This document discusses kidney stones, their causes, types, and treatments. It provides details on the main types of stones: - Calcium stones, which account for 80% of cases, form in alkaline urine and can be calcium oxalate or calcium phosphate. - Uric acid stones form in acidic urine and account for 5-10% of cases. They are associated with hyperuricemia. - Struvite (magnesium ammonium phosphate) stones form due to urinary tract infections and account for 10-15% of cases. - Cystine stones are very rare and due to a genetic disorder causing cystine to leak into the urine. It also covers laboratory investigations for kidney

2. Overview
• Introduction
• Conditions causing stone formation
• Types of kidney stones
• Calcium salts
• Uric acid
• Mg ammonium PO4
• Cystine
• Other (xanthine, etc.)
• Laboratory investigations
• Comparison Between Urosinal Syrup &
Zyloric Tablets

3. Urolithiasis
• Urolithiasis is the condition where urinary stones are
formed or located anywhere in the urinary system
• The term nephrolithiasis (or "renal calculus") refers to
stones that are in the kidney,
• Ureterolithiasis refers to stones that are in the ureter.
• The term cystolithiasis (or vesical calculi) refers to stones
which form or have passed into the urinary bladder.
• Stones are Composed of metabolic products present in
glomerular filtrate
• These products are in high conc.
 Near or above maximum solubility

5. Conditions causing
kidney stone formation
High conc. of metabolic
products in glomerular
filtrate
Changes in urine pH
Urinary stagnation
Deficiency of stone-forming
inhibitors in urine

6. High conc. of metabolic products in
glomerular filtrate is due to:
 Low urinary volume (with
normal renal function) due to
restricted fluid intake
 Increased fluid loss from the
body
 Increased excretion of metabolic
products forming stones
 High plasma volume (high
filtrate level)
 Low tubular reabsorption from
filtrate

7. Changes in urine pH
is due to:
• Bacterial infection
• Precipitation of
salts at different
pH
Urinary stagnation is
due to:
• Obstruction of
urinary flow

8. Deficiency of stone-forming
inhibitors:
Citrate, pyrophosphate, glycoproteins
inhibit growth of calcium phosphate and
calcium oxalate crystals
In type I renal tubular acidosis,
hypocitraturia leads to renal stones

10. Kidney
Stone type
Population Circumstances Details
Calcium
oxalate
80% when urine is
alkaline (ph>5.5)
Some of the oxalate in urine is produced by
the body. Calcium and oxalate in the diet
play a part but are not the only factors that
affect the formation of calcium oxalate
stones. Dietary oxalate is an organic
molecule found in many vegetables, fruits,
and nuts. Calcium from bone may also play
a role in kidney stone formation.
Calcium
phosphate
5-10% when urine is
alkaline (high pH)
: staghorn in renal pelvis (large)
Uric acid 5-10% when urine is
persistently acidic
Diets rich in animal proteins and purines:
substances found naturally in all food but
especially in organ meats, fish, and
shellfish.
Struvite 10-15% infections in the
kidney
Preventing struvite stones depends on
staying infection-free. Diet has not been
shown to affect struvite stone formation.
Cystine 1-2% rare genetic
disorder
Cystine, an amino acid (one of the building
blocks of protein), leaks through the
kidneys and into the urine to form crystals.

11. Calcium salt stones
 80% of kidney stones contain
calcium
 The type of salt depends on
• Urine pH
• Availability of oxalate
 General appearance:
• White, hard, radioopaque
• Calcium PO4: staghorn in renal
pelvis (large)
• Calcium oxalate: present in ureter
(small)
Calcium oxalate stones

12. Calcium salt stones
Causes of calcium salt stones:
 Hypercalciuria:
• Increased urinary calcium excretion
• Men: > 7.5 mmols/day
• Women > 6.2 mmols/day
• May or may not be due to hypercalcemia
 Hyperoxaluria:
• Causes the formation of calcium oxalates without hypercalciuria
• Diet rich in oxalates
• Increased oxalate absorption in fat malabsorption
 Primary hyperoxaluria:
• Due to inborn errors
• Urinary oxalate excretion: > 400 mmols/day

13. Calcium salt stones Treatment:
• Treatment of primary causes such as
infection, hypercalcemia, hyperoxaluria
• Oxalate-restricted diet
• Increased fluid intake
• Acidification of urine (by dietary
changes)
• Calcium salt stones are formed in
alkaline urine

14. Uric acid stones
• About 8% of renal stones
contain uric acid
• May be associated with
hyperuricemia (with or without
gout)
• Form in acidic urine
• General appearance:
• Small, friable, yellowish
• May form staghorn
• Radiolucent (plain x-rays
cannot detect)
• Visualized by ultrasound or
i.v. pyelogram

16. Mg ammonium PO4 stones
 About 10% of all renal stones contain Mg
amm. PO4
 Also called struvite kidney stones
 Associated with chronic urinary tract
infection
• Microorganisms (such as from Proteus
genus) that metabolize urea into
ammonia
• Causing urine pH to become alkaline
and stone formation
• Commonly associated with staghorn
calculi
• 75% of staghorn stones are of struvite type

