Kidney stones, also called calculi, are a common urinary tract disease. Symptoms can occur suddenly, causing intense pain that often forces a patient to seek medical treatment. Pain from a kidney stone may come and go, depending on the movement of the stone. Some patients describe the pain as the worst they have ever experienced.
Types / Causes
According to the "Emergency Nursing Core Curriculum," a stone is an abnormal collection of one or more substances such as calcium, uric acid and struvite in the urinary system. The most common stones are calcium salts, which occur in 75% of patients, and the remaining 25% are usually struvite and uric acid. Causes associated with calcium stones include malignancy, excessive intake of calcium and vitamin D or prolonged immobility. Struvite stones are made up of magnesium and/or ammonium or calcium phosphates. Patients who have indwelling catheters to drain the bladder are more likely to develop an infection, which can lead to a struvite stone. Patients suffering from gout, who therefore have high levels of uric acid in their blood, are at a higher risk of developing uric acid stones. Anatomical abnormalities can contribute to developing renal stones, such as urethral narrowing, an abnormally shaped kidney or an obstruction such as a tumor.
Kidney Function
Kidney stone formation is dependent on the volume and pH of urine produced and on the occurrence of abnormal concentrations of any of the substances noted above. The function of the kidneys is to filter out and eliminate waste products from the body. Various defects in kidney function can lead to a buildup of substances that can increase the possibility of a stone forming.
Risk Factors
As noted in the "Emergency Nursing Core Curriculum," risk factors associated with the development of a kidney stone include: sedentary lifestyle or a history of gout, previous kidney stones, frequent urinary tract infections, large intake of protein, calcium or fruit juice, pregnancy and dehydration.
Symptoms
A patient with a kidney stone often presents to the emergency department complaining of a sudden onset of excruciating pain. As the kidney stone migrates, the location of pain may vary; it may be in the mid-abdomen, groin or scrotum. The patient is extremely uncomfortable, irritable and unable to find a comfortable position. Patients with kidney stones have the urge to urinate but have difficulty doing so. Nausea and vomiting are common with kidney stones.
Treatment
According to the "'Emergency Nursing Core Curriculum," approximately 80% to 85% of kidney stones pass through the urinary system and exit on their own. Patients may require pain medication for comfort and intravenous fluids to help rehydrate and flush out the stone. In some cases, if the stone is too large to pass on its own, the patient may require surgical intervention.
References
- "Emergency Nursing Core Curriculum"; Emergency Nursing Association; 2007
- "British Journal of Nursing"; Urinary Tract Stones: Types, Nursing Care and Treatment Options; Steffall & Omara; 2008
- "Current Diagnosis and Treatment: Emergency Medicine"; McGraw Hill; 2010
- "Sheehy's Emergency Nursing Principles and Practice"; Emergency Nursing Association; 2010
