Pathophysiological Development of Nephrolithiasis
Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief. Pathophysiological Development of Nephrolithiasis
In this discussion:
Discuss with your colleagues the pathophysiological development of nephrolithiasis.
Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
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Include citations from the text or the external literature in your discussions. Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief. Pathophysiological Development of Nephrolithiasis
In this discussion:
Discuss with your colleagues the pathophysiological development of nephrolithiasis.
Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
Include citations from the text or the external literature in your discussions.
Nephrolithiasis, or rather renal stones, contributes to the solubility of different urine compounds due to salt crystallization and precipitation. This suggests that it is more probable that the body will continue producing stones. According to Hammer and McPhee (2019), 70 percent of stones have calcium. This may be influenced by hypercalciuria, which is idiopathic. Stones can be made from uric acid in people with excessive purine consumption or who have gout. Struvite stones can be developed by patients suffering from chronic UTIs with urease-producing organisms, whereas cystinuria can trigger stones in patients with deficient amino acid transport (Hammer & McPhee, 2019). By passing through the ureter, these stones can be passed naturally. The stone can lead to an obstruction of the urine flows, causing inflammation or hydronephrosis (Hammer & McPhee, 2019).
The rationale for whether this patient should be further evaluated for renal surgery.
It is vital to evaluate the patient before performing renal surgery. Before surgery recommendation, the stones should be weighed. A surgical operation may be needed for any stone measuring greater than 0.5cm. CT scans or ultrasounds may reveal the scale or the volume of stones. There are several considerations involved in experiencing a higher risk of developing kidney stones. The risk can be raised by drinking more sucrose, soda, fructose and supplementary calcium. An increased BMI, which has DM2, and cholelithiasis, are other high-risk parameters (Prochaska et al., 2016). Pathophysiological Development of Nephrolithiasis
Plan of care for the patient
A care plan should be developed to guide the patient after hospital discharge. Taking fluids of at least two liters a day and consuming food rich in magnesium, citrate, and fiber reduces stone formation risk. The patient should consider changing the diet or losing weight if he is overweight. Eating high fiber and a little sodium diet can prevent stone formation. Various studies have recommended zinc sulfate because of its inhibitory role in calcium oxalate formation. Yousefichaijan (2015) suggested that oral zinc sulfate tablets are more efficient than conventional nephrolithiasis treatment.
References:
Hammer, G. & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.
Prochaska, M. L., Taylor, E. N., & Curhan, G. C. (2016). Insights into nephrolithiasis from the nurses’ health studies. American Journal of Public Health, 106(9).
Yousefichaijan, P., Cyrus, A., Dorreh, F., Rafeie, M., Sharafkhah, M., Frohar, F., & Safi, F. (2015). Oral zinc sulfate as adjuvant treatment in children with nephrolithiasis: a randomized, double-blind, placebo-controlled clinical trial. Iran Pediatric Journal, 25(6). Pathophysiological Development of Nephrolithiasis