BÀI TỔNG hợp RENAL CALCULI

CAN THO UNIVERSITY OF MEDICINE AND PHARMACY RENAL CALCULI INSTRUCTOR: NGUYỄN THỊ TUYẾT MINH GROUP MEMBERS: Võ Văn Sơn 1553010046 Ôn Thị Mỹ Hảo 1553010015 Lê Phương Thảo 1553010052 Nguyễn Thị Mỹ Tiên 1553010058 Nguyễn Hữu Phúc 1553010042 Group 9: Renal Calculi Page RENAL CALCULI I) Introduction: Renal calculi, or kidney stones, are crystals of the salts that are normally present in urine A very high concentration of salts in urine may trigger precipitation of the salt and formation of crystals, which can range from microscopic size to 20mm in diameter The most common type of kidney stone is made of calcium salts, a less common type is made of uric acid Kidney stones are most likely to form in the renal pelvis Predisposing factors include decreased fluid intake or over ingestion of minerals (as in mineral supplements), both of which lead to the formation of the very concentrated urine The entry of kidney stone into a ureter may cause intense pain (renal colic) and bleeding Obstruction of a ureter by a stone may cause backup of urine and possible kidney damage Treatments include ureteroscopy to remove the stone, of lithotripsy, the use of shock waves to crush the stone into pieces that are small enough to be eliminated without causing damage to the urinary tract Kidney stones can develop in one or both kidneys and most often affect people aged from 20 to 60 According to the statistics of the World Health Organization (WHO), urinary tract stone disease is increasing, especially in poor countries and developing countries This disease is often recurrent It is quite common, with around three in 20 men and up to two in 20 women developing them at some stage of their lives In Vietnam, about 10 to 15 percent of population have kidney stones And in urinary diseases, kidney stones are 45 to 50 percent Group 9: Renal Calculi Page II) Causes And Classification: An inherited condition called hypercalciuria, which leads to large amounts of Kidney stones are known to be one of the most painful medical conditions calcium in urine There four main types of stones: calcium stones, uric acid stones, struvite  Anare overactive parathyroid gland  Kidney stones and disease cystine stones  A rare condition called sarcoidosis  Some OF cancer NAME STONE APPROXIMATE CONSTITUENTS  Calcium stones are usually either large and smooth or spiky and rough INCIDENCE Calcium oxalate 70 percent of all stones Calcium, oxalate Calcium phosphate 10 percent of all stones Calcium, phosphate Uric acid 5-10 percent of all stones Uric acid Struvite 10 percent of all stones Calcium, ammonia, phosphate Cystine Less than percent of all stones Cystine Medication-induced Less than percent of all stones stones Composition depends on medication or herbal product The cause of kidney stones varies according to the type of stones: CALCIUM STONES Calcium stones are the most common They can be made of calcium oxalate (most general), phosphate and meteate Calcium stones form when urine is supersaturated with the constituent ions that comprise the stone Hence, supersaturation with calcium and oxalate ions will promote the formation of calcium oxalate stones Supersaturation of urine with calcium and phosphate ions will promote the formation of calcium phosphate stones There’s too much calcium in the urine, which can be due to: Group 9: Renal Calculi Page URIC ACID STONES This type of kidney stones is more common in men than in women Several products of purine metabolism are relatively insoluble and can precipitate when urinary pH is low These include 2or 8-dihydroxyadenine, adenine, xanthine, and uric acid The crystals of uric acid may initiate calcium oxylate precipitation in metastable urine concentrates They develop when urine is too acidic They may be caused by:  A diet rich in purine can increase urine’s acidic level  A condition such as gout that prevents the body breaking down certain chemicals  A inherited condition that causes higher than normal level of acid in the body  Chemotherapy Group 9: Renal Calculi Page STRUVITE STONES This type of stones is found mostly in women with urinary tract infection Struvite precipitates in alkaline urine, forming stones Struvite stones are potentiated by bacterial infection that hydrolyzes urea to ammonium and raises urine pH to neutral or alkaline values They are caused by a kidney infection These stone can be large and cause urinary obstruction CYSTINE STONES Cystine stones are rare type of kidney stones They occur in both men and women Cystine kidney stones are due to cystinuria, an inherited (genetic) disorder of the transport of an amino acid (a building block of protein) called cystine that results in an excess of cystine in the urine (cystinuria) and the formation of cystine stones III) SYMPTOMS: Kidney stones don’t always cause symptoms When they’re small, which may go through the ureter without causing pain However, large stones may block urine flow, which can cause a number of painful