Stone renal

N.A. Parietaria judaica L. Flavonoids, tannins.99 A diuretic, demulcent, laxative. Restorative action on the kidneys, for nephritis, pyelitis, kidney stones, renal colic, cystitis, and edema. 

Calcium and oxalate arc closely associated with the fomiation of stones in the urinary tract. Kidney stones (renal calculi) and bladder stones are mineral deposits containing protein. They can have a diameter of a centimeter or greater. Most kidney stones (75%) are composed mainly of calcium oxalate or calcium oxalate with hydroxyapatite. Uric acid stones account for about 10% of stones xanthine stones are rare. Calcium containing kidney stones occur in fetem nations and affect about one person in 1000. The disease may occur in children, but typically occurs after rhe age of 30 and in men, Calcium biadder stones occur malniy in the children of underdeveloped countries, such as Thailand, and occur rarely in West em nations. Some kidney stones do not result in symptoms. Others may cause blood loss in the urine. Stones that obstruct the flow of urine from the kidney into the ureter result in violent pain, nausea, and vomiting. 

Allopurinol 300 mg q. 24 hr 30% 75% 50% 25% Adverse effects interstitial nephritis, exfoliative dermatitis, and rarely, xanthine stones renal excretion of active metabolite with half life of 25 hr in normal renal function, half life 1 wk in patients with ESRD Half dose No data Dose for GFR 10-50 ml/min... 

Oxalate, produced from glycine or obtained from the diet, forms precipitates with calcium. Kidney stones (renal calculi) are often composed of calcium oxalate. A lack of the transaminase that can convert glyoxylate to glycine (see Fig 39.6) leads to the disease primary oxaluria type I (PH 1). This disease has a consequence of renal failure attributable to excessive accumulation of oxalate in the kidney. 

D. Toxicity Drowsiness and paresthesias are commonly reported after oral therapy. Cross allergenicity between these and all other sulfonamide derivatives (other sulfonamide diuretics, hypoglycemic agents, antibacterial sulfonamides) is uncommon but does occur. Alkalinization of the urine by these drugs may cause precipitation of calcium salts and formation of renal stones. Renal potassium wasting may be marked. Patients with hepatic impairment may develop hepatic encephalopathy because of increased ammonia reabsorption. 

Two nucleation processes important to many people (including some surface scientists ) occur in the formation of gallstones in human bile and kidney stones in urine. Cholesterol crystallization in bile causes the formation of gallstones. Cryotransmission microscopy (Chapter VIII) studies of human bile reveal vesicles, micelles, and potential early crystallites indicating that the cholesterol crystallization in bile is not cooperative and the true nucleation time may be much shorter than that found by standard clinical analysis by light microscopy [75]. Kidney stones often form from crystals of calcium oxalates in urine. Inhibitors can prevent nucleation and influence the solid phase and intercrystallite interactions [76, 77]. Citrate, for example, is an important physiological inhibitor to the formation of calcium renal stones. Electrokinetic studies (see Section V-6) have shown the effect of various inhibitors on the surface potential and colloidal stability of micrometer-sized dispersions of calcium oxalate crystals formed in synthetic urine [78, 79]. 

Diuretics are one of the dmg categories most frequendy prescribed. The principal uses of diuretics are for the treatment of hypertension, congestive heart failure, and mobilization of edema fluid in renal failure, fiver cirrhosis, and ascites. Other applications include the treatment of glaucoma and hypercalcemia, as well as the alkafinization of urine to prevent cystine and uric acid kidney stones. 

Because renal impairment is common in older adults the nurse should give the sulfonamides with great caution. There isan increased danger of the sulfonamidescausng additional renal damage when renal impairment is already present. An increase of fluid intake up to 2000 mL (if the older adult can tolerate this amount) decreases the risk of crystals and stones forming in the urinary trad. 

The drugp used for gout are contraindicated in patients with known hypersensitivity. Probenecid is contraindicated in patients with blood dyscrasias or uric acid kidney stones and in children younger than 2 years. Sulfinpyrazone is contraindicated in patients with peptic ulcer disease and gastrointestinal inflammation. Colchicine is contraindicated in patients with serious gastrointestinal, renal, hepatic, or cardiac disorders and those with blood dyscrasias. 

From a therapeutic point of view, it is essential to confirm the presence of bacteriuria (a condition in which there are bacteria in the urine) since symptoms alone are not a reliable method of documenting infection. This applies particularly to bladder infection where the symptoms of burning micturition (dysuria) and frequency can be associated with a variety of non-bacteriuric conditions. Patients with symptomatic bacteriuria should always be treated. However, the necessity to treat asymptomatic bacteriuric patients varies with age and the presence or absence of underlying urinary tract abnormalities. In the pre-school child it is essential to treat all urinary tract infections and maintain the urine in a sterile state so that normal kidney maturation can proceed. Likewise in pregnancy there is a risk of infection ascending from the bladder to involve the kidney. This is a serious complication and may result in premature labour. Other indications for treating asymptomatic bacteriuria include the presence of underlying renal abnormalities such as stones which may be associated with repeated infections caused by Proteus spp. 

