Kidney stones: symptoms, treatment
- Causes of kidney stones
- Classification of renal calculi
- Mechanism of formation of kidney stones
- Symptoms of kidney stones
- Diagnosis of nephrolithiasis
- Kidney stones: treatment
The most topical task of modern urology is the problem of treating urolithiasis. To date, this pathology remains one of the causes of renal failure (about 7% of patients in need of hemodialysis - patients with ICD). The annual incidence of nephrolithiasis increases annually and leads to the development of various complications, and the results of treatment do not always satisfy their effectiveness.
Urolithiasis, called clinical nephrolithiasis in clinical terms, is a polyethological disease of the metabolism, manifested by the formation of calculi (stones) in the kidneys. This pathology, characterized by a tendency to relapse and severe persistent flow, is often hereditary.
Causes of kidney stones
Today, there are many theories explaining the causes of stone formation, but none of them can be considered up to the end of the faithful and established. According to experts, there are endogenous and exogenous factors provoking the development of nephrolithiasis.
- Hereditary predisposition;
- Increased absorption of calcium in the intestine;
- Enhanced mobilization of calcium from bone tissue (metabolic disorders in the bones);
- Anomalies in the development of the urinary system;
- Infectious-inflammatory processes;
- Disorders of the metabolism of uric acid and purine metabolism;
- Violation of parathyroid glands;
- Pathologies of the digestive tract;
- Some malignant diseases;
- Prolonged bed rest due to injuries or severe physical illnesses.
- Foods high in animal protein;
- Prolonged fasting;
- Excessive consumption of alcohol and caffeine;
- Uncontrolled use of antibiotics, hormonal drugs, diuretics and laxatives;
- Hypodinamy (the cause of the violation of phosphorus-calcium metabolism);
- Geographical, climatic and housing conditions;
- The genus of professional activity.
Classification of renal calculi
- The most common group of concrements (70% of the total) are inorganic compounds of calcium salts (calcium oxalate and calcium-phosphate stones). Oxalates are formed from oxalic acid, phosphates from apatite.
- Concrements of infectious nature (15-20%) - magnesium containing stones.
- Urine stones, or urates (concrements consisting of salts of uric acid). Make up 5-10% of the total.
- Protein stones, occurring in 1-5% of cases due to the violation of amino acid metabolism.
- Cholesterol stones (soft stones of black color, not visible on X-rays).
It should be noted that isolated forms of nephrolithiasis are rare. Most stones have a mixed (polymineral) composition.
In the event that the origin of nephrolithiasis is associated with the peculiarities of nutrition and the composition of drinking water, primary nephrolithiasis is diagnosed. This disease is due to persistent acidification of urine, excessive intestinal absorption of metabolites and decreased renal reabsorption.
In pathologies accompanied by metabolic disorders (hyperkalemia, hypercalcemia, hyperuricemia), it is a question of secondary nephrolithiasis.
Localization, size and shape
Stones can be localized in one or both kidneys (in the renal pelvis, as well as in the lower, middle or upper calyx). They are single and multiple. Dimensions of concrements, denoted in millimeters (<5,> 20), can vary from a pinhead to a renal cavity (coral stones can form a casting of the cup-and-pelvis system). In form, renal calculi can be round, flat, or angular.
Mechanism of formation of kidney stones
The mechanism of nucleation and development of nephrolithiasis depends on various factors (pH of urine, diathesis, selection of a particular type of salt, etc.). According to experts, the primary formation of concrements occurs in the renal pelvis and collecting tubules. First, a nucleus is formed, and then crystals begin to form around it.
There are several theories of stone formation (crystallization, colloidal and bacterial). Some authors note that the main role in the process of nucleus formation is played by atypical Gram-negative bacteria, capable of producing apatite (calcium carbonate). These microorganisms are detected in 97% of all renal calculi.
Most often nephrolithiasis is diagnosed in males. At the same time, women are characterized by heavier forms of pathology (for example, coral calculi occupying virtually the entire cervical system of the excretory organ).
In connection with the fact that kidney stones are a polyethological disease, before developing the tactics of treatment, it is necessary to try to find out the cause of the development of the pathological process.
