You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?
A. Increased calcium loss from the bones.
B. Decreased kidney function.
C. Decreased calcium intake.
D. High fluid intake.
Correct Answer: A. Increased calcium loss from the bones.
Bones lose calcium when a patient can no longer bear weight. The calcium lost from bones form calculi, a concentration of mineral salts also known as a stone, in the renal system. Renal stone disease is a common problem in patients with spinal cord injury. The factors responsible are thought to include hypercalciuria and chronic urinary infection. The urine of all stone patients was oversaturated with calcium phosphate for part of each day. Urinary calcium was elevated in 16% and plasma urate in 30% of the paraplegics studied.
Option B: Specific risk factors for CKD in stone formers include recurrent urinary tract infections, struvite and possibly uric acid stone composition, symptomatic stones, solitary kidney, ileal conduit, neurogenic bladder, and hydronephrosis.
Option C: The effect of calcium supplementation on stone formation is currently controversial. It is likely that large doses of supplemental calcium, especially if taken separately from a meal, may lead to stone formation. When necessary, stone-forming patients should be encouraged to take their calcium supplements with a meal and their stone disease should be monitored.
Option D: Increased water intake is associated with a reduced risk of kidney stones; increased consumption of tea and alcohol may reduce kidney stone risk. An average daily water intake was recommended for kidney stone prevention.
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