symptoms that can be severe This can happen when a kidney stone becomes stuck in the ureter The symptoms can be caused when kidney stones move around in your kidney and down the ureter Group 9: Renal Calculi Page RENAL COLIC Renal colic is the term medical professionals used to describe the pain caused by kidney stones Many people describe the feeling of kidney stones as a sharp pain on one side of their back or lower abdomen The pain often starts abruptly and then lingers, becoming more intense over time The location of the stone and its progress through your urinary tract can affect the type of symptoms you experience The affected area can also spread to include hip and groin area OTHER SYMPTOMS In addition to feeling severe pain in your back or side below your ribs, a number of other symptoms may also occur with kidney stones One of the most common problems is with urination This can include:  Hesitancy (difficulty urinating) and dysuria (pain while urinating)  Urgency (an urge to urinate more often than usual)  Urine that appears cloudy  Hematuria (blood in the urine): Because of the crystalline shape of the kidney stone, its uneven, jagged edges can cut into the sides of the renal pelvis and the ureter that cause blood in urine You can be:  Nausea  Vomiting  Chills  Fever These symptoms may indicate that you have an infection You should also seek medical care if you have them Group 9: Renal Calculi Page IV) DIAGNOSIS: The doctor will perform a physical exam This includes tapping on the back over the kidneys and pressing on the abdomen to detect tender locations The doctor will need to know the following:  Any previous kidney stones attack  History of cancer, sarcoidosis, or small bowel disease  Any medications being taken, including non-prescription substances, particularly high doses of vitamins D or C and calcium-containing antacids, ruling out other disorders Kidney stones that occur in children and young patients are more likely to result from inherited problems that cause excess cystine, xanthine, or, in some cases, calcium oxalate In adult patients, calcium stones are most common Other causes of pain that may mimic kidney stones include:     Gallstones Appendicitis Peptic ulcers Hepatitis If your doctor suspects you have a kidney stone, you may need to undergo diagnostic tests and procedures, such as: IMAGING TECHNIQUES: Various imaging techniques are helpful in determining the presence of kidney stones The best approach is using spiral (or helical) computed tomography (CT) scans a X-Rays: A standard x-ray of the kidneys, ureters, and bladder may be a good first step to identify stones, because many stones are visible on x-rays Calcium stones can be identified on x-rays by their white color Cystine crystals can also show up on x-rays b Computed Tomography: A type of CT scan called spiral or helical CT scan is currently the best method Group 9: Renal Calculi Page to diagnose stones in either the kidneys or the ureters CT scans can be used to find the exact location of the stone, as well as to look for anatomical problems that may have led to stone formation This test is fast, noninvasive, and it provides detailed, accurate images of even very small stones This is a better choice compared to x-rays, ultrasound and IVP for detecting kidney stones c Ultrasound: Ultrasound can detect uric acid stones and blockages in the urinary tract It is not useful for finding very small stones Ultrasound is also effective for children d Intravenous Pyelogram (IVP): In the procedure intravenous pyelogram (IVP), the patient is injected with dye X-rays are taken as the dye travels through the urinary tract This procedure is done to confirm the presence of kidney stones IVP should not be used on patients with kidney failure e Magnetic Resonance Imaging (MRI): Magnetic resonance imaging (MRI) techniques are showing promise for diagnosing urinary tract obstruction They are good options for children and pregnant women URINE TESTS: Urine tests that are used to determine the specific chemical and biological factors causing the stone should be performed about weeks after the attack, since the attack itself may change the levels of such substances, including calcium, phosphate, and citrate TESTING THE ACIDITY OF URINE: Testing whether urine is acidic or alkaline helps to identify the specific type of stone The levels of acidity or alkalinity in any solution, including urine, are indicated by the pH scale TESTING FOR BLOOD IN THE URINE: A dipstick test for blood in the urine (called hematuria) is typically performed when patients come to the emergency room with flank pain (the primary symptom of kidney stones) Group 9: Renal Calculi Page BLOOD TESTS: a Blood tests help determine what substances have formed the crystals and blood levels of urea nitrogen, creatinine, calcium, phosphate, and uric acid in patients with known or suspected calcium oxalate stones b Tests for Infection A test result that shows a high white blood cell