AETIOPATHOGENESIS :
1.Infection :
Organisms such as proteus , pseudomonas , klebsiella produce recurrent UTI.
2. Hot climates :
Cause increase in concentration of solutes resulting in precipitation of calcium which forms calcium oxalate stones .
3.Dietary factors :
Diet rich in red meat ,fish ,eggs ,tomatoes , mil ,spinach , rhubarb , lacking vitamins vit A.
4.Metabolic causes :
Hyperparathyroidism increases serum calcium level & Gout increases uric acid levels .
5.Immobilisation : paraplegic patients secrete large amounts of calcium in the urine.
6.Decreased urinary citrate :
When citric levels low it promotes precipitation of urinary calcium .
TYPES :
1.Calcium oxalate stone : It is also called mulberry calculi .It is common type of stone & also irregular having sharp projections ,hard ,single.
2. Phosphate stone : commonly occur in renal pelvis ,dirty white to yellow colour ,smooth ,round shaped .
3.Uric acid stone : Multiple ,small ,faceted,yellow coloured & common in patiens who consume red meat .
4. Cystine calculus : Increased excretion of cystine in urine results in cystine calculus .
CLINICAL FEATURES :
1.Renal pain : Dull aching to pricking type of pain posteriorly in the renal angle frmed by the sacrospinalis & 12 rib .
2.Ureteric colic : Severe colicky pain originating at the loin & radiating to the gron , testiclesvulva & medial aspects of thigh .
3.Haematuria :It is common with kidney stone ecause the majority of the stone are oxalate stones
4.Recurrent UTI : Fever with chills & rigors , burning & frequency micturition .
INVESTIGATIONS :
1. Blood urea & creatinine to rule out renal failure .
2. Plain x-ray KUB :
To diagnose stones 90% of the renal stones are radio opaque .
Enlarged renal shadow can be made out .
3. USG :
Diagnosis of the stone & size can be made out .
Exact location of stone can be made out .
Can confirm the enlarged kidney due to dilatation of collecting system
4.IVP :
To locate the stone exactly in relation to the kidney & ureter & to assess the renal function .
5.Urine culture & sensitivity .
COMPLICATIONS :
1. Calculous hydronephrosis .
2. Calculous pyonephrosis .
3. Renal failure .
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