Renal Calculi: Stone Formation and Its Prevention - Essay Sample

Introduction

Renal calculi are a disorder that results from the stone formation along the urinary tract or in the kidney. The humankind has suffered the adverse effects of kidney stone for centuries. It is the most frequent disease that affects the urinary tract. The most devastating problem is that there is no prevention of renal calculi since it is recurrent. The understanding of the stone formation mechanisms could help in the prevention of the condition. Renal calculi have been known to cause chronic kidney diseases, cardiovascular diseases, hypertension, and diabetes. The symptoms of renal calculi are based on the disorder's location that is ureter, kidney, urethra, or urinary bladder. Some of the signs and symptoms include flank pain, blocked urine flow, bloody urine, kidney dilation, renal colic, obstructive uropathy, and infections of the urinary tract (Leslie & Murphy, 2018). The results of these signs and symptoms may be vomiting and nausea. The treatment of the disease is involving, and it affects the nation's economy as well as the quality of life.

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Description of Renal Calculi

Another name used to describe renal calculi is kidney stones. Renal calculi are, therefore, masses of solids that are composed of crystals. The disease affects the kidney, but it can also develop along the urinary tract in ureter, urethra, and bladder parts of the tract (Sullivan, 2018). This condition is the most painful to the patients who suffer from it. The number of women affected by renal calculi is less than the number of men who suffer from the condition. The condition affects a total of 12% of the population of the world (Petros & Alelign, 2018). The standard type of renal calculi is calcium oxalate whose formation is at Randall's plaque at the surfaces of renal papillary. The mechanism with which the stones are formed involves a series of physiochemical events that include growth, nucleation, supersaturation, retention, and aggregation of the urinary stone (Aggarwal et al., 2014). The recurrence and prevalence rates of the disease in the world is increasingly alarming. The condition causes morbidity.

Causes

The development of kidney stones is related to urine volume increase. Alternatively, excretion of components that form stones such as uric acid, xanthine, cysteine, phosphate, oxalate, and calcium in high levels could cause the stones. Decreased levels of citrate or increased acidity in the urine could also cause renal calculi (Leslie and murphy, 2018). Urolithiasis may also cause renal calculi whereby crystallization of the solutes in the urine occurs, forming stones. The reasons behind urolithiasis are decreased the volume of urine, anatomic features that cause urinary stasis, infections of the urinary tract, dietary factors, genetic factors, and systemic acidosis. However, renal calculi are mostly caused by hydration and low volume of urine. Other factors that could cause renal calculi include hyperoxaluria, hypercalciuria, hypocitraturia, and hyperuricosuria. Intake of fatty acids could also contribute to kidney stones (Prochaska, Taylor & Curhan, 2016)

Clinical Findings

Studies have shown that the prevalence of renal calculi in the United States has tremendously increased (Leslie and Murphy, 2018). The condition affects all sexes, ages, and races, but it is more prevalent in men than women (Alelign & Petros, 2018). Research conducted recently have shown that the condition is affecting both the developing and developed countries. The increase in this trend is attributed to lifestyle changes, for example, dietary changes, lack of physical exercise, and global warming. The number of Americans estimated to be suffering from the condition annually is approximately 600,000, which is quite a large number of the population.

There are five types of renal calculi. The first one is calcium stones which include calcium phosphate and calcium oxalate. This type is composed of about 80% of the renal calculi. Nursing studies have shown that most of the kidney stones contain calcium oxalate. The formation of calcium stone is attributed to hyperuricosuria, hypercalciuria, hypomagnesuria, hypocitraturia, hyperoxaluria, and hypercystinuria. Calcium stone is more common than other kinds of kidney stones. The second one is magnesium ammonium phosphate which is common in patients who suffer from urinary tract infections that are chronic. The third one is urate which is caused by diet, and it is more prevalent in men than in women (Alelign and Petros, 2018). The fourth type is cysteine stones which are caused by the presence of excessive cystinuria in the excretions of the urinary tract. Lastly is the drug-induced which is caused by the use of a drug that enhances calculi formation whereby they interfere with metabolisms of purines and calcium oxalate.

Signs and Symptoms

Some several symptoms and signs are due to kidney stones. The patient does not experience the symptoms of renal calculi until there is movement of the stone through the ureter. The patient experiences severe pain, which is known as renal colic, which occurs on a single side of the abdomen or the back. The pain reflects in other areas such as the groin. This pain comes and disappears, and such patients suffer from restlessness. Other renal calculi symptoms include vomiting, fever, chills, nausea, smelly urine, bloody urine, frequent urination, and urination in small quantities. The patient may also show signs of obstructive pyelonephritis which is a dangerous condition and requires immediate surgery. However, if the kidney stone is low, these symptoms or pain cannot be experienced as it passes through the ureter.

