Urolithiasis

Pathophysiology/treatment

Irritative effects of stones moving within the urinary system (renal pelvis/calices, ureters, bladder, urethra) can lead to severe pain (renal colic) and if sufficiently obstructive to urine flow, can destroy kidney function. It may be recurrent in "stone-formers" and may be continuous when numerous or large renal pelvic (staghorn) calculi are present. It occurs in 15% of white men and 6% of all women in industrialized countries [48]. Diagnosis is based on history of stone formation and/or imaging studies (intravenous pyelogram or CT). The primary treatment for the disorder is the removal of the stone by spontaneous passage, which may be assisted by fragmentation using lithot-ripsy, or it may require surgical removal.

Drugs which relax the ureters include nonsteroidal anti-inflammatory drugs (NSAIDs), nifedipine, and tamsulosin, all of which have been demonstrated to facilitate stone passage. Otherwise, pain treatments employed are intended to be "temporizing" with the goal of relieving pain and ureteral spasming until stone removal occurs. These treatments are listed in Box 15.4. The two principal classes of agents used to treat pain from renal colic are NSAIDs and opioids. NSAIDs are often considered the first-line therapy because they directly address the underlying etiology of the pain by inhibiting prostaglandin synthesis and subsequently reducing vasodilation, intrarenal pressure, and urinary tract inflammation. In fact, some studies have shown NSAIDs to be superior to opioids in reducing pain scores and the need for further analgesic therapies [49]. Therapies to reduce stone formation include alkalini-zation of the urine, avoidance of certain drugs, use of thiazide diuretics, and dietary alterations.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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