1. Kidney Stones Presented By: Mary Jane Concengco, BSN, RN, NP Resident UCF Nursing Graduate Studies, 2010-2011 A Community Project In collaboration with Shepherd’s Hope

2. University of Central Florida Learning Objectives By the end of this presentation, you will: Know what a kidney stone is Know the signs & symptoms of kidney stones Know what the medical & surgical treatments are for kidney stones Know how to prevent kidney stones from recurring

3. University of Central Florida What my kidneys do? 2 kidneys located near the middle of our back, below our ribcage Kidneys are like “trash collectors.” The waste and excess water become urine.

4. University of Central Florida It is a hard solid lump that is formed inside the kidney. It can be the size of a grain of sand or it can be bigger. It is made from the waste products in the urine. A kidney stone may stay in the kidney or it may travel down the urinary tract, sometimes with or without pain. If its big enough it can get stuck and block the flow of urine and cause A LOT of PAIN.. What is a Kidney Stone?

5. University of Central Florida Family history Common in men than women Ages of 40-70 years old Common in Caucasians than African-Americans History of radiation Immobility because of illnesses Have metabolic disorders Risk Factors : Things You Can’t Change

6. University of Central Florida Other Risk Factors are If you: Have poor fluid intake, especially water. Eat a high protein, high salt, and low fiber diet Use calcium, vitamin C and D supplements

7. University of Central Florida Key Points about Kidney Stones You did not do anything wrong to get kidney stones. Sometimes we are just stone formers. Most stones pass on their own, without us even knowing we have them. But if the stones are too large to pass, it can cause infection, and obstruction of urine flow, which then can lead to kidney failure.

8. University of Central Florida Signs and Symptoms Call your provider if you have the following signs: Extreme pain in your back or side that will not go away Fevers, sweats, and/or chills Cloudy or bloody urine Nausea & vomiting Urine that smells bad A burning feeling when you urinate You feel like you have to go to the bathroom more frequently

9. University of Central Florida X-ray – KUB (kidney, ureters, and bladder) Renal Ultrasound CT scan of Abdomen and Pelvis IVP – Intravenous Pyelogram Once diagnosed having a kidney stone, further work up will be done to identify the type of stone it is. Tests include: 24 hr. urine collection, blood work for Calcium, phosphorus, uric acid, and parathyroid hormones How do kidney stones get diagnosed?

10. University of Central Florida Types of Kidney Stones If able, try to catch the stone (by straining your urine), and bring it to your provider to have it analyzed in the lab. There are 5 types of stones: Calcium – is the most common type Struvite Uric Acid Cystine Mixed (calcium oxalate/calcium phosphate) The prevention and management is all dependent with what type of stone you have.

11. University of Central Florida Surgical Management If you have a stone that will not pass by itself, you may need to have your stone removed by the following treatments done by a Urologist: Shock Waves – Extracorporeal Shock Wave Lithotripsy (ESWL) Tunnel Surgery – Percutaneous Nephrolithotomy Ureteroscopic Stone Removal Open Surgery

12. University of Central Florida Medical Management Initially: Observing and monitoring Provide pain control with medications After work up has been completed the following medications may be prescribed: Potassium Citrate Allopurinol Thiazide, such as HCTZ

13. University of Central Florida Drink 8 to 12 full glasses of water a day. Drink 2 glasses/cups/drinks of dark colored drinks per day, such as: juices, cola, coffee, tea (hot or ice), draft beer. Limit your salt intake to 1 tsp. per day. Eat up to 2 servings (size of your palm) of meat per day. Have only 3 servings/day of dairy products (milk, yogurt, cheese). Limit your foods that are high in oxalates, such as strawberries, cranberries, raspberries, green beans, spinach, rhubarb, beets, nuts, tofu, wheat bran, and chocolate. Prevention of Recurrence RENAL STONE DIET

14. University of Central Florida RECAP Remember you did not do anything wrong to get kidney stones. A kidney stone can be very painful, and needs to be treated quickly to prevent complications such as infection, obstruction or renal failure. Some dietary changes may help reduce the chance of recurrence. 50% will still have recurrence within 10 years. We must live a life in moderation, too much of anything isn’t always better or good. Balance!

15. University of Central Florida American Academy of Family Physicians. (2010). What you should know about kidney stones. Retrieved from http://familydoctor.org/online/famdocen/home.html on Nov. 1, 2010. http://familydoctor.org/online/famdocen/home.html Buttaro, T.M., Trybulski, J., Bailey, P.P, & Sandberg-Cook, J. (2008). Primary care: A collaborative practice. 3rd ed. Philadelphia: Mosby. National Institute of Diabetes and Digestive and Kidney Diseases. (2007). What I need to know about Kidney Stones. Retrieved on Nov. 5, 2010 from http://kidney.niddk.nih.gov/kudiseases/pubs/stones_ez/index.htmhttp://kidney.niddk.nih.gov/kudiseases/pubs/stones_ez/index.htm National Kidney and Urologic Diseases Information Clearinghouse (2009). Diet for Kidney Stone Prevention. Retrieved on Nov. 5, 2010. from http://kidney.niddk.nih.gov/kudiseases/pubs/kidneystonediet/index.htm References:

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