Rice bran fiber has fructo-oligosaccharides - a pre-biotic that helps friendly bacteria to proliferate in the gastrointestinal environment and improves intestinal and colon health (Tomlin and Read, 1988). Recent studies in humans (Kahlon and Chow, 1997) have revealed that rice bran fiber not only normalizes bowel function, but also helps in conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and Crohn s disease, and lowers the lipid levels. Rice bran fiber has been shown to significantly reduce renal stones (Jahnen et al., 1992). It is a good source of fiber in weight loss programs and therapeutic fiber diets for diabetics and heart patients. Fiber diets prevent cancer of the colon and large bowel, control obesity and improve bowel function. 

Other papers in the Symposium deal with the antioxidant and hypolipidemic effects of IP6, its chelating effects in heavy metal toxicity, inhibition of renal stones and other beneficial effects such as inhibition of platelet aggregation, inhibition of inflammatory responses (Shamsuddin, 1998). The lipid lowering effect and anti-neoplastic effect of 1P6 were extensively reviewed (Jariwalla, 1999). Hence, 1P6 is a valuable component of rice bran in preventing disease and maintaining health. 1P6 is present at 1.8-2% in rice bran. 

Upper and lower urinary tract infection, urosepsis, urinary incontinence refractory urinary retentions chronic, renal failure, bladder diverticuli, bladder stones, or recurrent gross hematuria. 

Uric acid excretion is reduced in patients with chronic kidney disease, putting them at risk for hyperuricemia. In patients with persistently acidic urine and hyperuricemia, uric acid nephrolithiasis can occur in up to 25% of patients in severe cases, uric acid stones can cause nephropathy and renal failure. Extreme hyperuricemia can occur because of rapid tumor cell destruction in patients undergoing chemotherapy for certain types of cancer (see Chap. 85). 

Probenecid is a uricosuric agent that blocks the tubular reabsorption of uric acid, increasing its excretion. Because of its mechanism of action, probenecid is contraindicated in patients with a history of uric acid stones or nephropathy. Probenecid loses its effectiveness as renal function declines and should be avoided when the creatinine clearance is 50 mL/minute or less. Its uricosuric effect is counteracted by low aspirin doses, which many patients receive for prophylaxis of coronary heart disease. 

Nephrolithiasis A condition marked by the presence of renal calculi (stones) in the kidney or urinary system. 

Calcium oxalate monohydrate responsible for the formation of most kidney stones significantly increased mitochondrial superoxide production in renal epithelial cells [42], Recombinant human interleukin IL-(3 induced oxygen radical generation in alveolar epithelial cells, which was suppressed by mitochondrial inhibitors 4 -hydroxy-3 -methoxyacetophe-none and diphenylene iodonium [43]. Espositio et al. [44] found that mitochondrial oxygen radical formation depended on the expression of adenine nucleotide translocator Anti. Correspondingly, mitochondria from skeletal muscle, heart, and brain from the Antl-deficient mice sharply increased the production of hydrogen peroxide. 

A 35-year-old male has renal stones and increased calcium (Ca) in the urine that is associated with normal serum Ca and parathyroid hormone levels. Which of the following agents could he used to treat this patient ... 

Allopurinol is the antihyperuricemic drug of choice in patients with a history of urinary stones or impaired renal function, in patients who have lymphoproliferative or myeloproliferative disorders and need pretreatment with a xanthine oxidase inhibitor before initiation of cytotoxic therapy to protect against acute uric acid nephropathy, and in patients with gout who are overproducers of uric acid. 

The major side effects associated with uricosuric therapy are GI irritation, rash and hypersensitivity, precipitation of acute gouty arthritis, and stone formation. These drugs are contraindicated in patients who are allergic to them and in patients with impaired renal function (CLcr <50 mL/min) or a history of renal calculi, and in patients who are overproducers of uric acid. 

The majority of UTIs are caused by a single organism however, in patients with stones, indwelling urinary catheters, or chronic renal abscesses, multiple organisms may be isolated. 

The most common side effects include somnolence, dizziness, anorexia, headache, nausea, word-finding difficulties, oligohidrosis, modest weight loss, and irritability. Symptomatic kidney stones may occur in 2.6% of patients. Hypersensitivity reactions may occur in 0.02% of patients, and it should be used with caution if at all in patients with a history of allergy to sulfonamides. Monitoring of renal function may be advisable in some patients. 

Glomerulonephritis, pyelonephritis, renal infarction, papillary necrosis, renal tumors, kidney stones Pyelonephritis, interstitial nephritis... 

There are also drugs which by themselves can cause kidney failure. The mechanisms behind drugs negative effects on the kidneys are multiple. Among the most important is diminished blood flow to the kidneys (prerenal failure). Others are immunological damages to the nephrons caused by deposition of autoimmune complexes or direct nephrotoxicity caused by for example, antibiotics. The kidney function can also be damaged by post-renal obstructions, for example, kidney stones, urethral strictures or prostate hyperplasia (Ashley 2004). 

Maxzide Maxzide-25 Anti hypertensive Diuretic Tab Triamterene 75 mg. hydrochlorothiazide 50 mg Tab Triamterene 37.5 mg. hydrochbrothiazide 25 mg 1 tab qd jaundice, pancreatitis, interstitial nephritis, renal stones. 1-2 tab qd... 

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