Kidney stones( kidney stone disease) - Causes, symptoms and treatment. MF.
Reasons for the appearance of kidney stones
Since renal stone disease is considered a poly-ioiologic disease, several causes are immediately identified that, to some extent, contribute to the deposition of calculi in the kidneys.
Probably the most significant role in the appearance of stones in the kidneys is a metabolic disorder, in particular, uric acid. A similar pattern is observed with gout, when the concentration of uric acid in the blood and urine increases several times. Consequently, all the conditions that lead to the development of gout must be considered as the causes of the development of kidney stones. The most significant in this list is the alimentary factor, which consists in the excessive use of meat, fatty foods, beer and wine in .
An increase in the amount of uric acid leads to the formation of urate stones, while oxalate and phosphoric stones develop because of the increase in the number of oxalates and phosphates, respectively. The causes of the latter conditions can be endocrine pathology, accompanied by an increase in the amount of vitamin D in the blood or the same nutritional factor, but this time with excessive consumption of mineral waters.
As the calculi form in the urinary tract, the mucosal state is also important in their development. In a situation where the mucous membrane of the renal pelvis is damaged, for example, because of the transmitted infectious diseases, the risk of developing renal stone disease rises several times.
Scheme of kidney stones
Symptoms of kidney stones
Symptoms of the disease directly depend on the size of the calculus. The least pronounced picture is observed with small stones and so-called sand. In this situation, the disease can be asymptomatic or manifests a slight pain in the kidney area. As a rule, the pain has a aching permanent character and is strengthened after a strong physical load or a jolting ride. In this case, there can be no changes in urine at all or there is an insignificant amount of blood that can not always be recognized without a microscope.
A more pronounced clinical symptomatology is observed with a large volume of concrements and when they close the lumen of the ureter. In a similar situation, the characteristic signs of renal colic develop. It manifests itself with sharp pains in the area of one or two kidneys, which are supplemented by nausea, vomiting and a significant amount of blood in the urine. When obturation( clogging) concrement of both ureters, there can be a complete absence of urine, which is called anuria.
Naturally, in this clinical picture, self-medication is inappropriate and patients immediately turn to the urologist. But in order to prevent the development of such serious symptoms, it is necessary to periodically be examined by a urologist for the presence of stones in the urinary ducts. This will help to identify diseases in time and take time to treat the latter.
Diagnosis of kidney stones
In a situation where the patient enters the department with a sharp attack of renal colic, the physician should immediately orient in the clinical picture in order to immediately proceed with emergency measures. Naturally, in such a situation, there is little time left for conducting additional studies and they are limited only to anamnesis and objective research of the patient. It is worth noting that the picture of renal colic is quite typical and, often, it is not so difficult to diagnose on the basis of symptoms alone.
In the same situation, when a patient with nephrolithiasis enters the hospital for routine treatment, he is provided with all the necessary spectrum of laboratory and instrumental methods of investigation. Perhaps, the examination begins with the determination of the general analysis of blood and urine .Typically, the first is usually normal, whereas in the second one you can see a different amount of blood and salts, depending on the stage of the disease and the size of the calculus.
Screening methods in the diagnosis of nephrolithiasis are review radiography of the abdominal organs and ultrasound of the kidneys .These two methods give the doctor all the necessary information and an accurate picture of the structure, quantity and position of the stones in the kidney cavity. This is extremely important and necessary to determine the further tactics of managing the patient.
Radiography. Coral bud of the kidney.
If X-rays and ultrasound give accurate information about the amount and structure of stones, they are absolutely uninformative in terms of determining the function of the kidney. For this, a slightly different but also simple and inexpensive method of investigation is used - excretory urography of .The patient is given a contrast in the vein, which is excreted by urine, after which an x-ray of the abdominal cavity is made. Contrast, passing along the urinary ways, indicates the state of the lumen of the latter.
In addition to these methods, computed tomography is often used, although it costs more, but gives much more informative data.
