Renal Calculi for Certified Emergency Nursing (CEN)

Renal Calculi

Definition/Etiology:

• Renal calculi = hard stones made up of mineral and salt deposits that form in the renal system (AKA “kidney stones”)
• 80% of stones are formed by calcium oxalate or calcium phosphate.
• No definitive cause – reduce risk factors

Risk factors:

• Personal/family history of kidney stones
• UTIs
• Low fluid intake
• Hx of diabetes/obesity/gout/HTN

Pathophysiology:

• Urine consists of several substances that are likely to form “crystals”
• These substances include calcium, oxalate and uric acid.
• If the pH is right and the environment is healthy, it will keep the substances from forming crystals that stick together and form stones. If the pH is altered or there is dehydration, we have a higher chance of those crystals forming and sticking together.

Clinical Presentation:

• Restless!
• Complaining of flank pain (usually one sided)
• May have decreased urination
• “wave-like” pain/ ebbs and flows
• Often accompanied with nausea/vomiting
• Pain or burning with urination

Collaborative Management:

Diagnostic tests:

• CT scan
• KUB
• Urine sample – often find hematuria
• Lab work….is your creat bumped? Is there infection?

Interventions:

• Pain management! (Toradol is common)
• Antiemetic
• Rest in a position of comfort

Evaluation | Patient Monitoring | Education:

Eval size of the stone:

• 4mm or less = passable
• 4mm-6mm = iffy
• 6mm or greater = lithotripsy likely
• Urine Strainer/ keep any findings for analysis
• Outpatient pain management/follow up

Linchpins: (Key Points)

• Flank pain radiating to the groin
• Fever and/or decreased urination = bad news.
• Pain management is key