Kidney stone overview: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
It is understood that nephrolithiasis is the result of combination of different mechanism responsible for different types of stones. Calcium stones are the most common type of kidney stones. Approximately 80% of all calcium stones are [[calcium oxalate]] stones. The pathophysiology of calcium stones is complex and involves dietary concerns, [[hypercalciuria]], [[hypocitaturia]], [[hyperoxaluria]][[Hyperuricosuria|, hyperuricosuria]] and biomineralization. The underlying pathophysiological mechanisms responsible for uric acid stones are low urine volume[[Hyperuricosuria|, hyperuricosuria]] and high acidic urine. [[Cystinuria]] is a rare hereditary gene disorder which causes impaired renal reabsorption of cationic amino acids and cystine. It is caused by mutations in either of the two subunits (rBAT(SLC3A2) and b0,+AT(SLC7A9)) forming cystine stones. Struvite stones are usually seen in patients which have infection with [[urease]] +ve organisms. Urine pH is usually alkaline (>7.2). Nephrolithiasis can be passed on to following generations due to rare causes of hypercalciuria such as hereditary [[distal renal tubular acidosis]], [[dent disease]], [[Bartter syndrome]] types III and IV, autosomal dominant hypocalcemic hypercalciuria and familial [[hypomagnesemia]]. Nephrolithiasis associated with [[Hyperparathyroidism]], [[Gout]], [[Hypocitaturia]], [[Sarcoidosis]], chronic [[urinary tract infections]] and [[Obesity]].On gross pathology, the characteristic findings of nephrolithiasis include location = 80% unilateral, usually in calyces, pelvis or bladder. The size=variable, 2-3 mm usually. All stones contain an organic matrix of mucoprotein. The shape of struvite stone is staghorn shaped. On microscopic histopathological analysis, the characteristic findings of nephrolithiasis include different shapes of stones/crystals are such as cystine= hexagonal, struvite= coffin lid shape, calcium oxalate= pyramid shape to dumbbell shape and [[uric acid]]= rectangular/rhomboidal. Oxalate crystals are highlighted by polarized light. Also, foreign body giant cells and macrophages are seen with the stones. | |||
==Causes== | ==Causes== | ||
Revision as of 06:32, 22 June 2018
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Kidney stone Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Kidney stone overview On the Web |
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American Roentgen Ray Society Images of Kidney stone overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Urinary stones was first discovered by E. Smith, an English archaeologist, in 1901 when he found bladder stone in Egyptian mummy aged 4500-7000 year. In the 4th century B.C., when Hipprocratic Oath was made,the line that refers to stones was mentioned: “I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work....I will not cut for the stone, but will leave this to be done by practitioners of this work.”In the 8th century B.C, treatment strategy for stone removal was developed by an Indian surgeon, Sushruta as written in Sushruta Samhita. In 1976, the first percutaneous stone surgery was performed by Fernstrom and Johansson. The famous cases of nephrolithiasis includes: in 1549, Michelangelo was diagnosed and treated for uric acid stones;in 1724, Sir Isaac Newton noted that he passed two small pea-sized stones and in 1961, Roger Moore, aka James Bond, experienced three kidney stone episodes and treated with surgery.
Classification
Nephrolithiasis may be classified according to [classification method] into 4 subtypes/groups: calcium stones, struvite stones, uric acid stones and cystine stones
Pathophysiology
It is understood that nephrolithiasis is the result of combination of different mechanism responsible for different types of stones. Calcium stones are the most common type of kidney stones. Approximately 80% of all calcium stones are calcium oxalate stones. The pathophysiology of calcium stones is complex and involves dietary concerns, hypercalciuria, hypocitaturia, hyperoxaluria, hyperuricosuria and biomineralization. The underlying pathophysiological mechanisms responsible for uric acid stones are low urine volume, hyperuricosuria and high acidic urine. Cystinuria is a rare hereditary gene disorder which causes impaired renal reabsorption of cationic amino acids and cystine. It is caused by mutations in either of the two subunits (rBAT(SLC3A2) and b0,+AT(SLC7A9)) forming cystine stones. Struvite stones are usually seen in patients which have infection with urease +ve organisms. Urine pH is usually alkaline (>7.2). Nephrolithiasis can be passed on to following generations due to rare causes of hypercalciuria such as hereditary distal renal tubular acidosis, dent disease, Bartter syndrome types III and IV, autosomal dominant hypocalcemic hypercalciuria and familial hypomagnesemia. Nephrolithiasis associated with Hyperparathyroidism, Gout, Hypocitaturia, Sarcoidosis, chronic urinary tract infections and Obesity.On gross pathology, the characteristic findings of nephrolithiasis include location = 80% unilateral, usually in calyces, pelvis or bladder. The size=variable, 2-3 mm usually. All stones contain an organic matrix of mucoprotein. The shape of struvite stone is staghorn shaped. On microscopic histopathological analysis, the characteristic findings of nephrolithiasis include different shapes of stones/crystals are such as cystine= hexagonal, struvite= coffin lid shape, calcium oxalate= pyramid shape to dumbbell shape and uric acid= rectangular/rhomboidal. Oxalate crystals are highlighted by polarized light. Also, foreign body giant cells and macrophages are seen with the stones.
Causes
Differentiating Hereditary pancreatitis from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
An x-ray may be helpful in the diagnosis of nephrolithiasis. Findings on an x-ray suggestive of nephrolithiasis include radiopaque stones such as Calcium oxalatecalcium phosphate, struvite and radiolucent stones which includes uric acid stones and cystine stones.