Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Lifestyle recommendation in patient of kidney stones to reduce the risk

A brief recommendation in patients of kidney stones. Management, complications, Methods to prevent kidney stones (Non-medical & Medical),Do's and Dont's in Kidney stone.

  • Loggen Sie sich ein, um Kommentare anzuzeigen.

Lifestyle recommendation in patient of kidney stones to reduce the risk

  1. 1. Lifestyle recommendation in patient of kidney stones to reduce the risk… By Siddesh Dhanaraj M. Pharama PES College of Pharmacy
  2. 2. Introduction  One of the mostcommon afflictions of modern society  The lifetime prevalenceof kidney stone disease is estimated at 1% to15%  The age of peak incidence in men 30 to 69 years and in women 50 to 79years.
  3. 3. Types of renal calculi
  4. 4. Diagnostic evaluation  Must identify associated metabolic disorders responsible for recurrent stone disease.  Medications  Dietary excesses, inadequate fluid intake or excessive fluid loss
  5. 5. Indications for Metabolic Evaluation  Strong family history ofstones  Recurrent stoneformers  Intestinal disease (particularly chronicdiarrhea)  Solitary kidney  Renal insufficiency  Anatomicabnormalities
  6. 6.  Pathological skeletal fractures  Osteoporosis  History of urinary tract infection with calculi  Personal history ofgout  Infirm health (unable to tolerate repeat stone episodes)  Stones composed of cystine, uricacid, struvite
  7. 7. Multichannel blood screen  Basic metabolic panel (sodium, potassium,chloride, carbon dioxide, blood urea nitrogen,creatinine)  Calcium  Intact parathyroid hormone  Uric acid
  8. 8. Urine  Urinalysis  pH > 7.5: infection lithiasis  pH < 5.5: uric acidlithiasis  Sediment forcrystalluria  Urine culture  Urea-splitting organisms: suggestive ofinfection lithiasis  Qualitative cystine
  9. 9. Radiological investigations
  10. 10. X-ray KUB  Most common imagingtechnique  Used in the follow up of patientsduring or after treatment for stones, particularly after ESWL.  Limited value if the stone isradiolucent.
  11. 11. Intravenous pyelography:  Outdated  Uses :  Radiolucent stones,  Anatomic abnormalities  All urologists can interpretthe x rays.
  12. 12. Ultrasonography  No radiationexposure  Detects radiolucentstones  Adjunt in ESWL  Inefficient in detecting smallstones
  13. 13. CT urography  Investigation of choice inthe imaging of kidney stones.  Sensitivity : ~95%  Specificity: ~98%  Information regarding the composition of stones  Confirms the diagnosis in which USG in equivocal
  14. 14. MRI  Provide 3D image withoutradiation  Lower accuracyand  Expensive
  15. 15. Stone analysis  Direct furthermanagement  Struvite: infection lithiasis.
  16. 16. Conservative medical management  Made for all patients regardless of the underlying etiology of their stonedisease  Calculi smallerthan 0.5 cm pass spontaneously
  17. 17. Fluid recommendations  Volume:  daily urine outputof 2 L (Borghi et al, 1999).
  18. 18.  Carbonated water protection againstrecurrent stone formation.  Citrus Juices provide increased urinaryvolumeand increased urinary citrate excretion.
  19. 19. Dietary Recommendations  Decreased animal proteinintake.  Sodium restriction  Combined : stone episodes decrease roughly by 50%
  20. 20. Obesity  Increase risk of stoneepisodes  Metabolicsyndromeand stone disease: potential correlation  Dietary calcium restriction actually increases stone recurrence risk.
  21. 21. Evaluationn of conservative management  Re-evaluation after 3-4months  If metabolic or environmental abnormalitieshave been corrected:  Continue treatment and thepatient  Followup every 6 to 12 monthswith repeat 24-hour urine testing.
