Raiza Q. Hasiman

BSN 3B

Refection Paper on Nephrolithiasis

Nephrolithiasis and renal lithiasis are medical terms for kidney stones. Incidence of kidney stone formation is fairly high and up to ten in 100 people may get at least one stone in their lifetime. It’s usually impossible to miss this condition due to its overt symptoms, but the precise meaning of the condition in terms of long-term health may be dependent on type of stones that develop.

It helps to understand some of the different types of stones that occur in nephrolithiasis. These include struvite stones, which typically form around infectious matter in the kidneys. Some people develop calcium or calcite stones that may be due to excessive levels of calcium oxalate. Those with high uric acid levels may have uric acid stones, or sometimes stones are composed primarily of certain amino acids (cystine stones). Other times cause of formation is not fully clear.

The symptoms associated with nephrolithiasis are often difficult to miss. Many people feel significant pain that may occur just below the ribs or in the stomach, pelvis and groin. Urinating tends to cause discomfort and people may feel constant urges to use the bathroom. When urine is produced the color may be wrong and it could brown or pink, or possibly bright red. When people have struvite stones, they may also show signs of nephrolithiasis with fever and flulike symptoms.

Though many people are able to pass a kidney stone without additional help, the discomfort can increase and complications may sometimes result. Pain can become so bad that nausea andvomiting begin or fever jumps very high. If discomfort reaches an intolerable level, people are advised to seek medical help. Diagnosing presence of kidney stones can lead to treatment and help to determine if underlying conditions need intervention on a more consistent basis to prevent future stone formation.

Diagnosis of nephrolithiasis doesn’t necessarily mean huge interventions. If infection is suspected, antibiotics might be given. Large stones may not be able to pass and doctors might consider different methods for breaking them up, including surgical removal or the use of scopes or radiofrequency to break up and remove stones. For fairly small stones, normal treatment typically consists of getting the affected person to increase water intake significantly and giving supportive medications such as over the counter pain relievers to reduce discomfort, until the stone passes.

High levels of uric acid, high amino acid levels or high calcium levels that create nephrolithiasis all may suggest ongoing conditions that might require continuing care once a stone is passed. Doctors typically want to analyze stones to identify their origin so they know what steps to take to prevent stone formation in the future. Continuing treatment to avoid nephrolithiasis may thus

take many forms depending on types of stones, but not all people will require additional intervention beyond passage of a stone.

Dietary interventions are designed to alter the concentration of one or more crystal-forming and/or crystal-inhibiting substance in the urine. Increasing water intake should increase urine volume and lower the urinary concentration of all crystal-forming substances. More narrowly targeted dietary interventions include reducing dietary oxalate to lower urinary oxalate and risk ofcalcium oxalate stones; reducing dietary animal protein and other purines to lower urinary uric acid and risk of uric acid stones; and maintaining normal dietary calcium to bind intestinal oxalate and thereby lower urinary oxalate and risk of calcium oxalate stones. Some demographic characteristics and comorbidities predict recurrent stone outcomes, but it is unclear how these factors affect relative effectiveness of treatments. It also is unclear how patient biochemical and stone characteristics affect treatment outcomes; nonetheless they are sometimes used to justify tailored dietary interventions