count might indicate infection However, since the number of white blood cells could also increase in response to the extreme physical stress of a kidney stones attack c Tests for Metabolic Problems About half of children with stones have an identifiably metabolic disorder, which increases their risk of stone recurrence five-fold d Parathyroid Tests to detect parathyroid hormone levels For example, calcium stones in middle-aged women may be due to parathyroid abnormalities V) TREATMENT: Treatment for kidney stones varies, depending on the types of stone and the cause SMALL STONES WITH MINIMAL SYMPTOMS: Most kidney stones won't require invasive treatment You may be able to pass a small stone by: DRINKING WATER Drinking as much as to quarts (1.9 to 2.8 liters) a day may help flush out your urinary system Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine PAIN RELIEVERS Passing a small stone can cause some discomfort To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve) Group 9: Renal Calculi Page 10 MEDICAL THERAPY Your doctor may give you a medication to help pass your kidney stone This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain MEDICINAL HERBS Following herbs are used to help pass kidney stones and reduce the pain they cause -Smilax glabra, imperata cylindrica , plantago major, and desmodium styracifolium… LARGE STONES AND THOSE THAT CAUSE SYMPTOMS: Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more extensive treatment Procedures may include: USING SOUND WAVES TO BREAK UP STONES • For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL) • ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable USING A SCOPE TO REMOVE STONES • To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter • Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing You may need general or local anesthesia during this procedure Group 9: Renal Calculi Page 11 SURGERY TO REMOVE VERY LARGE STONES IN THE KIDNEY • A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back • You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover Your doctor may recommend this surgery if ESWL is unsuccessful PARATHYROID GLAND SURGERY • Some calcium phosphate stones are caused by overactive parathyroid glands which are located on the four corners of your thyroid gland, just below your Adam's apple When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result • Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone Removing the growth from the gland stops the formation of kidney stones Or your doctor may recommend treatment of the condition that's causing your parathyroid gland to overproduce the hormone VI) COMPLICATIONS OF TREATMENT: The different kinds of treatment for larger stones may cause some complications These complications depend on treatment which you have used, size and position of your stones They could include: SEPSIS: an infection that has spread through the blood causes many symptoms throughout the whole body STEINSTRASSE: steinstrasse is the medical name of a blockage that is caused by fragments of stone in the ureter (the tube attaches each kidney to the bladder) AN INJURY TO THE URETER : Group 9: Renal Calculi Page 12 Hemorrhage (extensive bleeding) during the operation is a clear and main risk factor for ureteral injury Sudden hemorrhage should never be treated with blind cautery (searing of tissue) or suturing, but rather direct pressure, sharp dissection and exposure of the bleeding vessels followed by accurate and precise suturing When a ureteral injury is diagnosed and repaired at the initial presentation/exploration, there is rarely a high degree of sickness However, when diagnosis is delayed, sickness including body-wide response to serious infection, loss of kidney function and possible death can occur in up to 50 percent of patients Urine leakage can also cause abscess and scarring of the ureter, leading to obstruction and formation of abnormal passages URINARY TRACT INFECTION (UTI) : to identify an UTI, keep an eye out for the following symptoms:  A burning feeling when you urinate  A frequent or intense urge to urinate, even though there is less urine when you urinate  Pain or pressure in your back or lower abdomen  Cloudy, dark, bloody, or strange-smelling urine  Feeling tired or shaky  Fever or chills (a sign the infection may have reached your kidneys) BLEEDING DURING SURGERY BACK PAIN DUE TO THE PIECES OF STONES NOT GOING OUT VII) PREVENTION: Prevention of kidney stones may include a combination of lifestyle changes and medications 1) LIFESTYLE CHANGES: You may reduce your risk of kidney stones if you:  Drink water throughout the day: for people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day Your doctor may ask you to measure your urine output to make sure that you're drinking enough water Group 9: Renal Calculi Page 13 If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine If your urine is light and clear, you're likely drinking enough water  Eat fewer oxalate-rich