  22. 22. If, however, A metabolicdefect persists, A more Selective medical therapy may beinstituted…
  23. 23. Selective medical therapy Narcotic Relieves pain, dulls the senses and causes drowsiness. May become addictive. Nonsteroidal anti-inflammatory drug Relieves pain, decreases inflammation and reduces fever. Diuretic Increases urine production to get rid of excess salt and water.
  24. 24. Surgical management (Ureteroscopy for Urolithiasis Outpatient Surgery)  Symptomatic renal stones in patientswithout any other etiology ofpain.  Ureteroscopy (URS) is a form of minimally invasive surgery using a small telescope that is passed through the urethra and into the ureter to remove a stone. Often the stone requires fragmentation with a laser which then allows the smaller fragments to removed with a grasping device. Only about 10-15% or urethral stones require surgical intervention. URS is approximately 95% successful in removing stones in the lower ureter and about 85-90% successful in treating and removing stones in the upper ureter and kidney.
  25. 25. Minimally invasive surgeries  Percutaneous nephrolithotomy(PNL)  Extracorporeal shock wave lithotripsy(ESWL)  Retrograde intrarenal surgery(RIRS)  Laparoscopic and robotic stonesurgery
  26. 26. Open surgical management 1. Nephrolithotomy 2. Pyelolithotomy 3. Extended pyelolithotomy
  27. 27. PRE OPERATIVE EVALUATION
  28. 28. Pre-procedural antimicrobials  Bacteriologic evaluation of the urine is mandatory for all patients  Antimicrobial prophylaxis for all cases of percutaneous renal surgery (Wolf et al, 2008).
  29. 29.  Antimicrobial coverage should includeorganisms common to the urinarytract:  Escherichia coli,  Proteus sp.,  Klebsiella sp.,  Enterococcus sp.  and theskin:  Staphylococcus aureus,  coagulase-negative Staphylococcus sp.,  group A Streptococcus sp.)
  30. 30. Percutaneous nephrolithotomy  Indications: 1. Stone size >2 cm in size 2. Staghorn stones 3. Hard stone not fragmented by ESWL 4. Urinary tract obstruction that need correction
  31. 31.  Complications:  Acute and delayed hemorrhage  Collecting system injury  Visceral injury  Pleural injury  Metabolic and physiologic complications
  32. 32. Post op fever and sepsis Neuromusculoskeletal complications Venous thromboembolism Tube dislodgement Collecting system obstruction Loss of renal function Death
  33. 33. POSTPROCEDURAL NEPHROSTOMY DRAINAGE Malecot’scatheter Balloon catheter
  34. 34. Copecatheter Ureteral stent
  35. 35. Extracorporeal Shockwave Lithotripsy  Most patients harboring “simple” renal calculi can be treated satisfactorily with SWL  Outpatient procedure  Indication  stone size < 2 cm size
  36. 36. Contraindications Pregnancy Large abdominal aortic aneurysm Uncorrectable bleeding disorder Body habitus Obstruction distal to the stone
  37. 37. Complications: Fragments may become impacted in the ureter Hematuria Renal hematoma Infection Kidney damage
  38. 38. Retrograde Intrarenal Surgery (RIRS)
  39. 39. Indications: Failed ESWL RIRS assisted ESWL Radiolucent stones Calyceal diverticular stone
  40. 40.  Used in patients with ESWLcontra-indications:  Bleeding disorder oranticoagulant  Obesity  Pregnancy
  41. 41.  Complications:  Sepsis  Steinstrasse  Stricture  Uretericinjury  UTI Steinstrasse Stricture Ureteric injury
  42. 42. Anatrophic nephrolithotomy  Gold standard for staghorn calculi  Removal of all calculi and open surgical correction of the anatomical obstruction
  43. 43.  Complications:  Pulmonary complications  Post op renal hemorrhage  Stone recurrences  Urinary extravasation
  44. 44. Pyelolithotomy  Effective, especially for extra renalpelvis  For pelvicstone
  45. 45. Lifestyle recommendation in patient of kidney stones to reduce the risk…
  46. 46. Thank You

×