Internal Medicine (Theory) · MU Sofia

29. Nephrolithiasis

Covers the formation of kidney stones in the urinary tract, starting with urine supersaturation and the risk factors behind it, including diet, dehydration and genetic causes. A table sets out stone types by composition and incidence, followed by the stone-formation sequence, symptoms such as renal colic, and examination and laboratory findings. It then compares imaging options in a table, lists supportive treatment and preventive measures, and ends with complications such as hydronephrosis and urosepsis.

Inside: 11 sections · 2 labelled pictures · 3 tables · 15 flashcards · 3 min

Topic 27 of 58 in the MU Sofia syllabus for Internal Medicine (Theory) (Medicine, Year 3). The free AceMed note covers it in 11 sections, about 382 words (3 min of reading), with 15 flashcards.

In this note

  1. Nephrolithiasis (Kidney Stones)
  2. Definition
  3. Etiology / Risk Factors
  4. Classification of Stones
  5. Pathogenesis
  6. Symptoms
  7. Diagnosis
  8. Imaging
  9. Treatment
  10. Prevention
  11. Complications

Definition

Nephrolithiasis refers to the formation of solid calculi (stones) in the renal pelvis, calyces, ureter, or bladder, either unilaterally or bilaterally. These stones are formed due to supersaturation of urine with crystal-forming substances, leading to precipitation and aggregation into stones.

Etiology / Risk Factors

  • Supersaturation of urine with substances such as calcium, oxalate, uric acid, or cystine.
  • Dehydration (↓ urine volume = ↑ concentration of solutes).
  • Dietary factors:
  • High sodium → ↑ calcium excretion (calcium oxalate stones).
  • High protein → ↑ uric acid and ↓ urine pH.
  • Hypercalciuria (idiopathic or due to hyperparathyroidism).
  • Hyperuricosuria → uric acid stones.
  • Chronic UTIs by urease-producing organisms (e.g., Proteus, Klebsiella) → struvite stones.
  • Genetic causes (e.g., cystinuria → cystine stones).

Pathogenesis

  1. 1. Supersaturation of urine with stone-forming substances.
  2. 2. Crystal nucleation and aggregation into a stone.
  3. 3. Stones often form in the renal pelvis and are initially painless.
  4. 4. Pain begins when a stone moves and obstructs the ureter:
  • Ureteric obstruction → ↑ intraluminal pressure.
  • Results in ureteral spasm, renal colic, hydronephrosis.
  1. 5. Ischemic injury may occur due to vasoconstriction and cytokine-mediated inflammation.

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