اورولیتیازیس، urolithiasis، سنگ کلیه

اورولیتیازیس، urolithiasis، سنگ کلیه

اسلاید 1: Clinical Approach to UROLITHIASIS M.M.Hosseini,M.D.SUMS15.6.97

اسلاید 2: BACKGROUND Urinary stone disease continues to occupy an important place in everyday urological practice. The average lifetime risk of stone formation has been reported in the range of 5-10%. A predominance of men over women (approx. 3:1) can be observed with an incidence peak between the fourth and fifth decade of life. Recurrent stone formation is a common problem with all types of stones and therefore an important part of the medical care of patients with stone disease.

اسلاید 3: Theories of Stone FormationA. Nucleation TheoryB. Stone Matrix TheoryC. Inhibitor of Crystallization Theory Most investigators acknowledge that these 3 theories describe the 3 basic factors influencing urinary stone formation. It is likely that more than one factor operates in causing stone disease. A generalized model of stone formation combining these 3 basic theories has been proposed.

اسلاید 4: RISK FACTORS •Start of disease early in life: <25 years•Single functioning kidney•Disease associated with stone formation: - hyperparathyroidism - renal tubular acidosis (partial/complete) - jejunoileal bypass - Crohn’s disease - intestinal resection - malabsorptive conditions - sarcoidosis hyperthyroidismDM

اسلاید 5: RISK FACTORS •Medication associated with stone formation: - calcium supplements - vitamin D supplements - acetazolamide - ascorbic acid in megadoses ( > 4 g/day) - sulphonamides - triamterene - indinavir•Anatomical abnormalities associated with stone formation: - tubular ectasia (medullary sponge kidney) - pelvo-ureteral junction obstruction - calix diverticulum, calix cyst- ureteral stricture - vesico-ureteral reflux - horseshoe kidney - ureterocele

اسلاید 6: Etiology A). Disorders of urinary tract:congenital abnormalitiesobstructive processes;Neurogenic dx of the urinary tract;inflammative and parasitogenic damages;foreign bodies of urinary tract;traumatic injuries.B) Liver and digestive tract disorders:C) Endocrine diseaseshyperparathyreoidism; D.) Infect focuses of the urogenital system.E) Metabolism disorders.essential hypercalciuria;renal ricketsF) Injuries those leads to continuous immobilizationfractures of the vertebral column and limbsosteomyelitisdiseases of the bones and jointschronic diseases of the visceral organs and nervous system.G) Climate and geographical causes.dry and hot climate with a high vaporizationdecrease water supplyiodine deficiencyH) Disorders of nutrition and vitamins balance:retinole deficiency in food.Excessive amount of the ergocalciferole

اسلاید 7: Renal Calculi

اسلاید 8: Diagnostic work up

اسلاید 9: Medical HistoryA personal as well as a family history should be obtained for all patients. A history of inflammatory bowel disease, recurrent urinary tract infection, prolonged periods of immobilization, gout, or familial occurrence of certain inherited renal diseases, eg, renal tubular acidosis or cystinuria, should be sought.

اسلاید 10: Clinical ManifestationsAcute obstruction of the urinary tract may cause renal colic, a form of severe abdominal pain often accompanied by nausea and vomiting due to celiac ganglion stimulation. Onset is sudden, often during the night or in the early morning

اسلاید 11: Clinical ManifestationsObstructing calculi in the upper urinary tract cause an extreme crescendo like pain in the flank that generally radiates laterally around the abdomen to the corresponding groin and testicles in males and labia major in females.When the stone obstructs the midureter, the pain tends to radiate to the lateral flank and abdominal region. However, when the obstruction is in the distal ureter (near the ureterovesical junction), the patient exhibits symptoms of bladder irritation (frequency and urgency or genital pain).

اسلاید 12: Clinical ManifestationsFever is rarely present except when a urinary tract infection accompanies obstruction. Pulse rate and blood pressure, however, may be elevated as a result of the pain and agitation caused by the renal colic. The patients abdomen is generally flat and soft, with moderate deep tenderness on palpation where the calculus is lodged. Some patients also have extensive hyperesthesia of the abdominal wall, either anteriorly or posteriorly. The costo-vertebral area may be tender to percussion.