Renal Calculi

Pathophysiology of Renal Calculi

The disease develops when urine is highly concentrated with calcium and other chemicals such as calcium oxalate. The overconcentration of the urine results in the development of nodes and gets deposited on the urothelium. The calcium oxalate deposition is referred to as the renal calculi. The crystals get attached to the surfaces, hence causing a strong attachment and a change in the appearance of the nephrons (Saçl? et al., 2019). The calcium oxalate crystals are therefore referred to as kidney stones, and they impair the functioning of the kidneys. The basic functional unit of the kidneys is the nephrons and the renal calculi hinder the functioning by reducing the functional capacity, something that reduces the recommended functional competence of the kidneys (Abou-Elela 2017).

In some cases, calcium oxalate grows n Randall’s plaques, usually composed of hydroxyapatite crystals. The corrosion of the epithelial walls of urinary system causes pain and adverse symptoms. With the continued deposition of calcium oxalate, the kidney stones increase in size and corrosion becomes worse. The glomerular functioning gets compromised with more stone formation hence causing renal failure.

The etiology of renal calculi relates to diet. Consumption of a diet that has excess quantities of calcium results in kidney stones since the extraction capacity is compromised, hence reducing what is considered a physiologic functioning of the kidneys (Abou-Elela 2017). Sometimes, the excretion capacity of the kidneys gets compromised hence the minerals are deposited causing renal calculi. Another major cause of renal calculi is dehydration (Saçl? et al., 2019). Water is a basic element in the human body and helps in the promotion of ideal functioning, hence a reduction of water levels in the body is a key threat to what is considered ideal renal physiology. (Abou-Elela 2017)

Renal calculi also complicate by impacting negatively on other organs. Advanced stages of renal calculi result in complications such as hydronephrosis, pyelonephritis, hematuria, nocturia, chronic kidney injury and end stage renal disease. With compromised functioning of the kidneys, renal calculi predisposes.

Clinical presentations of renal calculi

The first sign of renal calculi is pain which is during urination (Saçl? et al., 2019). In most cases, the pain is in the lower abdomen, towards the back and behind the ribs. Pain is also experienced during urination since the stones injure the urothelium, thus causing an irritation during the process (Saçl? et al., 2019).

Another clininal presentation of renal calculi is reduced urine output. Renal calculi block the path of urine flow, resulting in reduced urine output. Additionally, the renal calculi reduce the number of nephrons, hence the waste secretion from the kidneys is compromised, translating to reduced urine output.

The differentiating symptom of renal calculi from other pathophysiological disorders is blood in urine, severe pain, nausea and vomiting, chills and fever all appearing at once. Additionally, renal stones may also appear in the urine which is a hallmark of renal calculi.

Diagnosis and Evaluation

Urinalysis is another recommended test whereby the sample collected is checked for increased WCC, nitrates, and hematuria Hematuria is an indication of infection to the system and renal calculi that needs to be addressed in the best ways possible (Abou-Elela 2017). The analysis should also entails scrutinizing red blood cells, urinary casts, bacteria, leukocytes and crystals (Abou-Elela 2017).

Complete blood count (CBC) is a required test in determination of the renal calculi presence. The existence of neutrophilia is a strong indication of struvite stones which usually occurs as a result of bacterial infections (Yu et al., 2017).

Imaging techniques may be used in the process of diagnosis (Abou-Elela 2017). A CT urogram can be done on a patient showing the symptoms to help in ascertaining the presence of the stones. CT scan is a good technique in helping determine the presence of the stones since it helps in detection of hydronephrosis, detection of the size of stones and the location (Yu et al., 2017).

Patient teaching

A patient with renal calculi should drink water at least three times a day to help in relieving the adversity of the condition (Abou-Elela 2017). The body needs water to perform basic physiological functions. With adequate water intake, the renal system is in a good state since the wastes and chemicals does not become concentrated to form the calculi (Abou-Elela 2017). A patient should therefore consider water intake a routine diet behavior to prevent formation of renal calculi.

Pharmacologic management at home such as using analgesics to relieve the pain caused by the stones. Diclofenac suppository is a good drug to help the patient relieve the pains. Calcium channel blockers such as Nifedipine are recommended for managing the condition since it prevents deposition of calcium in the renal system. Anti-spasmodic drugs such as dicyclomine also works well (Abou-Elela 2017). Finally, relaxants such as diazepam is good for management especially when it comes to bladder and urethral relaxation for painful micturition.

The patient should seek additional self-care techniques such as sound waves to break the stones, surgery to remove the stones, parathyroid gland surgery, and using a scope to identity the calculi and remove them (Lin et al., 2020). Eradication of the stones is the major approach in making life comfortable. As a permanent solution, the surgical interventions are good since they help in reducing the challenge of nephrolithiasis which is a necessary aspect of making the patients comfortable (Abou-Elela 2017).

The red flags for renal calculi patients include a change in pain location and character whereby severity and persistence are reported in the abdominal area. When hematuria occurs, that is a danger sign and should be taken seriously to help in the prevention of the condition (Abou-Elela 2017). Finally, urinary retention should be considered a danger sign and the patient needs to visit a health facility for further examination.

Differential Diagnoses

1. Appendicitis.
2. Ectopic pregnancy.