Identify and select appropriate interventions including
diagnostic tests and nursing interventions. Analyze physiological and psychological
responses to illness and treatment modalities
Purpose: Examine case studies related to renal and urologic systems and answer the
assigned questions. This assignment should help refine your clinical/critical thinking skills
What are the treatment options for renal calculi based on the cause of the stones?
Critical Thinking: Treatment of Renal Calculi
Renal calculi, also known as kidney stones or nephrolithiasis, are hard, crystalline
mineral substances formed within the urinary tract or kidney, symptomized by flank pain, and
hematuria (Curhan, 2011). Though some run within the lineage, their occurrence is prompted by
a decrease in volume of urine, or an excess of substances that form stones within the urine. To
confirm the presence or absence of kidney stones, various diagnostic tests are carried out,
including blood tests to check the levels of calcium, uric acid, phosphorus, and electrolytes;
kidney function tests; urinalysis, which is done to check for red blood cells in the urine, or
crystals; and stone type examinations. In addition, abdominal CT scans can also be carried out,
as well as MRI, X-rays, Ultrasound and Intravenous pyelogram (IVP) of the kidney and
abdomen (Pietrow, 2007).
Treatment of kidney stones is dependent on the cause of the calculi, which is specific for
every type of stone. The most common ones are calcium stones, cysteine stones which form in
people with cystinuria, struvite stones mostly found in women, uric acid stones more common in
men than women, and other substances including triamterene, indinavir and acyclovir
medications (Pietrow, 2007).
Usually, small stones pass on their own with intake of fluids. However, bigger stones
may need some medications to decrease their formation and help to fragment them. Allopurinal
is used for uric stones; antibiotics are common for struvite stones; phosphate solutions for
CRITICAL THINKING 2
calcium stones; sodium citrate and thiazide diuretics for general use (Curhan, 2011). Surgical
procedures like lithotripsy, percutaneous nephrolithotomy and ureteroscopy may be necessary if
the condition is worse, as is deemed by the doctor (Pietrow, 2007).
Curhan, G. C. (2011). Nephrolithiasis. In: Goldman, L. & Schafer, A.I., (eds.). Cecil Medicine.
24th ed. Philadelphia, Pa: Saunders Elsevier.
Pietrow, P. K. (2007). Preminger GM. Evaluation and medical management of urinary lithiasis.
In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier.