Renal Calculi PDF

Renal calculi Renal stones are uncommon in childhood When they occur, predisposing causes must be sought: UTI structural anomalies of the urinary tract metabolic abnormalities. The most common are phosphate stones associated with infection, especially with Proteus. Calciu...

Renal calculi Renal stones are uncommon in childhood When they occur, predisposing causes must be sought: UTI structural anomalies of the urinary tract metabolic abnormalities. The most common are phosphate stones associated with infection, especially with Proteus. Calcium-containing stones occur in idiopathic hypercalciuria, the most common metabolic abnormality, and with increased urinary urate and oxalate excretion.  Deposition of calcium in the parenchyma (nephrocalcinosis) may occur with hypercalciuria, hyperoxaluria, and distal renal tubular acidosis.  Nephrocalcinosis may be a complication of furosemide therapy in the neonate. Cystine and xanthine stones are rare. Presentation may be with haematuria, loin or abdominal pain, UTI, or passage of a stone.  Stones that are not passed spontaneously should be removed, by either lithotripsy or surgery, and any predisposing structural anomaly repaired if possible. A high fluid intake is recommended in all affected children. If the cause is a metabolic abnormality, specific therapy may be possible.  Renal tubular disorders Fanconi syndrome (generalized proximal tubular dysfunction) Proximal tubule cells reabsorb essential salts, ions and small molecules which have been filtered out by the glomerulus. They are among the mos metabolically active in the body, so are especially vulnerable to cellular damage. The cardinal features are excessive urinary loss of amino acids, glucose, phosphate, bicarbonate, sodium, calcium, potassium, and magnesium. presenting with: polydipsia and polyuria salt depletion and dehydration hyperchloraemic metabolic acidosis rickets faltering or poor growth. Proteinuria  Transient proteinuria may occur during febrile illnesses or after exercise and does not require investigation.  Persistent proteinuria is significant and should be quantified by measuring the urine protein-to-creatinine ratio in an early morning sample (normal protein-to-creatinine ratio no diarrheal prodrome , genetic Etiology and relapses frequently. Rx is Monocolonal AB ( eculizmuab) Treatment Supportive mainly, ,some cases may need dialysis