1. Dr Kushma Nand Renal Physician
Kidney stones
Dr Kushma Nand
Renal Physician

2. 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

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

4. 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

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

6. 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

7. 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 -

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

9. 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