Renal and Ureteric Stone

What is renal and ureteric stone?

Renal stone is known Ureteric stone is known as nephrolithiasis as Ureterolithiasis found inside the Presence of stone in kidneys. the ureter They vary in size from Usually comes from the as small as a grain of kidney sand to as large as a grapefruit

EPIDEMIOLOGY
Most urinary calculi develop in persons aged 20-49 years. Peak incidence occurs in people aged 35-45 years, but the disease can affect anyone at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life male-to-female ratio of 3:1 Calcium and uric stones more frequent in male while infectious stones more common in female In a patient who has passed one stone, the likelihood of passing a second stone is ~15% (over 3 years) ~50% (by 15 years)

Dietetic

Hyperparathyroidism

Altered urinary solutes and colloids

Formation of stone etiology

Prolonged immobilisation Decreased urinary citrate

Inadequate urinary drainage and urinary stasis

Renal infection

TYPES OF RENAL CALCULUS

Phosphate calculus Calcium oxalate
8085% Irregular sharp projections Hematuria! Discoloured stones Radiopaque 6 -20% Calcium phosphate (hydroxy apatite) Ammonium magnesium phosphate (struvite) Smooth, dirty white Prefer alkaline urine May cause very large staghorn calculi 510% Hard, smooth, usually multiple Yellow to red brown Microscopic multicolour needle-like Pure uric acid stone is Radioluscent 1% Very hard, multiple Pink or yellow turns greenish when exposed to air Microscopic Hexagonal, translucent, form casts Prefer acidic urine

Uric acid

Cystine

PATHOPHYSIOLOGY
Two basic phenomena 1. Supersaturation of the urine by stoneforming constituents, including calcium, oxalate, and uric acid
Ions from the supersaturated urine

Microscopic crystalline

Act as nidi

Likely the underlying cause of uric acid & cystine stone

2. Deposition of stone material on a renal papillary calcium

phosphate nidus
Calcium phosphate precipitates in the basement membrane of the thin loops of Henle

Urinary calculus

Erodes into interstitium

Calcium phosphate, calcium oxalate, stone matrix deposit on the substrate

Accumulates in subepithelial space of the renal papilla

Eventually erode through the papillary urothelium