To determine the cause of the disease and exclude concomitant pathologies, provides a complete biochemical blood test for to some patients, which is indicated by the amount of oxalates, urates and phosphates in the blood.
Treatment of kidney stones
Treatment of nephrolithiasis is divided not by emergency care, which is used in renal colic and systemic therapy, aimed mainly at preventing relapses.
For emergency care, drugs from the group of antispasmodics are used, which can be easily purchased at any pharmacy. Such medications as no-spa, spasmalgon, baralgin have a relaxing effect on the ureter wall, which facilitates the passage of the stone into the bladder cavity. The best effect is observed with intravenous administration of drugs, although some doctors insist on intramuscular injection.
In addition to antispasmodics during an acute period, non-pharmacological correction methods are used, which consist in the appointment of a hot bath and a heating pad to a sore spot. The mechanism of action of thermal procedures is about the same as that of antispasmodics.
These activities can only be considered temporary, since renal stone disease has a very high tendency to relapse. The only sure way to get rid of a stone in the kidney is to remove the latter. To date, there are several techniques for such an operation.
When large volumes are used classic nephrotomy , which is used since the days of Nikolai Pirogov. To date, a large number of deficiencies of such an operation have been proved, but with stones of impressive size it remains simply irreplaceable.
As for the current trends in the treatment of nephrolithiasis, ultrasound lithotripsy is considered to be the most effective and least traumatic at this stage of urology development. The essence of the operation is the use of a special apparatus, which by means of ultrasound cuts the stones inside the kidney, and the latter then leave together with the urine.
In unresectable cases, the stent is inserted into the ureter, which acts as a bypass shunt, through which urine outflow from the kidney to the bladder occurs. But it must be remembered that such an operation is only symptomatic and incapable of completely curing the patient. Approximately once a month a patient needs to replace a stent. It is worth noting that the procedure is rather unpleasant and painful.
Nutrition and lifestyle with kidney stones
Kidney stone disease is one of those pathologies, the management and treatment of which occurs under strict diet control. In this situation, a table is appointed for Pevzner, the main essence of which is to reduce the amount of salt consumed, fatty foods and extractives that contribute to the formation of kidney stones. Also strictly controlled water regime, in order to not heavily load so the affected organ.
Rehabilitation after illness
In the case of an operation, patients with nephrolithiasis need exactly the same rehabilitation as all other patients after surgery. In a remote period, such patients are recommended to visit special resorts, where mineral and mud treatment of kidney stone disease is performed. Basically, such resorts are located in the mountainous area, where there are natural springs of mineral waters.
Treatment of kidney stones with folk remedies
As practice shows, patients with kidney stone disease resort to folk methods of treatment only before the onset of the first attack of renal colic. Considering the situation in general, it can be noted that none of the schemes of folk treatment, which are used for kidney stones, does not have a positive effect in the final result. A variant of the exception can be considered the use of decoction of field horsetail in the early stages of the process of formation of stones.
Complications of kidney stones
The most formidable complication of nephrolithiasis is bilateral bilateral renal colic. In a situation where it is accompanied by stagnation of urine in both kidneys, the pathological products of metabolism are released into the blood. This is accompanied by a deterioration in the general condition of the patient and the appearance of symptoms from the nervous system. A critical point in the development of renal encephalopathy is renal coma, which, as a rule, results in a fatal outcome.
No less dangerous complication is infection of the kidney, which is promoted by the presence of concrements. In a similar situation, pyelonephritis develops, which can be complicated by a kidney abscess or even purulent inflammation of the perineal tissue.
Prevention of nephrolithiasis
Prevent the formation of kidney stones only if you adhere to a constant strict diet, lead an active lifestyle, be protected from hypothermia and infection of the genitourinary system. It is worth noting that, intentionally, prevention of kidney stone disease, unfortunately, is carried out very rarely by patients. As a rule, it is used only in those cases when the patient has confirmed the initial stage of the disease, there is an increased amount of salts in the urine or he has had surgery on this matter.
Rev.doctor urologist Astashin Е.Е.