BIOL 25960 - Kidney Stones: Alteration of Physiological Systems

This report provides a comprehensive overview of kidney stones, also known as nephrolithiasis, which result from the accumulation of minerals and salts in the kidneys. It discusses the etiology, highlighting that kidney stones form when urine contains high levels of crystal-forming substances like oxalate, uric acid, or calcium, or lacks substances that prevent crystal formation. The pathophysiology involves crystal accumulation, adhesion to the urothelium, and the formation of stones, with calcium oxalate stones eroding the urothelium. Clinical manifestations include severe pain in the lower rib areas, back, and abdomen, radiating to the groin, along with painful urination and red or brown urine. Treatment options involve pain management with opioids and procedures like lithotripsy, percutaneous nephrolithotomy, and ureteroscopy to break or remove the stones. The report also summarizes a primary research article that evaluates the effectiveness of ultra-mini-percutaneous nephrolithotomy (UMP) as a treatment for kidney stones, concluding that UMP is an effective intervention with a low complication rate, especially for medium-sized stones.

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Kidney stones or nephrolithiasis, which is also known as renal lithiasis, is the result of the
accumulated deposit of several minerals and salts, which is formed due to kidney functions in the
inner linings of the organ. This disease could affect any section of the urinary tract and can lead
to complications from the kidney to the gall bladder (Marieb & Hoehn, 2016).
Etiology
Kidney stones generally from within an individual, whose urine contain a higher amount
of crystal-forming substance such as oxalate, uric acid or calcium than the fluid or water
concentration (Haley et al., 2016). Further, if the urine of an individual lacks the substance that
prevents crystal formation, then kidney stones could be observed. Therefore, improper water
intake and physiological changes could develop kidney stones in patients (Tepeler et al., 2016).
Pathophysiology
Pathophysiological growth of kidney stones starts with accumulation of crystals formed
due to supersaturated urine and then sticks to the urothelium hence, it leads to nidus leading to
stone growth related situation. Further, in the research of Scales et al. (2014), it was noticed that
upon developing on Randall’s Plaques, calcium oxalate stones erode the urothelium leading to
the nucleus formation for the oxalate deposition within the kidney linings. Further, crystal
adhesion on the cell surface is favored by the crystal adhesive molecules which is expressed due
to lack of fluid in the body, leading to kidney stone formation (Kirkali et al., 2015).
Clinical manifestations

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Clinical manifestations of kidney stones are severe pain in lower rib areas, back, and side
of the abdomen. Further, it was also observed that the pain grows up to the groin and lower
abdomen (Marieb & Hoehn, 2016). This pain specifically radiates in the form of waves and the
intensity of it fluctuates. Patients may also feel severe pain while urination and the color of the
urine become red or brown, with a foul smell. Secondary symptoms are associated with fever,
nausea, and vomiting (Scales et al., 2014).
Treatment option and prognosis
To prevent severe pain among patients, opioids will be provided. Further, to treat or
break the stones present in the kidney linings, Lithotripsy will be provided which will break the
bigger stones in smaller particles by the extracorporeal shocks so that it could easily be pass
through the bladder and ureters. Further, percutaneous nephrolithotomy and ureteroscopy will be
conducted (Kirkali et al., 2015).
In primary research conducted by Tepeler et al. (2016), the primary aim of the
researchers was to understand the outcomes of ultra-mini-percutaneous nephrolithotomy as a
treatment to the kidney stones. To understand the effect, the researchers assessed a surgeon, who
performed 49 UMP surgeries on patients with kidney stones and after each, operation, the patient
characteristics, operative data, and postoperative outcomes were assessed. After conducting 50
operations in 34 right and 16 lift renal units in 48 patients and in 96% patients, the UMP worked
as an effective intervention for kidney stones and only 10% rate of complication was observed
(Tepeler et al., 2016) Further, it was also observed that in medium-sized stone treatment, UMP
operation had higher efficiency and less complication rate. Therefore, ultra-mini-percutaneous

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nephrolithotomy could be used as one of the interventions for the treatment of kidney stones
inpatient. References
References
Haley, W. E., Enders, F. T., Vaughan, L. E., Mehta, R. A., Thoman, M. E., Vrtiska, T. J., ... &
Rule, A. D. (2016, December). Kidney function after the first kidney stone event.
In Mayo Clinic Proceedings (Vol. 91, No. 12, pp. 1744-1752). Elsevier.
Kirkali, Z., Rasooly, R., Star, R. A., & Rodgers, G. P. (2015). Urinary stone disease: progress,
status, and needs. Urology, 86(4), 651-653.
Marieb, E. N., & Hoehn, K. (2016). 10th edn, Human anatomy & physiology: Harlow.
https://books.google.co.in/books?id=LFR8jwEACAAJ&dq=Marieb,+E.+N.,+
%26+Hoehn,+K.+(2016).+Human+anatomy+%26+physiology:
+Harlow.&hl=en&sa=X&ved=0ahUKEwiJi5vrx8fgAhUU5LwKHYHiDuAQ6AEIKDA
A
Scales, C. D., Lai, J. C., Dick, A. W., Hanley, J. M., van Meijgaard, J., Setodji, C. M., & Saigal,
C. S. (2014). Comparative effectiveness of shock wave lithotripsy and ureteroscopy for
treating patients with kidney stones. JAMA surgery, 149(7), 648-653.
Tepeler, A., Başıbüyük, İ., Tosun, M., & Armağan, A. (2016). The role of ultra-mini
percutaneous nephrolithotomy in the treatment of kidney stones. Turkish journal of
urology, 42(4), 261.