Kidney Stones are small, hard deposits of mineral
and acid salts on the inner surfaces of the kidneys
Alternative names include:
Nephrolithiasis (Kidney Stone Disease)
Stones are classified by their location in the urinary
system and their composition of crystals.
More than 1 million cases annually in US
1 in 272 or 3.6 per 1000 Americans develop
80% of stones under 2mm in size
90% of stones pass through the urinary
Generally stone smaller than 6mm are passable
(National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK)
(National Kidney and Urologic Disease Information Clearinghouse; NKUDIC)
Kidney Stone Formation
Highly concentrated urine
Imbalance of pH in urine
Acidic: Uric and Crystine Stones
Alkaline: Calium Stones
Inflammatory Bowel Disease
Types of Stones
-Types of Stones (Chart pg1170)
-Most stones contain more than one crystals. Classified by crystal that
makes up the majority of the stone.
Calcium Oxalate: Most common. Foods high is oxalate, rhubarb, star
fruit, beets, beet greens, collards, okra, refried beans, spinach, Swiss
chard, sweet potatoes, sesame seeds, almonds and soy products,
vitamin D, metabolic disorders, and bypass surgery increase calcium
oxalate concentration in urine.
Struvite stones: Most often found in women. Result of UTI. Tend to be
a stag’s-horn shape.
Uric acid stones. Formed of uric acid, a byproduct of protein
metabolism. Caused by high protein diet and gout.
Cystine stones: Fairly uncommon. Caused by kidneys over excreting
amino acid which is general linked to a hereditary disorder.
It is a hot summer day, and you are an RN in the emergency
department (ED). S.R., an 18-year-old woman, comes to the ED
with severe flank and abdominal pain and N/V. S.R. looks very
tired, her skin is warm to touch, and she is perspiring. She paces
about the room doubled-over and is clutching her
abdomen. S.R. tells you that the pain started early this morning
and has been pretty steady for the past hours. She gives a
history of working outside as a landscaper and takes little time for
water breaks. Her past medical history (PMH) includes 3 kidney
stone attacks, all during late summer. Exam findings are that her
abdomen is soft and w/o tenderness, but her left flank is
extremely tender to touch, palpation, and percussion. You place
S.R. in one of the examination rooms and take the following VS
118/98, 90, 20, 99 F. UA shows RBC of 50 to 100 on voided
specimen, WBC 0.
What are key factors are
important to consider?
Signs and Symptoms
What are the key findings? Additional S/S:
Severe flank pain Presence of UTI
Abdominal pain Fever or Chills
Nausea and vomiting Pain in groin, labia or
Elevated temperature, BP, Cloudy or foul-smelling
and respirations urine
UA positive for RBC Dysuria
Objective Data: Persistent urge to void
perspiration, clutching of
the abdomen, doubled-
Left flank tendernes
What additional information
should you ask this patient?
Frequency of urination
Do you experience pain while urinating?
What is your typical diet?
How did patient’s kidney stones resolve
themselves in the past?
Identify this patient’s risk
What are her risk factors? Additional risk factors:
Past Medical History Family or Personal Hx
Hx of 3 kidney stone Gender (male)
attacks Age (20-55)
Dehydration/Lack of Fluids Race (Caucasian)
Occupational exposure Diet
Labor Intensive High sodium
Outdoors High protein
Weather/Climate Food high in oxalate
Hot, dry Vit A/D, grapefruit juice
High Blood Pressure
Abnormal Lab Values
-Test and Diagnostics
-Blood Analysis: Search for elevated calcium or uric acid.
-Urine Analysis: Search for stone-forming minerals,
-Abdominal xray: helps monitor stone size
-Ultrasound: may miss small stones
-Intravenous pyelography: A contrast dye is injected into a vein in
your arm and a series of X-rays is taken as the dye moves
through your kidneys, ureters and bladder. Helps determine
stone location and extent of blockage. Not for pt with renal
What questions do you need
to ask before a patient has an
Do you have a history of renal failure?
