8.11 Urolithiasis
Urolithiasis, commonly referred to as kidney stones or renal calculi, refers to stones that develop within the urinary tract. Nephrolithiasis refers to stones in the kidney, and ureterolithiasis refers to stones in the ureter(s).
Pathophysiology and Risk Factors
Urolithiasis typically occurs due to the crystallization of substances present in urine, such as calcium, oxalate, uric acid, cystine, or phosphate. Different types of stones form based on the predominant mineral content. See Figure 8.15[1] for an image of renal calculi.
Risk factors for stone development include insufficient fluid intake, excessive dietary intake of high mineral content, and hypercalcemia related to hyperparathyroidism or other medical conditions. Risk factors also include gout, repeated urinary tract infections, anatomical abnormalities within the urinary tract, and family history of urolithiasis.[2],[3]
Assessment
Signs and symptoms of urolithiasis can vary depending on the size and location of the stone, associated complications of the blockage, and an individual’s tolerance of the pain associated with urolithiasis. See Table 8.11a for clinical manifestations of urolithiasis across body systems.
Table 8.11a. Clinical Manifestations of Urolithiasis[4],[5]
| Body System | Physical Assessment Findings |
|---|---|
| Urinary | Flank or abdominal pain (often described as severe and intermittent that may radiate to the groin or lower abdomen), hematuria, dysuria, urgency, and presence of crystals in urine |
| Integumentary | Pallor or diaphoresis due to severe pain |
| Cardiovascular | Tachycardia due to severe pain and associated anxiety |
| Gastrointestinal | Nausea and vomiting due to severe pain |
| Musculoskeletal | Guarding of the abdomen or affected side due to severe pain, restlessness, or inability to find a comfortable position |
Diagnostic Testing
Diagnostic testing for urolithiasis involves various examinations and imaging studies to confirm the presence of urinary stones; determine their location, size, composition; and assess any associated complications. A urinalysis is performed to detect the presence of blood, crystals, or signs of infection in the urine. A 24-hour urine collection can help to measure various components in the urine such as high levels of calcium, oxalate, uric acid, or citrate. Imaging studies are ordered to visualize the presence of stones. A CT scan performed without contrast can provide detailed images of the urinary tract, allowing for localization, measurement, and characterization of the stones. X-rays can be useful in identifying certain types of stones, especially calcium stones.[6],[7]
Nursing Diagnoses
Nursing diagnoses for clients with urolithiasis can help guide nursing care and address the specific needs of these individuals.
Common nursing diagnoses include the following:
- Acute Pain
- Impaired Urinary Elimination
- Risk for Infection
- Readiness for Enhanced Knowledge
Outcome Identification
Outcome identifi