: General Collaborative care1  Drug therapy  Pain control  Others (See previous slides)  Nutritional therapy( 결석 성분에 따라 식이 변경 )  수분섭취 증가 ( 하루 3L 이상 )  저옥살산염 식이 ( 진한 녹색채소, 땅콩, 초콜릿, 비타민 C 제한 )  저염식이 ( 하루 2g 이하 )  요산결석 - 저퓨린식이 ( 육류식사 하루 2 회 이하로 제한 )  감귤류 과일쥬스 섭취증가 ( 레몬에이드 등 하루 2L 이상 )  고칼륨혈증의 경우 칼슘제한 ( 칼슘포함 식사 하루 2 회 이하로 제한 ) 9 김금순 외 (2012), Lewis et al.(2014)

10. Urinary track calculi: General Collaborative care2  Lithotripsy( 쇄석술 )  레이져 쇄석술 (laser lithotripsy)  체외 충격파 쇄석술 (extra corporeal shock wave lithotripsy: ESWL)  경피적 쇄석술 (percutaneous lithotripsy)  전기수력학적 쇄석술 (Electrohydraulic lithotripsy) 10 Lewis et al.(2014)

11. Urinary track calculi: General Collaborative care3  Surgical stone removal  Nephrolithotomy( 신결석적출술 )  Pyelolithotomy)( 신우적석술 )  Ureterolithotomy( 요관절석술 ) 11 Lewis et al.(2014)

12. Urinary track calculi : Nursing diagnosis  결석의 자극과 관련된 통증  결석재발 예방에 대한 지식부족 ( 수분섭취, 식이제한 )  약물복용에 대한 지식부족 읽을 부분 : 김금순 외 (2012, p. 1536-8) 12 김금순 외 (2012), Lewis et al.(2014)

13. References 13 김금순 외 (2012). 성인간호학 II, 7 판. 수문사 Lewis, Sharon L.; Dirksen, Shannon Ruff; Heitkemper, Margaret M.; Bucher, Linda (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences. Kindle Edition.