week 4 Kidney paper
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Husson University *
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Jan 9, 2024
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Uploaded by DrDangerSalamander32
Nephrolithiasis
Nephrolithiasis (Kidney stones) is a common kidney disease. 1 in 10 people will develop
kidney stones in their life span. I unfortunately do not have experience in taking care of patients
with kidney stones but have had personal experience with it. My older brother has had kidney
stones and was in a lot of pain during the process of passing the stone. He was fortunate to not
have any complications from it and has not had recurrence of kidney stones.
Renal calculi or kidney stones are crystals that have clustered and lumped together,
usually composed of minerals. The size of these clusters can vary, and usually the larger they are
the more symptoms a person will have. There are 4 types of kidney stones that can develop,
calcium oxalate, which is the most common type, followed by uric acid stones, struvite, and
cystine. Usually in healthy kidneys crystals are prevented from forming by chemicals in our
urine, when minerals start to form crystals in kidneys they cluster and grow, usually in the
interstitium of kidneys. These stones start to cause an issue when they obstruct urine flow, further
damage can be done when the stone passes through the urinary system (Dlugasch, 2021).
The most common symptom is pain with the movement of the stone. Pain can be mild to
severe depending on the size of the stone, usually the larger the stone the more painful it is. The
pain is usually felt in the lower back but can also radiate to the lower abdomen and groin area.
Other signs include hematuria (blood in urine), nausea, vomiting, fever, chills, and urine can
appear cloudy and have an odor (Dlugasch, 2021).
Some conditions can increase a person’s risk for getting a kidney stone, including
gastrointestinal malabsorption, primary hyperthyroidism, obesity, type 2 diabetes mellitus, distal
renal tubular acidosis. Risk factors for developing stones include family history of kidney stones,
lower urine volume, and diets rich in animal protein, oxalate, sodium, sucrose, and fructose
(Curhan, 2022).
If suspecting a patient with nephrolithiasis thorough examination and history is a good
starting point. Urinalysis, urine culture with pH, and serum calcium should be done as well. Best
practice for diagnosing nephrolithiasis is non-contrast renal CT, the sensitivity is 95% and
specificity is 98%. If the stone can be retrieved chemical analysis should be done to determine
the type of stone. Determining the type of stone can help with prevention of further stones.
(Stack, 2020).
In acute management the goal is to provide pain relief. If the patient is having
uncontrollable pain, suspected sepsis, or anuria, or is an older adult with comorbidities, the
patient should be directed to Emergency department or immediate referral to Urology. If stone
does not pass spontaneously the patient should be referred to Urology for stone removal
(Fontenelle, 2019). If the stone is small, between 5- 10 mm, Tamsulosin and Nifedipine can be
used to assist with expulsion of the stone. Larger stones can be broken down into smaller parts
by extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy
(Dlugasch, 2021).
Patients that have had a kidney stone are at a higher risk of developing another one in
their life, there are several ways to prevent stones from developing. Recommendations are to
increase fluid intake and maintain hydration status, weight loss if obesity is an issue, increase
physical activity, low sodium diet, restriction of oxalate-rich foods, decrease in animal protein
intake, and increase intake in fruits and vegetables, especially citrus fruit. Some studies have
shown that increase in caffeine and green tea intake lowers risks for recurring kidney stones
(Peerapen, 2023).
It is important to address pain management for patients with kidney stones. Determining
the size and type of the stone are key elements in determining course of treatment and prevention
for future stones. Providing resources and education around lifestyle modifications can help with
prevention.
Curhan G.C. (2022). Nephrolithiasis. Loscalzo J, & Fauci A, & Kasper D, & Hauser S, &
Longo D, & Jameson J(Eds.), Harrison's Principles of Internal Medicine, 21e. McGraw
Hill. https://accessmedicine-mhmedical com.husson.idm.oclc.org/content.aspx?
bookid=3095§ionid=263550180
Dlugasch, L., & Story, L. (2021a).
Applied Pathophysiology for the advanced practice nurse
.
Jones & Bartlett Learning.
Fontenelle, L. F., & Sarti, T. D. (2019). Kidney Stones: Treatment and Prevention.
American
family physician
,
99
(8), 490–496.
Stack S.W. (2020). Nephrolithiasis. Stern S.C., & Cifu A.S., & Altkorn D(Eds.), Symptom to
Diagnosis: An Evidence-Based Guide, 4e. McGraw Hill.
https://accessmedicine-
mhmedical-com.husson.idm.oclc.org/content.aspx?bookid=2715§ionid=249057991
Peerapen, P., & Thongboonkerd, V. (2023). Kidney Stone Prevention.
Advances in nutrition
(Bethesda, Md.)
,
14
(3), 555–569.
https://doi-
org.husson.idm.oclc.org/10.1016/j.advnut.2023.03.002
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