View Full Version : Renal stones ( Causes - C/P - Investigations - Treatment )

Medical Videos
06-05-2009, 09:51 AM
Renal stones

●Most of renal stones 90 % composed of Ca salts,
types of renal stones are the following :-
Ca oxalate.
Ca phosphate.
Magnesium - ammonium phosphate stones.
Urea acid stones.
Cystine stones.

Predisposing factors :

1 - Metabolic causes

A- Ca stones : mainly Ca oxalate & Ca phosphate associated
with : Hypercalcuria
Vit D intoxication.
Renal tub. acidosis.
B- Uric acid stone : in hyperuricemia & hyperuricosuria.
C- Cystine stones Cystinuria.

2-Obstruction & infection

Urinary tract infection stasis epith. Debris + pus debris

act as nidus

stones deposition of crystals

3-Dietary factors Milk &its products Ca stones.

4-Climate hot weather with excessive sweating.

5-Primary renal disease
-Polycystic kidney. –medullary sponge kidneys.
Oxalate stone :
usually brownish, mamillated, single, or multiple,

Uric acid stone :
whitish, smooth, single, multiple, radiolucent.

whitish, single, multiple, present in alkaline urine. radioopaque laminated.

single or multiple radioopaque

Deposition of Ca in the renal parenchyma may lead
to nephrocalcinosis. This may occur in hyperparathyroidism, renal T. B., vit D intoxication & renal tubular acidosis
Stag horn calculi:
may fill the renal pelvis & branch into the calyces.

Presentation of renal stones
Obstruction migration ulceration metaplasia Infection

hydronephrosis colic haematuria malignancy pyelonephritis

Renal colic loin
radiates to groin
for few hrs
Post renal acute renal failure.
Chronic renal failure.
tender loin.
palpable kidney with hydro or pyonephrosis..
Signs of renal failure.


X-ray All stones are radioopaque.
Pure Uric acid, radiolucent
(with Ca deposition radioopaque).
Urine RBCs (painful haematuria)
pus cell with 2 ry infection.
Crystals e.g. oxalate, phosphate, urate
S. Ca, uric acid, 24h urinary Ca , urate ,oxalate.
I V P back pressure, stone utreter.
Sonar back pressure, stone, kidney.
Renal scan reveals obstruction.


I- Medical ttt :
renal colic bed rest - warmth to loin.
Analgesics : morphia 15-30 mg or
pethidine 100 mg I.M.
antispasmodic atropine sulfate.
NSAID antiprostaglandin
Infusion method by

(Saline + atropine + papaverine)
ttt of stones (fluids + antispasmodics + diuretics)
stones may pass spontaneously if small < 0.5 cm diameter.

Specific ttt according to type of stone :

ªCa stones.

-Idiopathic Hypercalcuria ttt : thiazides ¯ Ca in urine
-Primary hyperparathyroidism ttt : surgery
- R. tub. acidosis Na HCO3.
ªOxalate stones ttt : cholestyramine can bind oxalate.

-Oxaluria is due to over absorption of dietary
Oxalate (intestinal oxaluria) Ca oxalate stone.
-Na HCO3 used to treat all types of stones but, Vit C treat
phosphate stones.

ªUric acid stone

ttt: Fluids.
Na HCO3.
ªCystine stone

ttt : Fluids.
Alkali (Na HCO3).

Diet for prophylaxis
Ample of fluids
Milk ¯ & cheese in Ca stones.
¯ spinach rhubarb in oxalate stones.
¯ liver, ¯kid., ¯ sardines in uric stones.

II- Surgical ttt:

Indications 1- Big stone. 2- Multiple stones
3- Staghorn stone.
4- Stone in renal pelvis.
5-Complicated with hydronephrosis.
Surgical & instrumental tt see surgery.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)