Contraindicated with renal failure
Have you ever have a reaction to iodine?
Contrast contains iodine
Is there a possibility you could be pregnant?
Are you currently taking any medications?
Metformin may react with contrast
Contrast contains iodine
Check BUN and Creatinine levels prior to IVP
Our outcomes and Interven.
Invention for casestudy and general
Two Focuses of Treatment:
Treatment of acute problems, such as pain, n/v, etc
Identify cause and prevent kidney stones from reoccurring
Strain urine for stones
Invasive Procedure (may be necessary)
Lithotripsy: used to eliminate the stone form
the urinary tract.
Types: extracorporeal shock-wave, percutaneous
ultrasonic, electrohydraulic, and laser.
Pyelolithotomy (Renal Pelvis)
Drink 3 liters of fluid per day (14 cups)
Lemonade (citrate decrease stone formation)
Watch amounts of oxalate
Renal Disease: A Manual of Patient Care by
Lynn Wenig Kagan, RN, PhD
Differential Diagnosis: Renal and Electrolyte
Disorders by Saulo Klahr, MD
Journal Article #1
Purpose: Determine effectiveness of an herbal supplement
made out of varuna and banana stems, “Herbmed,” on kidney
Study: 77 patients participated in a randomized, placebo,
double-blinded study that was conducted in India from July 2007
to February 2008. Two groups were formed: Group A with calculi
5-10mm and Group B with calculi >10mm.
Results: Patients relieving the herbal supplement showed a
33% reduction in the size of their kidney stone.
Conclusion: Herbmed is an herbal treatment that may have
promising effects in reducing kidney stone size and expulsion.
Journal Article #2
Purpose: To determine the possible effects fructose has on the
formation of kidney stones.
Study: The researchers looked at three different cohorts (older
woman, younger women, and men) over combined 48 years of
follow up. 4902 new symptomatic kidney stones were documented
among these three cohorts.
Results: The results from the study showed that there is a positive
correlation between the intake of fructose and the development of
Conclusion: Fructose intake can increase insulin resistance which
lowers the pH in the urine and increases ones’ risk for the
development of uric acid kidney stone. Nurses need to adequately
assess the patient’s diet and educate patients on ways to prevent
Journal Article #3
Purpose: The study looked specifically at anxiety associated with
treatment, surgery, for kidney stones.
Study: The anxiety of 66 patients was assessed before and after
treatment, using three forms of measurement tools: palmar sweat
test, visual analogue scale, and Speilberger state anxiety
questionnaire. The two groups that were compared were open
surgery to minimally/non-invasive treatment.
Results: The results from the study showed no significant change in
the questionnaire answers between the three indicators of anxiety.
But, there was a fair reduction in the analogue scores post-
operatively in-patients who had open surgery. These same patients
also had a lower palmar sweat response. But, pre-operatively
patients who going to have open surgery had higher analogue
Conclusion: The two primary causes of anxiety were pain and
being under anesthesia. Open surgery treatment resulted in lower
levels of anxiety than non-invasive treatments.
Joey has a Kidney Stone….
Asselman, M., & Verkoelen, C. (2008). Fructose intake as a risk factor for kidney stone disease. Kidney
International, 73(2), 139-140. Retrieved from CINAHL with Full Text database.
Brown, S. (1990). Quantitative measurement of anxiety in patients undergoing surgery for renal calculus
disease. Journal of Advanced Nursing, 15(8), 962-970. Retrieved from CINAHL with Full Text database.
Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O'Brien, P.G., & Bucher, L. (2007). Medical surgical
nursing. St.Louis: Mosby, INC. .
Patankar, S., Dobhada, S., Bhansali, M., Khaladkar, S., & Modi, J. (2008). A prospective, randomized,
controlled study to evaluate the efficacy and tolerability of Ayurvedic formulation "varuna and banana
stem" in the management of urinary stones. Journal of Alternative & Complementary Medicine, 14(10),
1287-1290. Retrieved from CINAHL with Full Text database.
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