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ANALYSIS OF STONES
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Tissue debris
Aggregation
Stone formation
FORMATION OF STONES
1.Calcium - a) hypercalcaemia
b) hyperparathyroidism
c) hypercalciuria
2.Oxalate - G1, hyperoxalaturia
3.Cystine
4.Uric Acid
5.Infection - Urea-splitting organisms
6.Congenital / metabolic defects:
- medullary spone kidney
- renal tubular acidosis
CLINICAL PRESENTATION
1. Flank/loin pain, colicky + radiation
- haematuria
- nausea and vomiting
- chills/fever/frequency, if infected
2. Loin tenderness
3. Bilateral stones : renal failure
INVESTIGATIONS
1. IVU and DTPA
2. Serum creatinine calcium
3. Urine pH
4. 24-hour urine
5. Urine cultures
6. Stone analysis
METABOLIC ABNORMALITIES
(N = 392)
Hypercalciuria 28%
Hyperoxaluria 16%
Hyperuricosuria 14%
Cystinuria 0.5%
Hyperparathyroidism 1%
Primary oxalosis 0.25%
Renal tubular acidosis0.25%
INDICATIONS FOR TREATMENT
Failures:
1.Access problems
2.Stone migration
100% - 20 Years
(Williams 1963)
PREVENTION OF STONES
1. Treatment of causes
2. Dietary manipulations
T Jarrett 1999