foods: if you tend to form calcium oxalate stones, your doctor may recommend restricting foods that are rich in oxalates These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products  Choose a diet which is low in salt and animal protein: reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes Consider using a salt substitute  Continue eating calcium-rich foods, but take caution with calcium supplements: calcium in food doesn't have an effect on your risk of kidney stones Continue eating calcium-rich foods unless your doctor advises otherwise Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones You may reduce the risk by taking supplements with meals Diets that are low in calcium can increase kidney stone formation in some people Ask your doctor for a referral to a dietitian who can help develop an eating plan that reduces your risk of kidney stones MEDICATIONS: Medications can control the amount of minerals and acid in your urine and may be helpful in people who form certain kinds of stones The type of medication your doctor prescribes will depend on the kind of kidney stones you have Here are some examples:  Calcium stones To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation  Uric acid stones Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones  Struvite stones To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection Long-term use of antibiotics in small doses may help achieve this goal For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones  Cystine stones Cystine stones can be difficult to treat Your doctor may recommend that you drink more fluids so that you produce a lot more urine If that Group 9: Renal Calculi Page 14 alone doesn't help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine VIII) CONCLUSION: Kidney stones are common and recur frequently Calcium oxalate stones are the most common Urine supersaturation is increased with low urine volume and with increased urinary excretion of calcium, oxalate, phosphate, cysteine or uric acid Citrate is the most common inhibitor of crystal formation and urinary pH is very important for preventing or treating different types of stones There are many stone risk factors among which diet is very important Urgent stone removal and treatments are done by urology using surgery or ESWL Medical and dietary treatments are most important ways to prevent recurrence of stone Consumption of ample fluids is essential, and dietetic advice is helpful REFERENCES: http://www.medscape.com/viewarticle/745456_2 http://emedicine.medscape.com/article/983759-overview http://www.medicinenet.com/script/main/art.asp?articlekey=8529 www.healthline.com/health/kidney-stones http://www.nhs.uk/Conditions/Kidney-stones/Pages/Causes.aspx www.nhs.uk/Conditions/kidney-stones/Pages/Introduction.aspx http://www.uwhealth.org/urology/types-of-kidney-stones/11206 http://www.healthline.com/health/symptoms-of-kidney-stones#Symptoms2 Group 9: Renal Calculi Page 15 VOCABULARY Vocabulary Pronunciation Anesthesia /ˌænəsˈθiːziə/ Appendicitis \ə-ˌpen-də-ˈsī-təs\ Colic /ˈkɑːlɪk/ Cystinuria \ˌsis-tə-ˈnu̇r-ē-ə, ˈnyu̇r-\ Meaning The use of anaesthetics during medical operations Inflammation of the vermiform appendix Severe pain A metabolic defect characterized by excretion of excessive amounts of cystine in the urine and inherited as an autosomal recessive trait A plant whose leaves, flowers or seeds are used to flavour food, in medicines or for their pleasant smell Herb /hɜːb/ Hepatitis \ˌhe-pə-ˈtī-təs\ Hypercalciuri a \-ˌkal-sē-ˈyu̇r-ē-ə\ Hyperparathyroidism \-ˌper-ə-ˈthī-ˌrȯi-ˌdizəm, -ˌpa-rə-\ A condition in which the parathyroid is too active Invasive /ɪnˈveɪsɪv/ Involving cutting into the body Microscopic /ˌmaɪkrəˈskɒpɪk/ Extremely small and difficult or impossible to see without a microscope Percutaneous ˌpɜːkjuːˈteɪniəs/ Made or done through the skin Precipitation /prɪˌsɪpɪˈteɪʃn/ A chemical process in which solid material is separated from a liquid /ˈruːbɑːrb/ Rhubarb Sarcoidosis \ˌsär-ˌkȯi-ˈdō-səs\ Group 9: Renal Calculi Inflammation of the liver Excessive urinary calcium excretion The thick red stems of a garden plant, also called rhubarb, that are cooked and eaten as a fruit A chronic disease of unknown cause that is characterized by the formation of nodules especially in the lymph nodes, lungs, bones, and skin Page 16 Group 9: Renal Calculi Page 17 Group 9: Renal Calculi Page 18 Type Document Heading Here Type sub heading here Group 9: Renal Calculi Page 19 ...Group 9: Renal Calculi Page RENAL CALCULI I) Introduction: Renal calculi, or kidney stones, are crystals of the salts that are normally... lungs, bones, and skin Page 16 Group 9: Renal Calculi Page 17 Group 9: Renal Calculi Page 18 Type Document Heading Here Type sub heading here Group 9: Renal Calculi Page 19 ... caused when kidney stones move around in your kidney and down the ureter Group 9: Renal Calculi Page RENAL COLIC Renal colic is the term medical professionals used to describe the pain caused by