Mr Jagger is a 53-year-old male, who has presented to emergency complaining of severe left flank pain. He is in extreme distress, is very pale and is complaining that the pain is making him want to vomit. The examining physician suspects that he has renal calculi. How do renal calculi form, how are they diagnosed and what complications might arise if Mr Jagger remains untreated?
Renal calculi, also known as kidney stones, occur when glomerular filtrate passes through the nephron, where urine is concentrated with stone-forming salts (Bagga et Al., 2013). Ions in the urine are capable of forming solid salts that can grow into stones (Bagga et Al., 2013). Through the process of crystallization, a small nidus grows into a large stone when urine is supersaturated (Craft and Gordon, 2010). Supersaturation is defined as the state in which a solution contains more dissolved substances than can be dissolved in water; stones may form during periods of supersaturation such as after a large meal or when dehydrated (Craft and Gordon, 2010). The walls of the renal tubules and papillae also attract crystal niduses, which facilitates their formation into stones and occlusion of the tubule (Craft and Gordon, 2010). It takes approximately 5-7 minutes for substances to pass through the collecting duct to the bladder, and during this time stone crystals bind together until they are large enough to…
(2013) New Insights into the pathogenesis of renal calculi. Urologic Clinics of North America, 40, (1). Pp. 1-12.
Craft, J., Gordon, C., Tiziani, A., Huether, S., McCance, K., and Brashers, V. (Eds.). 2010. Understanding Pathophysiology. Chatswood, NSW: Elsevier.
Gnessin, E., Lingeman, J., and Evan, A. (2010) Pathogenesis of Renal Calculi. Turkish Journal of Urology, 36 (2). Pp. 190-199.
Pearle, M. (2012) Shock-Wave Lithotripsy for Renal Calculi. The New England Journal of Medicine, 367 (1). Pp….