Urinary/Kidney Stones - Overview (signs and symptoms, risk factors, pathophysiology, treatment)

hello in this video we're going to talk about kidney stones kidney stones or urinary stones have many names including Euro Lethe ASIS which is actually formation of stones along the urinary tract or Neph roli thesis which is stones forming specifically in the nephron or the kidneys to make things even more confusing urinary or kidney stones can also be called renal or urinary calculi calculi essentially means stones however these words are used interchangeably but essentially mean the same thing kidney stones in order to understand kidney stones we have to revise the anatomy here the adrenal glands which are endocrine glands sit above the kidneys the kidneys form urine urine will then travel down the ureter and be stored in the bladder the bladder can stretch and once full we urinate the urine will flow through the urethra and then out the ureter has three sites of constriction where it contracts the smooth muscle and these are important to know because these are the sites where narrowing can occur and also the site where urinary stones can Lodge the sites of ureter ik constriction include the pelvic ureteric junction the pelvic brim and the vesicular ureter ik Junction the visco ureter ik Junction is actually the connection between the ureter and the urinary bladder which is sort of behind and under the urinary bladder the kidney is organ responsible for filtering the blood and disposing of waste it's important for regulating blood pressure and regulating electrolyte balance it is also responsible for producing some important hormones such as erythropoietin and activation of vitamin D here is the adrenal glands which are again the endocrine glands that sit above our kidneys here is the ureter looking inside the kidney it consists of pyramids called the medulla pyramids surrounding the medulla pyramids is the cortex the medulla pyramids joins the tip of the medulla pyramids joins and forms the calyx the calyx then joined together and form and drain into the renal pelvis the renal pelvis has a renal artery and renal vein entering and exiting it residing around and within the medullary pyramids are the functional units of the kidneys called nephrons nephrons are structures which filter our blood they secrete wastes and allow reabsorption of things into the bloodstream thus it has a main role in regulating electrolyte and fluid balance in our body the head of the nephron is the Bowman's capsule where the afferent arteriole brings blood in forming the glomerulus and then we have the efferent arteriole leaving the glomerulus once filtering has occurred within the Bowman's capsule the filtrate will travel along the tube you'll of the nephron firstly it will pass the proximal convoluted tubules then it will go down towards the loop of Henle the distal convoluted tubules and then finally the collecting duct looking more closely at the tube you'll the cells that line the nephron tubules are predominantly cuboidal epithelial cells within the tube you'll of the nephrons crystal like structures can fall the crystal like structures are essentially precipitance of some electrolytes that have accumulated there this crystal is actually a urinary stone if the crystal is small it will just pass in the urine but if it remains in the kidneys in the nephron it can grow bigger and become a kidney stone a kidney stone again is basically a big crystal the kidney stone can lead to an obstruction the obstruction within the tube you'll can create a buildup of pressure in the tube you'll this pressure can cause irritation and this irritation is read by the brain as renal colic there is also an inflammatory process going on due to the obstruction and this also leads to the renal colic the pain we feel when there is urinary stones in the body alternatively the urinary stone can lodge or get stuck within the ureter remember the sites of constriction of the ureter well the stones can get stuck there and when this happens irritation and pain can occur due to stretching of the fibers that are there that which are caused again by the increase in pressure within the ureter with this increase in pressure proximally to the site of obstruction and with the irritation going on edema can occur and the ureter will contract more vigorously trying to push the stone out this is called hyper peristalsis and so with this in mind the clinical presentation of kidney stones can include acute flank pain which can radiate to the back or towards the groin and the flanks there can be associated fever because of the inflammation and nausea and vomiting there can be also urinary frequency and urgency hematuria the person may present to be obese the risk factors for developing a kidney stone include a high-protein diet high salt diet male Caucasian obesity dehydration medications including antacids and carbonic anhydrase inhibitors sodium and calcium containing medications also increases the risk of developing kidney stones crystal urea is also risk factor as well as having a family history these risk factors will lead to a number of things first some of these risk factors will increase urinary solute concentration including concentration of calcium uric acid and calcium oxalate and sodium some of these risk factors will also decrease the stone forming inhibitors which include citrate and magnesium the increase in urinary solutes and the decrease in urinary stone inhibitors causes urine supersaturation leading to urinary crystal formation or urinary stone formation a decrease in urinary volume such as in dehydration and an excessive increase or decrease in urinary pH also contributes to urine supersaturation so in summary urine supersaturation with stone forming salts results in crystal formation urine Neri stone formation and as I mentioned there are a lot of types of urinary forming salts such as calcium uric acid and oxalate and because of this there are many types of stones kidney stones the stone pathology can be broadly divided into five different types these include calcium oxalate stones which make up the majority 75% there is also the calcium phosphate as well Stu vite is common in chronic urinary tract infections there's also uric acid stones and cysteine stone investigations for suspected renal calculi renal stones include a full blood count CRP magnesium calcium phosphate levels urinalysis which may show hematuria a 24-hour urine calcium level phosphate level oxalate urate cysteine and xanthine levels and this can show us what type of kidney stone he might be x-ray can be performed to detect a kidney stone an ultrasound can also detect a kidney stone kidney stone an ultrasound may show a to stick shadowing ultrasound may also reveal hydronephrosis if the obstruction is within the ureter causing backflow of urine which will dilate the ureter approximately finally a CT scan can also be used which can show kidney stones let's look at an algorithm again the clinical presentation of kidney stones include fever nausea vomiting acute flank pain radiating to the groin or the back the pain is often described as stabbing and severe there is tachycardia with or without hematuria the triad for urinary or kidney stones some say is fever vomiting and acute flank pain so in an acute setting analgesia is given with or without an antiemetic to prevent vomiting IV fluids are administered carefully most urinary stones if small less than half a centimeter will pass spontaneously without any intervention however if intervention is required it is either done electively or as soon as possible by intervention I mean surgical management and surgical management will depend on how big the kidney stone is as well as where the kidney stone is if it is within the ureter or within the actual kidney percutaneous 'no Frasca me allows placement of a small flexible rubber tube a catheter through the skin and into the kidney and this is in order to drain urine out if there is signs of obstruction this is more of a symptomatic relief in terms of removal of the kidney stone there is your tarik stent insertion here is the ureter and let us say the stone is lodged within the ureter well a stent a rod can be fed up through the urethra through the bladder and up the ureter to the side of obstruction and the stent can be placed there the stent will allow drainage of the urine essentially bypassing the blockage the urine can then just drain straight into the bladder if the urinary stone is within the kidney a procedure called a percutaneous nephrology Atum ii can be performed in this procedure the aim is to remove the stone from the kidney by a small puncture wound through the skin it is most suitable for removal of stones that are more than let's say 2 centimeters in size and which are present around the pelvic region of the kidney another surgical procedure that can be done for urinary stones within the ureter or within the kidneys is a simple endoscopic procedure that will break down the stone within the kidneys or the ureter alternatively there is open surgery to remove and break the stone finally there is the extra corporeal shock wave lithotripsy which uses shock waves to break up stones that form in the kidneys to enable easy passage of these fragments out of the body within urine you