Symptoms of kidney stones
- Sometimes, kidney stone disease occurs almost asymptomatically, that is, a person can learn about his disease only if the stone goes away during the urination. However, more often the passage of the concrement is accompanied by pain of varying intensity, which arise when it moves along the urinary tract (the so-called renal colic). The localization of pain may be different (this depends on the level of fixation of the stone). If the stone is delayed immediately upon exiting the kidney, patients complain of pain in the lower back (on the right or on the left side). When the lump is obstructed in the ureter, pain can be given to the genitals, the lower abdomen, the inside of the thigh, or to localize at the navel.
- Hematuria (the appearance of blood in the urine) is the second most important symptom of urolithiasis. Sometimes the amount of blood allocated is insignificant (microhematuria), and sometimes quite abundantly (macrohematuria). In the latter case, urine acquires the color of meat slops. The development of bleeding is explained by the fact that with the progress of the calculus along the urinary tract, soft tissues of the kidneys and ureters are injured. It should be noted that the blood in the urine appears after an attack of renal colic.
- Dysuria (violation of urination). Problems with urination (mandatory urges and a difficult outflow of urine) occur when passing through the urinary bladder and urethra. In the case when the stone completely blocks the exit from the bladder to the urethra, it is possible to develop anuria (complete absence of urine). Urostage of the kidneys (violation of the outflow of urine) is a rather dangerous condition that can lead to the development of an acute inflammatory process (pyelonephritis), which is one of the complications of kidney stone disease. This condition is accompanied by an increase in body temperature to 39-40 C and other symptoms of general intoxication.
With pelvic nephrolithiasis caused by the formation of small stones in the renal pelvis, the disease is characterized by a recurrent course, accompanied by repeated attacks of painful pains resulting from acute obstruction of the urinary tract.
Coronal (cup-and-pelvic) nephrolithiasis is quite rare, but at the same time, the most severe form of kidney stone disease, caused by a stone that occupies more than 80% or the entire calyx-pelvis system. Symptoms of this condition are periodic low intensity pain and episodic macrogematuria. Gradually pyelonephritis joins the pathological process and chronic renal failure slowly develops.
Diagnosis of nephrolithiasis
Diagnosis of nephrolithiasis includes the following measures:
- collection of anamnesis (information about the diseases that have been transferred, the development of the disease, living conditions, etc.);
- laboratory examination of blood and urine (with mandatory determination of calcium, phosphate, oxalate and uric acid levels in the blood and bacteriological analysis of urine);
- ultrasound examination of the kidneys;
- review and excretory urography.
According to medical indications, magnetic resonance imaging or computed tomography with intravenous conduction can be performed.
In the case of an independent deviation of the calculus, a study is made of its chemical composition.
Kidney stones: treatment
Conservative treatment of nephrolithiasis is aimed at correction of metabolic disorders, leading to the formation of kidney stones, independent removal of them and elimination of the inflammatory process. The complex of therapeutic measures includes:
- diet therapy;
- correction of water and electrolyte balance;
- antibacterial therapy;
- balneological and sanatorium-and-spa treatment
Diet and drinking regimen for nephrolithiasis
When appointing a diet, first of all, the chemical composition of the removed stones and the nature of metabolic disturbances are taken into account. To general dietary recommendations include diversity and at the same time the maximum limit of the total amount of food and the use of a sufficient amount of fluid (daily volume of excreted urine should reach 1.5-2.5 liters). As a drink it is allowed to use pure water, cranberry and cowberry fruit drinks and mineral water. At the same time, it is necessary to limit products that are rich in stone-forming substances to the maximum.
Drug therapy aimed at correction of metabolic disorders is prescribed based on the diagnostic survey data. Treatment is conducted by courses, under strict medical supervision. With all forms of nephrolithiasis, anti-inflammatory, diuretic, stone-destroying, analgesic and antispasmodic drugs are used. Antibacterial therapy is also performed, antiplatelet agents, angioprotectors and herbal preparations are recommended.
