Renal Stones

Kidney stones
Also

known as nephrolithiasis,
urolithiasis or renal calculi.
Solid concretions ( crystal
aggregations) of dissolved minerals in
urine
found inside the kidneys or ureters.
They vary in size from as small as a
grain of sand to as large as a grapefruit

 Kidney

stones (calculi) are hardened

mineral deposits that form in the kidney.
They originate as microscopic particles
and develop into stones over time. The
medical term for this condition is
nephrolithiasis, or renal stone disease.

Location of Renal stones

 A vast

majority of stones will contain

elements of calcium within them and
therefore are easily seen on x-ray having
the same density as bone.
Depending on the size, number, and the
location of the stone(s) as well as it's
composition guides initial and then further
management can be implemented.

Renal stones
Kidney stones occur in 1 in 20 people at
some time in their life.
Urolithiasis is rare in children. When
present, it is often associated with
specific metabolic disorders or anatomic
abnormalities.
For precipitation of crystals in urine to
occur, the urine must be
"supersaturated" for the precipitating
crystal.

 Stone

formation secondary to infection

and/or obstruction related to a congenital
malformation of the urinary tract often
present before the age of 5.
Cystinuria, idiopathic calcium oxalate
urolithiasis and primary
hyperparathyroidism more often begin
around puberty or in the mid-teens.

Stone Formation

Kidney stones form when there is a high level

of mineral (s) ; i.e. calcium (hypercalciuria),
oxalate (hyperoxaluria), or uric acid
(hyperuricosuria) in the urine;
a lack of citrate in the urine; or insufficient
water in the kidneys to dissolve waste
products.
Urine normally contains chemicalscitrate,
magnesium, pyrophosphatethat prevent the
formation of crystals.

 Low

levels of these inhibitors can contribute to

the formation of kidney stones.
Citrate is thought to be the most important
The chemical composition of stones depends
on the chemical imbalance in the urine.
The four most common types of stones are
comprised of calcium, uric acid, struvite, and
cystine.

Calcium Stones
Approximately

85% of stones are composed

predominantly of calcium compounds.
The most common cause of calcium stone
production is excess calcium in the urine
(hypercalciuria).
In hypercalciuria, excess calcium builds up in
the kidneys and urine, where it combines with
other waste products to form stones.
Low levels of citrate, high levels of oxalate and
uric acid, and inadequate urinary volume may
also cause calcium stone formation.

Calcium stones are composed of oxalate (calcium

oxalate) or phosphate (calcium phosphate).
Calcium phosphate stones typically occur in patients
with metabolic or hormonal disorders such as
hyperparathyroidism and renal tubular acidosis.
These stones come in 2 different types - monohydrate
and dihydrate.
Calcium oxalate dihydrate stones usually break easily
with lithotripsy.
Monohydrate stones are among the most difficult
stones to fragment.

lithotripsy

Cause of hypercalciuria
Increased

intestinal absorption of calcium

(absorptive hypercalciuria),
excessive hormone levels
(hyperparathyroidism),
and renal calcium leak (kidney defect that
causes excessive calcium to enter the urine)
Prolonged inactivity also increases urinary
calcium and may cause stones.
Renal tubular acidosis (inherited condition in
which the kidneys are unable to excrete acid)
significantly reduces urinary citrate and total
acid levels and can lead to stone formation.

Calcium oxalate monohydrates

Calcium oxalate monohydrates

Calcium oxalate dihydrates

Calcium oxalate dihydrates

Uric Acid Stones

Digestion

produces uric acid.

If the acid level in the urine is high or too much
acid is excreted, the uric acid may not dissolve
and uric acid stones may form.
They are not visible on X-rays.
Patients with gout often develop these stones.
Uric acid stones form in acidic urine and often
dissolve when the urine is alkalinized.

 Genetics

may play a role in the

development of uric acid stones, which
are more common in men.
Approximately 10% of patients with
kidney stone disease develop this type
of stone.

Struvite Stones

Also called an infection stone, develops when a

urinary tract infection (e.g., bladder infection) affects
the chemical balance of the urine.
Bacteria in the urinary tract release chemicals that
neutralize acid in the urine, which enables bacteria to
grow more quickly and promotes struvite stone
development.
They are capable of splitting urea into

ammonia, decreasing the acidity of the urine

and resulting in favorable conditions for the
formation of struvite stones.

 Organisms

which alkalinize the urine can

cause struvite stones to form.
Struvite stones are more common in
women.
The stones usually develop as jagged
structures called "staghorns" and can
grow to be quite large.

Struvite

Cystine Stones
Cystine

is an amino acid. Some

people inherit a rare, congenital
condition that results in large
amounts of cystine in the urine.
This condition (called cystinuria)
causes cystine stones that are
difficult to treat and requires lifelong therapy.

Cystine

The key features to the formation of

stones

Family history,
Age of onset,
Fluid intake pattern,
Diet, medications,
History of infections.
Certain stone formation has a genetic predisposition
Some an autosomal recessive pattern, including cystinuria
and primary hyperoxaluria,
Some have an autosomal dominant pattern such as renal
tubular acidosis (RTA) or the syndrome of idiopathic
calcium oxalate urolithiasis.

Causes and Risk Factors

A low level of citrate is a risk factor for hypocitraturia.

Congenital kidney defect that may increase urinary
calcium loss and stone formation (medullary sponge
kidney)
Excessive parathyroid hormone, which causes calcium
loss (hyperparathyroidism)
Gout (caused by excessive uric acid in the blood)
High blood pressure ( hypertension)
Inflammation of the colon that causes chronic diarrhea,
dehydration, and chemical imbalances (colitis)
Sodium (hypernatremia)

 Inherited

condition in which the kidneys are

unable to excrete acid (renal tubular acidosis)
Painful joint inflammation (arthritis)
Urinary tract infectious (affect kidney function)
Diet plays an important role in the
development of kidney stones. A diet high in
sodium, fats, meat, and sugar, and low in
fiber, vegetable protein, and unrefined
carbohydrates increases the risk for renal
stone disease.

 High

doses of vitamin C (i.e., more than 500

mg per day) can result in high levels of oxalate
in the urine (hyperoxaluria) and increase the
risk for kidney stones. Oxalate is found in
berries, vegetables (e.g., green beans, beets,
spinach, squash, tomatoes), nuts, chocolate,
and tea.
Stone formers should limit their intake of
cranberries, which contain a moderate amount
of oxalate.