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Kidney stones: symptoms, treatment

Content:

The most pressing 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 requiring hemodialysis are ICD patients). 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, in clinical terminology referred to as nephrolithiasis, is a polyetiological metabolic disease, manifested by the formation of stones (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 true and well-established until the end. According to experts, there are endogenous and exogenous factors that trigger the development of nephrolithiasis.

Endogenous factors

Stones in the kidneys

  • Hereditary predisposition;
  • Increased calcium absorption in the intestines;
  • Increased mobilization of calcium from bone tissue (metabolic disturbance in the bones);
  • Anomalies of the urinary system;
  • Infectious and inflammatory processes;
  • Disorders of uric acid metabolism and purine metabolism;
  • Dysfunction of the parathyroid glands;
  • Pathology of the digestive tract;
  • Some malignant diseases;
  • Long bed rest due to injury or severe somatic diseases.

Exogenous factors

  • Foods high in animal protein;
  • Prolonged fasting;
  • Excessive intake of alcohol and caffeine;
  • Uncontrolled intake of antibiotics, hormonal drugs, diuretic and laxatives;
  • Hypodynamia (cause of impaired phosphorus-calcium metabolism);
  • Geographical, climatic and housing conditions;
  • Kind of professional activity.


Classification of kidney stones

Mineralogical classification

  1. The most common group of stones (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.
  2. Concretions of infectious nature (15-20%) - magnesium-containing stones.
  3. Uric acid stones, or urates (stones consisting of uric acid salts). Make up 5-10% of the total.
  4. Protein stones that occur in 1-5% of cases due to disorders of amino acid metabolism.
  5. Cholesterol stones (soft stones of black color, not visible on X-rays).

It should be noted that isolated forms of nephrolithiasis are quite rare. More often stones have the mixed (polymineral) structure.

In the event that the origin of kidney disease is associated with the peculiarities of nutrition and composition of drinking water, primary nephrolithiasis is diagnosed. This disease is caused by persistent acidification of urine, excessive intestinal absorption of metabolites and reduced kidney reabsorption.

In pathologies involving metabolic disorders (hyperkalemia, hypercalcemia, hyperuricemia), this is 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. Concrement sizes, denoted in millimeters (<5,> 20), can vary from a pinhead to the size of the renal cavity (coral-shaped stones are capable of forming an impression of the cup-pelvis-plating system). The shape of the kidney calculi can be round, flat or angular.

The mechanism of formation of kidney stones

The mechanism of nucleation and development of nephrolithiasis depends on various factors (urine pH, type of diathesis, excretion of one or another type of salts, etc.). According to experts, the primary formation of stones 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, colloid and bacterial). Some authors note that atypical gram-negative bacteria capable of producing apatite (calcium carbonate) play a major role in the process of nucleation. These microorganisms are detected in 97% of all kidney stones.

Most often, nephrolithiasis is diagnosed in males. At the same time, women are characterized by more severe forms of pathology (for example, coral concrements that occupy almost the entire abdominal system of the excretory organ).

Due to the fact that kidney stones - a disease polietiologichesky, before developing treatment tactics, you must try to find out the cause of the pathological process.

Symptoms of kidney stones

  1. Sometimes kidney disease is almost asymptomatic, that is, a person can find out about his illness only if a stone moves away in the process of urination. However, more often the discharge of calculus is accompanied by pains of varying intensity arising from its progress along the urinary tract (the so-called renal colic). Localization of pain may be different (it depends on the level of fixation of the stone). If the stone is delayed directly at the exit of the kidney, patients complain of pain in the lower back (right or left side). With the delay of calculus in the ureter, pain can be given to the genitals, lower abdomen, inner thigh, or localized in the navel.
  1. Hematuria (the appearance of blood in the urine) is the second most common symptom of urolithiasis. Sometimes the amount of blood secreted is insignificant (microhematuria), and sometimes quite abundantly (gross hematuria). In the latter case, the urine becomes the color of meat slop. The development of bleeding is explained by the fact that the soft tissues of the kidneys and ureters are injured when advancing the calculus along the urinary tract. It should be noted that blood in the urine appears after an attack of renal colic.
  1. Dysuria (urination disorder). Urinary problems (urgency and difficulty urinating) occur when calculus passes through the bladder and urethra. In the case when the stone completely blocks the exit from the bladder to the urethra, the development of anuria (complete absence of urine) is possible. Kidney urostasis (violation of urine outflow) is a fairly 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 up to 39-40 C and other symptoms of general intoxication.

In case of 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 excruciating pain resulting from acute obstruction of the urinary tract.

Coral (cup-pelvis) nephrolithiasis is quite rare, but at the same time, the most severe form of kidney stones, caused by a stone that covers more than 80% or the entire cup-pelvis system. Symptoms of this condition are recurrent pain of low intensity and episodic gross hematuria. Gradually, pyelonephritis joins the pathological process and chronic renal failure develops slowly.

Diagnosis of kidney disease

Diagnosis of nephrolithiasis includes the following activities:

  • history taking (information about past diseases, disease development, living conditions, etc.);
  • laboratory testing of blood and urine (with the obligatory determination of the level of calcium, phosphate, oxalate, and uric acid in the blood and bacteriological analysis of urine);
  • ultrasound of the kidneys;
  • review and excretory urography.

According to medical indications, magnetic resonance imaging or computed tomography with intravenous contrast can be performed.