After percutaneous nephrolitholapaxy, remote lithotripsy of the open operation, instrumental or independent removal of the stone, a course of drug therapy is also conducted. Duration of treatment is established exclusively individually, in accordance with medical indications and the general condition of the patient.
Physiotherapeutic treatment of nephrolithiasis, aimed at normalization of metabolic processes, relaxation of the smooth muscles of the urinary system and elimination of inflammation, includes ultrasound, laser therapy and anelgesic action of various types of pulse current.
To date, the only possible way of prolonged exposure to the human body with medical correction of urolithiasis is with herbs. As a raw material, individual herbs, herbal preparations, as well as phytopreparations made on their basis can be used. Medicinal products of vegetable origin must be selected by a specialist, depending on the chemical composition of the calculus. Such drugs have a diuretic and anti-inflammatory effect, are able to destroy and excrete kidney stones, and also to stabilize metabolic processes in the body.
This method of treatment of nephrolithiasis is prescribed both in the presence of a stone, even after its removal. It should be noted that sanatorium treatment has its limitations (it is carried out if the diameter of the stones does not exceed 5 mm). In the presence of urate, oxalate and cystine stones, patients are sent to resorts with alkaline mineral waters (Kislovodsk, Zheleznovodsk, Essentuki, Pyatigorsk). Phosphate stones are treated with acid waters of mineral origin (Truskavets).
Crushing and removing stones
For today the main direction of treatment of nephrolithiasis is crushing and excretion of stones from the kidneys. This applies to concrements, the size of which exceeds 5 mm.
Note: this technique does not eliminate the cause that caused the formation of stones, and therefore after their removal, it is possible to re-stone formation.
Remote impact on the concrement shock-wave method involves the use of a special device (lithotriptor). Depending on the modification of the device, a powerful ultrasonic or electromagnetic wave smoothly and painlessly overcomes soft tissues and has a crushing effect on the solid foreign body. In the beginning, the stone is broken up into smaller fractions, after which it is unhindered from the body.
Remote lithotripsy is an effective and relatively safe method of treatment, through which a rapid therapeutic effect is achieved. Immediately after the procedure, the excretion of stones is observed during the process of urination. Subsequently, the patient can continue to take medication at home.
Laser crushing is the most modern and safest method, used in the presence of kidney stones of various sizes. At carrying out of procedure the nephroscope entered through a urethra is used. Through it to the kidney is fed a laser fiber, which turns into fragments concrements, the dimensions of which do not exceed 0.2 mm. Further, the sand is easily removed with urine. It should be noted that this is a minimally invasive, absolutely painless procedure that can be used even when removing coral stones.
In urological practice, this technique is used to remove small stones located in the kidney, ureter, bladder or urethra. The procedure is performed on an outpatient basis, i.e. does not require hospitalization. The stone is crushed or excreted by a urethroscope inserted into the ureter, or a nephroscope injected directly into the kidney. It should be noted that this is a rather traumatic technique that requires a high level of professionalism and extensive experience from the urologist.
Percutaneous contact nephrolitholapaxia
This technique, which involves the crushing and extraction of the kidney stone with a nephroscope, is used if the dimensions of the formation exceed 1.5 cm. When carrying out the operation in the lumbar region, a puncture stroke is performed (a cut not exceeding 1 cm in diameter) leading to the lower segment of the kidney. Through it is introduced a nephroscope and miniature surgical instruments used for crushing and extraction of stones.
Surgical removal of stones
At the moment, surgical removal of stones from the kidneys, in view of the high invasiveness of the open surgery, is carried out strictly according to medical indications. This method removes large stones that clog the urinary tract, or completely fill the cup-and-pelvis system. At the same time, surgical intervention can be prescribed for chronic pyelonephritis, which develops against a background of kidney stone disease, with ineffectiveness of lithotripsy, as well as in macrohematuria.
In conclusion, it is necessary to pay attention to the fact that in the presence of kidney stones, no medical technique can be used separately from others, that is, this disease requires an integrated approach to treatment. Within 5 years after removal of concrements the patient should be on dispensary observation, periodically undergo diagnostic procedures and a course of conservative therapy aimed at correction of metabolic disorders and elimination of infection.
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