Diagnosis

Any patient who is suspected of having kidney stones should undergo a urinalysis. Most of the patients show hematuria, while others do not show hematuria (Leslie and Murphy, 2018). If the urine contains crystals, the person is likely to be suffering from kidney stones. Positive nitrites, bacteria, and leucocytes are signs of infection, and they should be treated and cultures aggressively (Diri A & Diri B, 2018). Another method of diagnosis is obtaining a KUB to screen for the presence of any nephrolithiasis. However, the diagnosis may be inaccurate due to the presence of significant stones that are uncalcified. An ultrasound could be of assistance to determine any obstruction and resultant hydronephrosis, which is carried out by pregnant women who cannot undergo an x-ray. Hydronephrosis can also be used to determine the resistive index, which may be a sign of ureteral obstruction.

An ultrasound can diagnose the presence of uric acid and stones that are non-calcific, especially if the stones are significant, but smaller stones cannot be identified. The best way and most reliable way of diagnosing renal calculi are through a CT scan of the pelvic and a non-contrast abdominal. This will give information of any obstruction and resultant hydronephrosis. Other laboratory specimens to be obtained include a differential white blood cell count and a culture of the patient's urine in case he or she has urinalysis that shows the possibility of infection (Leslie and Murphy, 2018). A CT scan of the pelvic and a non-contrast of the abdomen should be carried out before an IV contrast since it can make the diagnosis hard. A simultaneous KUB follows the positive results of a CT scan on the presence of kidney stones. This aids in the tracking of the stone's progress, the shape and calcification degree which the CT scan cannot identify alone.

Treatment

There are various ways of treating renal calculi. Some of the calculi should be observed as outpatients, whereby some intervention may be needed. For the case of the smaller stones, they are treated through a medical expulsion therapy using alfuzosin or nifedipine. Infections of the urinary tract are treated using antibiotics. Some cases of renal calculi require immediate intervention (Leslie and Murphy, 2018). An obstructing stone whereby the patient has a fever, sepsis, and infection of the urinary tract in which the treatment involves immediate surgery to decompress it through radiology or urology. Other cases include pain and nausea, bilateral obstruction, obstruction with high creatinine and obstruction stone in one kidney.

In a scenario where the patient has an obstructing stone and has an infection of the urinary tract, relieving the obstruction should be the first thing. The ease is through a placement with a nephrostomy tube or use of a ureteral double J stent. The treatment method is determined by urology. If the renal calculi are severe, the patient should be treated using a nephrostomy tube. Once the infection ceases, definitive stone management should be carried out. The stones can be managed surgically in different ways. The stones can be broken using Extracorporeal shockwave lithotripsy (ESWL), especially at the upper ureter and the kidney (Leslie and Murphy, 2018). Percutaneous nephrolithotomy can be used to manage stones at the renal pelvis, which are large. The stones can be managed endoscopically in the ureter using ureteroscopy that uses laser lithotripsy. After treatment, the evaluation of the patient is highly recommended to identify the cause of the stones.

Conclusion

In conclusion, although there have been developments of a new treatment for renal calculi, it has considerably increased globally. Calcium oxalate formation of stone pathogenesis is a step that involves growth, nucleation, retention, and aggregation of the crystal. Renal stone mechanisms of formation have aspects that have remained unclear. Understanding the mechanisms of the formation of these stones is the most appropriate way of acquiring the best treatment methods for renal calculi. Additionally, understanding the pathogenesis, genetic basis, and pathophysiology of mechanisms of formation of the kidney stones will help in the discovery of drugs and medications that will help in the management of the condition in the future.

References

Aggarwal, K. P., Narula, S., Kakkar, M., & Tandon, C. (2014). Nephrolithiasis: molecular mechanism of renal stone formation and the critical role played by modulators. BioMed research international, 2014.

Alelign, T., & Petros, B. (2018). Kidney stone disease: an update on current concepts. Advances in urology, 2018.

Diri, A. & Diri, B. (2018). Management of staghorn renal stones. Renal Failure. 40(1), 357-362

Leslie, S.W., & Murphy, P.B. (2018). Calculi renal. In StatPearls [Internet]. StatPerals Publishing.

Prochaska, M.L., Taylor, E. N., & Curhan, F.C. (2016). Insights into nephrolithiasis from the nurses' health studies. American journal of public health, 106(9), 1638-1643

Sullivan, D. (2018). Kidney stones. Retrieved from www.healthline.com/health/kidney-stones