Urolithiasis
Presented By :
Aamir Sharif
HO at Hijaz Hospital
Overview
Introduction
Conditions causing stone formation
Types of kidney stones
Calcium salts
Uric acid
Mg ammonium PO4
Cystine
Other (xanthine, etc.)
Laboratory investigations
Comparison Between Urosinal Syrup
& Zyloric Tablets
Urolithiasis
Urolithiasis is the condition where urinary stones are
formed or located anywhere in the urinary system
The term nephrolithiasis (or "renal calculus") refers to
stones that are in the kidney,
Ureterolithiasis refers to stones that are in the ureter.
The term cystolithiasis (or vesical calculi) refers to stones
which form or have passed into the urinary bladder.
Stones are Composed of metabolic products present in
glomerular filtrate
These products are in high conc.
Near or above maximum solubility
Conditions causing
kidney stone formation
High conc. of
metabolic products in
glomerular filtrate
Changes in urine pH
Urinary stagnation
Deficiency of stoneforming inhibitors in
urine
High conc. of metabolic products
in glomerular filtrate is due to:
Low urinary volume (with
normal renal function) due
to restricted fluid intake
Increased fluid loss from
the body
Increased excretion of
metabolic products forming
stones
High plasma volume
(high filtrate level)
Low tubular reabsorption
from filtrate
Changes in urine
pH
is due
to:
Bacterial
infection
Precipitation
of salts at
different pH
Urinary stagnation
is due to:
Obstruction of
urinary flow
Deficiency of stoneforming inhibitors:
Citrate, pyrophosphate,
glycoproteins inhibit growth of
calcium phosphate and calcium
oxalate crystals
In type I renal tubular acidosis,
hypocitraturia leads to renal
stones
Calcium salt stones
80% of kidney stones contain
calcium
The type of salt depends on
Urine pH
Availability of oxalate
General appearance:
White, hard, radioopaque
Calcium PO4: staghorn in
renal pelvis (large)
Calcium oxalate: present in
ureter (small)
Calcium oxalate stones
Calcium salt stones
Causes of calcium salt stones:
Hypercalciuria:
Increased urinary calcium excretion
Men: > 7.5 mmols/day
Women > 6.2 mmols/day
May or may not be due to hypercalcemia
Hyperoxaluria:
Causes the formation of calcium oxalates without
hypercalciuria
Diet rich in oxalates
Increased oxalate absorption in fat malabsorption
Primary hyperoxaluria:
Due to inborn errors
Urinary oxalate excretion: > 400 mmols/day
Calcium salt stones Treatment:
Treatment of primary causes such
as infection, hypercalcemia,
hyperoxaluria
Oxalate-restricted diet
Increased fluid intake
Acidification of urine (by dietary
changes)
Calcium salt stones are formed in
alkaline urine
Uric acid stones
About 8% of renal stones
contain uric acid
May be associated with
hyperuricemia (with or
without gout)
Form in acidic urine
General appearance:
Small, friable, yellowish
May form staghorn
Radiolucent (plain x-rays
cannot detect)
Visualized by ultrasound
or i.v. pyelogram
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Mg ammonium PO4 stones
About 10% of all renal stones contain
Mg amm. PO4
Also called struvite kidney stones
Associated with chronic urinary tract
infection
Microorganisms (such as from
Proteus genus) that metabolize
urea into ammonia
Causing urine pH to become
alkaline and stone formation
Commonly associated with staghorn
calculi
75% of staghorn stones are of
struvite type
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Cystine stones
A rare type of kidney stone
Due to homozygous cystinuria
Form in acidic urine
Soluble in alkaline urine
Faint radio-opaque
Treatment:
Increased fluid intake
Alkalinization of urine (by dietary
changes)
Penicillamine (binds to cysteine to form
a compound more soluble than cystine)
Laboratory investigations
of kidney stones
If stone has formed and
removed:
Chemical analysis of stone
helps to:
Identify the cause
Advise patient on prevention
and future recurrence
Laboratory investigations
of kidney stones
If stone has not formed:
This type of investigation identifies causes
that may contribute to stone formation
Serum calcium and uric acid analysis
Urinalysis: volume, calcium, oxalates and
cystine levels
Urine pH > 8 suggests urinary tract
infection (Mg amm. PO4)
Urinary tract imaging:
Ultrasound and i.v. pyelogram
Comparison Between Urosinal Syrup &
Zyloric Tablet
Urosinal Syrup
Zyloric Tablet
Name of the product
Urosinal
Zyloric Tablets
Composition
Barley Salt 500 mg
Potassium Nitrate500 mg
Solanum nigrum
(Leaves)125 mg
Solanum nigrum Berries
62.5 mg
Preservatives
BaseQ.S
Allopurinol 100 mg ,
Excipents
Lactose
Maize Starch
Povidone
Magnesium Stearate
Purified Water
Pharmaceutical form
Syrup:120 ml
(Tablets) 100 & 300 mg
Indications
Urinary Bladder Ailments,
Kidney Disorders, Liver
Disorders, Urinary
Retention
indicated for reducing
urate/uric acid formation in
conditions where urate/uric
acid deposition has already
occurred (e.g. gouty
arthritis, skin tophi,
nephrolithiasis) or is a
predictable clinical risk (e.g.