18. Cystine stones
• A rare type of kidney stone
• Due to homozygous cystinuria
• Form in acidic urine
• Soluble in alkaline urine
• Faint radio-opaque
Treatment:
• Increased fluid intake
• Alkalinization of urine (by dietary changes)
• Penicillamine (binds to cysteine to form a
compound more soluble than cystine)

19. Laboratory investigations
of kidney stones
If stone has formed and removed:
 Chemical analysis of stone helps to:
• Identify the cause
• Advise patient on prevention
and future recurrence

20. Laboratory investigations
of kidney stones
If stone has not formed:
• This type of investigation identifies causes that
may contribute to stone formation
Serum calcium and uric acid analysis
Urinalysis: volume, calcium, oxalates and
cystine levels
Urine pH > 8 suggests urinary tract infection
(Mg amm. PO4)
Urinary tract imaging:
Ultrasound and i.v. pyelogram

21. Comparison Between Urosinal Syrup &
Zyloric Tablet
Urosinal Syrup Zyloric Tablet

22. Name of the product Urosinal Zyloric Tablets
Composition Barley Salt 500 mg
Potassium Nitrate500 mg
Solanum nigrum
(Leaves)125 mg
Solanum nigrum Berries
62.5 mg
Preservatives
BaseQ.S
Allopurinol 100 mg ,
Excipents
Lactose
Maize Starch
Povidone
Magnesium Stearate
Purified Water
Pharmaceutical form Syrup:120 ml (Tablets) 100 & 300 mg
Indications Urinary Bladder Ailments,
Kidney Disorders, Liver
Disorders, Urinary
Retention
indicated for reducing
urate/uric acid formation in
conditions where urate/uric
acid deposition has already
occurred (e.g. gouty
arthritis, skin tophi,
nephrolithiasis) or is a
predictable clinical risk (e.g.
treatment of malignancy
potentially leading to acute
uric acid nephropathy).

23. Name of the product Urosinal Zyloric Tablets
Pharmacodynamic It lowers the level of uric
acid in the body, and
alleviates gout and
rheumatism.
Mechanism not known
Allopurinol is a xanthine-
oxidase inhibitor. Allopurinol
and its main metabolite
oxipurinol lower the level of
uric acid in plasma and urine
by inhibition of xanthine
oxidase, the enzyme
catalyzing the oxidation of
hypoxanthine to xanthine and
xanthine to uric acid. In
addition to the inhibition of
purine catabolism in some
but not all hyperuricaemic
patients, de novo purine
biosynthesis is depressed via
feedback inhibition of
hypoxanthine-guanine
phosphoribosyltransferase.
Other metabolites of
allopurinol include allopurinol-
riboside and oxipurinol-7
riboside.

24. Name of the
product
Urosinal Zyloric Tablets
Pharmacokinetics Not Known Allopurinol is active when given orally and is rapidly
absorbed from the upper gastrointestinal tract.
Allopurinol is negligibly bound by plasma proteins and
therefore variations in protein binding are not thought to
significantly alter clearance.
Estimates of bioavailability vary from 67% to 90%.
Peak plasma levels of allopurinol generally occur
approximately 1.5 hours after oral administration of Zyloric,
but fall rapidly and are barely detectable after 6 hours.
Approximately 20% of the ingested allopurinol is excreted
in the faeces.
Elimination of allopurinol is mainly by metabolic
conversion to oxipurinol by xanthine oxidase and
aldehyde oxidase, with less than 10% of the unchanged
drug excreted in the urine.
Allopurinol has a plasma half-life of about 1 to 2 hours

25. Name Of The product Urosinal Zyloric Tablets
Dosage Children:
2.5 ml (half a
teaspoonful) mixed
with milk or Sharbat
Bazoori in the
morning and in the
evening.
Adults:
5 ml (one
teaspoonful) mixed
with milk or sharbat
Bazoori in the
morning and in the
evening
Children:
Children under 15 years: 10 to 20
mg/kg bodyweight/day up to a
maximum of 400 mg daily.
Use in children is rarely indicated,
except in malignant conditions
(especially leukaemia) and certain
enzyme disorders such as Lesch-
Nyhan syndrome.
Adults:
In the absence of specific data,
the lowest dosage which
produces satisfactory urate
reduction should be used. i.e
100mg/day
Contraindications Not Reported Zyloric should not be
administered to individuals known
to be hypersensitive to allopurinol
or to any of the components of
the formulation.

26. Name Of The product Urosinal Zyloric Tablets
Interaction with other
medicinal products
Not Known Salicylates and uricosuric
agents decrease its activity
Chlorpropamide
increased risk of prolonged
hypoglycaemic activity
Theophylline: Inhibition of
the metabolism of
theophylline
Frequency of skin rash
increases patients receiving
ampicillin or amoxicillin
concurrently with allopurinol
Side Effects No side effects reported Skin reactions are the most
common reactions and may
occur at any time during
treatment.
They may be pruritic,
maculopapular, sometimes