In the case of self-discharge of calculus, a study of its chemical composition is carried out.

In the process of preoperative preparation, the patient requires consultation of the anesthesiologist, therapist and other narrow specialists.

Kidney stones: treatment

Conservative therapy

Conservative treatment of kidney disease is aimed at the correction of metabolic disorders leading to the formation of kidney stones, their independent elimination and elimination of the inflammatory process. The complex of therapeutic measures includes:

  • diet therapy;
  • correction of water and electrolyte balance;
  • physiotherapy;
  • antibacterial therapy;
  • phytotherapy;
  • physiotherapy;
  • spa and spa treatment

Diet and drinking regime with nephrolithiasis

When prescribing a diet, first of all, the chemical composition of the removed stones and the nature of metabolic disorders are taken into account. The general dietary recommendations include diversity and at the same time, the maximum limitation of the total volume of food and the use of a sufficient amount of fluid (the daily volume of urine should reach 1.5-2.5 liters). For drinking it is allowed to use pure water, cranberry and lingonberry fruit drinks and mineral water. At the same time, products rich in stone-forming substances should be limited as much as possible.

Drug therapy

Drug therapy aimed at correcting metabolic disorders is prescribed on the basis of diagnostic examination data. Treatment is carried out by courses, under strict medical supervision. In all forms of nephrolithiasis, anti-inflammatory, diuretic, expelling, analgesic and antispasmodic drugs are used. Antibacterial therapy is also carried out, antiplatelet agents, angioprotectors and herbal preparations are recommended.

After percutaneous nephrolitholapaxy, remote lithotripsy of open surgery, instrumental or self-removal of the stone, a course of drug therapy is also conducted. The duration of treatment is determined individually, in accordance with the medical indications and the general condition of the patient.

Physiotherapy treatment

Physiotherapy treatment of nephrolithiasis, aimed at normalizing metabolic processes, relaxing the smooth muscles of the urinary system and eliminating inflammation, includes ultrasound treatment, laser therapy and anelgesing action of various types of pulsed current.

Phytotherapy

To date, the only possible method of prolonged exposure of the human body during medical correction of urolithiasis is herbal treatment. The raw materials can be used individual herbs, herbal, as well as herbal remedies, made on their basis. Herbal remedies of plant origin should be selected by a specialist, depending on the chemical composition of the calculus. Such drugs have a diuretic and anti-inflammatory effect, capable of destroying and removing kidney stones, as well as stabilizing metabolic processes in the body.

Spa treatment

This method of treatment of kidney disease is prescribed as in the presence of a stone, and after its removal. It should be noted that the spa treatment has its limitations (it is carried out in the event that 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 acidic mineral waters (Truskavets).

Crushing and stone removal

To date, the main focus of the treatment of nephrolithiasis is the fragmentation and removal of kidney stones. This applies to stones, whose dimensions exceed 5 mm.

Note: this technique does not eliminate the cause that provoked the formation of stones, and therefore, after their removal, re-stone formation is possible.

Remote lithotripsy

The remote impact on the calculus by the shock-wave method involves the use of a special apparatus (lithotriptor). Depending on the modification of the device, a powerful ultrasonic or electromagnetic wave easily and smoothly overcomes soft tissues and has a crushing effect on the solid foreign body. Initially, the stone is broken into smaller fractions, and then freely removed from the body.

Remote lithotripsy is a fairly effective and relatively safe method of treatment, through which a rapid therapeutic effect is achieved. Immediately after the procedure, stones are excreted during urination. Subsequently, the patient may continue medication at home.

Laser lithotripsy

Laser crushing is the most modern and safest method used in the presence of stones of various sizes in the kidneys. During the procedure, a nephroscope inserted through the urethra is used. Through it, a laser fiber is fed to the kidney, which turns into stones fragments whose dimensions do not exceed 0.2 mm. Next, the sand freely displayed with the urine. It should be noted that this is a minimally invasive, absolutely painless procedure that can be used even when removing coral stones.

Transurethral Urethranoscopy

In urological practice, this technique is used to remove small stones, localized in the kidney, ureter, bladder, or urethra. The procedure is performed on an outpatient basis, i.e. it does not require hospitalization. The stone is crushed or excreted using a urethroscope inserted into the ureter, or a nephroscope inserted directly into the kidney. It should be noted that this is a rather traumatic method, requiring high urgency and great experience from the urologist.

Percutaneous contact nephrolitholapaxy

This technique, which involves crushing and removing a kidney stone using a nephroscope, is used if the size of the formation exceeds 1.5 cm. When performing an operation in the lumbar region, a puncture stroke is performed (incision not exceeding 1 cm in diameter) leading to the bottom kidney segment. Through it is introduced 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, due to the high invasiveness of open surgery, is carried out strictly according to medical indications. This method removes large stones that block the urinary ducts, or completely fill the cup-pelvis system. At the same time, surgical intervention can be prescribed for chronic pyelonephritis, which develops against the background of kidney stones, with the ineffectiveness of lithotripsy, as well as with gross hematuria.

In conclusion, it is necessary to pay attention to the fact that in the presence of kidney stones, no medical method can be used separately from the others, that is, the disease requires a comprehensive approach to treatment. Within 5 years after the removal of stones, the patient should be under observation, periodically undergo diagnostic procedures and a course of conservative therapy aimed at correcting metabolic disorders and eliminating infection.


| May 27, 2015 | | 1 436 | Diseases of the genitourinary system
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