treatment of malignancy
potentially leading to acute
uric acid nephropathy).
Name of the product
Urosinal
Zyloric Tablets
Pharmacodynamic
It lowers the level of uric
acid in the body, and
alleviates gout and
rheumatism.
Mechanism not known
Allopurinol is a xanthineoxidase inhibitor. Allopurinol
and its main metabolite
oxipurinol lower the level of
uric acid in plasma and urine
by inhibition of xanthine
oxidase, the enzyme
catalyzing the oxidation of
hypoxanthine to xanthine and
xanthine to uric acid. In
addition to the inhibition of
purine catabolism in some
but not all hyperuricaemic
patients, de novo purine
biosynthesis is depressed via
feedback inhibition of
hypoxanthine-guanine
phosphoribosyltransferase.
Other metabolites of
allopurinol include allopurinolriboside and oxipurinol-7
riboside.
Name of the
product
Urosinal
Pharmacokinetics
Not Known
Zyloric Tablets
Allopurinol is active when given orally and is rapidly
absorbed from the upper gastrointestinal tract.
Allopurinol is negligibly bound by plasma proteins and
therefore variations in protein binding are not thought to
significantly alter clearance.
Estimates of bioavailability vary from 67% to 90%.
Peak plasma levels of allopurinol generally occur
approximately 1.5 hours after oral administration of Zyloric,
but fall rapidly and are barely detectable after 6 hours.
Approximately 20% of the ingested allopurinol is excreted
in the faeces.
Elimination of allopurinol is mainly by metabolic
conversion to oxipurinol by xanthine oxidase and
aldehyde oxidase, with less than 10% of the unchanged
drug excreted in the urine.
Allopurinol has a plasma half-life of about 1 to 2 hours
Name Of The product
Urosinal
Zyloric Tablets
Dosage
Children:
2.5 ml (half a
teaspoonful) mixed
with milk or Sharbat
Bazoori in the
morning and in the
evening.
Adults:
5 ml (one
teaspoonful) mixed
with milk or sharbat
Bazoori in the
morning and in the
evening
Children:
Children under 15 years: 10 to 20
mg/kg bodyweight/day up to a
maximum of 400 mg daily.
Use in children is rarely indicated,
except in malignant conditions
(especially leukaemia) and certain
enzyme disorders such as LeschNyhan syndrome.
Adults:
In the absence of specific data,
the lowest dosage which
produces satisfactory urate
reduction should be used. i.e
100mg/day
Contraindications
Not Reported
Zyloric should not be
administered to individuals known
to be hypersensitive to allopurinol
or to any of the components of the
formulation.
Name Of The product
Urosinal
Zyloric Tablets
Interaction with other
medicinal products
Not Known
Salicylates and uricosuric
agents decrease its activity
Chlorpropamide
increased risk of prolonged
hypoglycaemic activity
Theophylline: Inhibition of
the metabolism of
theophylline
Frequency of skin rash
increases patients receiving
ampicillin or amoxicillin
concurrently with allopurinol
Side Effects
No side effects reported
Skin reactions are the most
common reactions and may
occur at any time during
treatment.
They may be pruritic,
maculopapular, sometimes
