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IV.

THE PATIENTS ILLNESS (Nephrolithiasis)


Pathophysiology (Book-based)

Non-modifiable Factors Modifiable Factors


 Age (over 20 to 40 years
old)  Faulty Diet
 Sex (Male>Female 4:1 )  Metabolic disorders, obesity
 Family history,  Excessive medications (ceftriaxone)
Hereditary  Low fluid intake and excessive intake of protein, salt
 Race (Mostly Caucasian), and oxalate
influence with lifestyle,
diet  Nature of work (occupation)
 Seasonal factors  Stimulation of Calcium precursor
 Urinary tract  Weight Loss
malformation  Hypertension
 Hyperparathyroidism
 Diabetes Melitus
RENAL CALCULI FORMATION

Super saturation of Precipitation of the Growth through


one or more salts in salts from a liquid to crystallization or
the urine agglomeration
a solid state
(aggregation)

Super saturation of
salt in the urine Temperature PH Salt forms crystals
which can grow into
stones in the presence
Alkaline urine of super saturated urine
Multiple salts may increases risk of
precipitate into forming calcium
crystals stones due to
excessive calcium
Acidic urine increases
Formation of Nidus risk of forming uric
(nucleus) of a acid stones due to
urinary calculus. increase in acidic food
intake

Xanthine readily
Intermittent precipitates with
supersaturation due to acidic urine but Ph
ingestion of a meal or does not directly
during dehydration affect the formation of
may also contribute this type of stone
Renal tubules and
papillae have surfaces
which attract
3 Endogenous factors:
crystalline nidus and
add biological
material forming
stones
Crystal growth Particle Retention Matrix
inhibting
substances
Antegrade urine flow, Organic matrix
Pyrophosphate, urinary stasis,
Potassium citrate, anatomic abnormalities
Magnesium
Pomote growth of
infection calculi
Impairment in natural
flushing of crystals
Retention of stone
foramtion

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