Urolithiasis (Urinary Stones)

• Meliputi :
• NEPHROLITHIASIS (RENAL CALCULI / KIDNEY STONE)
• URETEROLITHIASIS (URETER CALCULI)
• CYSTOLITHIASIS (BLADDER CALCULI)

Case Definition: Urolithiasis - Health.mil

https://www.health.mil/Reference-Center/Publications/2015/07/01/Urolithiasis
• Urolithiasis is the formation of urinary calculi (“stones”) in the urinary
system.
• Nephrolithiasis or “kidney stones” refers to calculi or stones in the
kidney and is the most common form of urinary tract stone disease.
• Ureter and bladder calculi almost always originate in the kidneys.
 Prevalence / Epidemiology
• Stone incidence depends on geographical, climatic, ethnic, dietary and
genetic factors.
• The recurrence risk is basically determined by the disease or disorder
causing the stone formation.
• Accordingly, the prevalence rates for urinary stones vary from 1% to 20% .
In countries with a high standard of life such as Sweden, Canada or the US,
renal stone prevalence is notably high.
• Di Indonesia , prevalensi Batu Ginjal sebesar 0,6% atau 6 per 1000
penduduk . Prevalensi tertinggi di DI Yogyakarta (1,2%), diikuti Aceh (0,9%),
Jawa Barat, Jawa Tengah, dan Sulawesi Tengah masing–masing sebesar 0,8
persen. (RISKESDAS 2013)

https://uroweb.org/wp-content/uploads/EAU-Guidelines- http://www.depkes.go.id/resources/download/general/Hasil%
Urolithiasis-2016-1.pdf 20Riskesdas%202013.pdf
Etiology
• Urinary stones formed by mineralization process.
• Urinary stones are polycrystalline aggregates composed of varying
amounts of crystalloid and organic matrix.
• Many of theories , still incomplete.
Patophysiology
• Stone formation required supersaturated urine.
Classification
• Stones can be classified into those caused by: infection, or non-
infectious causes (infection and non-infection stones); genetic defects
; or adverse drug effects (drug stones)
• By Composition
Stone composition is the basis for further diagnostic and management
decisions. Stones are often formed from a mixture of substances
Risk groups for
stone
formation
Other Classification
• Also can be classified according to size, location, X-ray characteristics,
beside from aetiology of formation, composition, and risk of
recurrence
• Stone size is usually given in one or two dimensions, and stratified
into those measuring up to 5, 5-10, 10-20, and > 20 mm in largest
diameter.
• Stones can be classified according to anatomical position: upper,
middle or lower calyx; renal pelvis; upper, middle or distal ureter; and
urinary bladder
• Can be classified according to plain X-ray appearance [kidney-ureter-
bladder (KUB) radiography] , which varies according to mineral
composition
• Non-contrast-enhanced computed tomography (NCCT) can be used to
classify stones according to density, inner structure and composition,
which can affect treatment decisions
Diagnostic Evaluation
• Detailed medical history and physical examination
• Ultrasound (US) should be used as the primary diagnostic imaging
tool, although pain relief, or any other emergency measures should
not be delayed by imaging assessments. (has sensitivity of 45% and
specificity of 94% for ureteric stones and a sensitivity of 45% and
specificity of 88% for renal stones)
• The sensitivity and specificity of KUB radiography is 44-77% and 80-
87%, respectively
• KUB radiography should not be performed if NCCT is considered
• Non-contrast-enhanced computed tomography (NCCT) has become
the standard for diagnosing acute flank pain, and has replaced
intravenous urography (IVU)
• NCCT can determine stone diameter and density.
• When stones are absent, the cause of abdominal pain should be
identified.
• In evaluating patients with suspected acute urolithiasis, NCCT seems
to be significantly more accurate than IVP
• Each emergency patient with urolithiasis needs a succinct biochemical
work-up of urine and blood besides imaging
• Stone analysis should be performed in all first-time stone formers.
• In clinical practice, repeat stone analysis is needed in the case of:
• recurrence under pharmacological prevention;
• early recurrence after interventional therapy with complete stone clearance;
• late recurrence after a prolonged stone-free period
SUMMARY
• Urinary stones are most often caused by decreased urine volume or by
increased excretion of stone-forming components such as calcium, oxalate,
urate, cystine, xanthine, and phosphate.
• Factors predisposing an individual to stone formation include reduction in
fluid intake, increased exercise with dehydration, medications that cause
hyperuricemia and a history of gout.
• The colic-type pain associated with the transit of kidney stones through
the ureter is often severe radiating to the back and groin. The majority of
stones pass in 48 hours. Treatment requires a combined medical and
surgical approach and depends upon the location of the stone, the extent
of obstruction, and the function of the affected kidney