Symptoms of kidney stones and methods of their treatment
Many factors of modern life contribute to the development of urolithiasis, and absolutely everything suffers this pathology. Among predisposing factors, hypodynamia, eating habits, metabolic disorders, unfavorable ecological conditions come to the fore. Consequently, there is no single cause for the development of this pathology, in this case affects a whole set of factors, both external and internal.
From endogenous causes, infectious lesions of the genitourinary system, which in most cases lead to a violation of urinary outflow and ischemic events in the renal parenchyma, should be mentioned. An important role is played by hereditary and acquired tubulopathies, abnormalities in the structure and location of the kidneys, endocrine pathology.
There is a somewhat greater predisposition of the male population to this disease, however, in women, the disease is much heavier and with more stones. At the moment, doctors adhere to several theories of stone formation in the kidneys, but none of them sheds full light on the mechanisms of urolithiasis. It is established that urolithiasis refers to multifactorial diseases, which occurs with a large number of physico-chemical changes in blood and urine.
Types of kidney stones
To date, the mineralogical structure of practically all stones that occur in the urinary system is well known.
Most of the stones contain inorganic calcium compounds. These include:
Those stones that contain magnesium salts are relatively rare and often are accompanied with an infectious urinary tract infection. This type of stones is more common in older people.
To even more rare are cystine and xanthine stones. They occur in people with disrupted metabolism of proteins, and in particular amino acids, and account for less than 1% of all cases of urolithiasis.
The most common type of stone is mixed or polymineral. Such stones are heterogeneous in their composition and are represented by several types of organic and inorganic compounds. Basically, they are accompanied by urinary tract infections and metabolic disorders.
The primary process of stone formation usually begins in the collecting canaliculi of the kidneys or in the pelvis. First, the core of the stone is formed, and then a layering of various crystals occurs on it. The growth of the stone occurs both due to the growth of the core itself and due to peripheral growth due to the settling of new crystals on it. In one stone, it is possible to find several layers of dissimilar structure. This fact is evidence of joining the urinary infection.
Clinic of urolithiasis
It is thought that chronic pyelonephritis is thought to precede urolithiasis, but it can not be called the root cause in all cases.
The severity of the clinical picture depends on many factors - the duration of the existence of kidney stones, their shape and size, their location.
But wherever the focus of urolithiasis is, the symptoms of kidney stones are always accompanied by pain. Its intensity and character depends on the location of the calculus. So, with the location of the stone at the level of the waist or abdomen, the pain may be paroxysmal or permanent, if the stone is localized in the bladder - the pain will be of a cramping character, may give in the groin, thigh or genitals. The pain is most pronounced when the calculus is located in the pelvis of the kidney or when it passes through the ureter. Painful progress is usually caused by stones more than a centimeter in diameter, the rest can go out on their own with urine.
Renal colic is usually caused by stone movement and spasm of muscle fibers caused by this movement. Colic has very characteristic features:
- Strong paroxysmal pain in the lumbar region;
- Rapid urge to urinate, while urine may not go out at all or be excreted in droplets;
- Tension of the abdominal muscles;
- Dyspeptic reactions - nausea, urge for vomiting, temporary constipation;
- Febrile state;
- The patient rushes on the bed - no posture brings relief.
The stone usually moves from its place after lifting heavy weights, careless and abrupt movements, strong jumps or long driving( especially on uneven roads), injuries to the lumbar region, excessive fluid intake. These factors have an irritating effect on the tissue of the kidney and ureter, in response they react with reflex spasm and "shift" the stone from its place. Sometimes the cause of colic is not the output of the stone, but the excretion of a large amount of "sand" - very small crystals.
However, not all stones make themselves felt, in some cases they exist for years and are found accidentally with ultrasound of the kidneys for another disease of the urinary system.
How the kidney stones
are defined The definition of renal colic is not difficult. In the urine, blood will always be present( micro- or macrohematuria).If blood is not found in the analysis, it is usually regarded as an indirect sign of the obstruction of the lumen of the urinary tract by concrement. In case the urine is heavily stained with blood, it means that traumatization of the mucous membrane of the pelvis or ureter occurred during the movement of the stone.
More than half of the cases except for hematuria in the urine are found leukocytes in large quantities, up to pyuria, but this characteristic is not considered characteristic of renal colic and indicates the presence of severe inflammation in the kidneys.
About how the kidney stones look, there are whole stories, first of all it is due to their rather bizarre shape and the difficulties of their exit from the urinary tract. The released calculus is usually examined with the help of spectral analysis and optical crystallography, in order to determine its structure.
On the overview radiographs of the kidney stones are fairly well visualized in the form of various shadows of various shapes and all kinds of localization. Kidney stones can also be determined with contrast urography. In this case, a special X-ray contrast substance is introduced and, with the help of successive radiography, it is monitored for its progress in the urinary system. Where there is a calculus, usually there is a complete or partial stasis of the X-ray of the contrast medium, which indicates the presence of an obstruction.
With ultrasound of the kidneys, the picture can be very different, but in most cases, with renal colic, an expansion of the urinary tracts over the zone of localization of the calculus is detected.
Also, an auxiliary research method is Doppler study of kidney vessels. The main feature of kidney stones in this study is a change in the ratio of blood flow velocity in the obstruction zone. Another method that makes it possible to determine the state of microcirculation is the method of radiothermometry. With renal colic, there is a local spasm of the vessels in the area of the stone location, respectively, here, and temperature changes.
All these methods allow not only to reveal and specify the location of concrements, but also to outline the tactics of treatment.
How to treat urolithiasis
It is extremely important during treatment of urolithiasis to try to eliminate the root cause of the disease. All methods of treatment are divided into conservative and surgical. Surgical measures are usually passed only in extreme cases, when conservative measures did not lead to an improvement in the condition.
The main place is occupied by preparations for litholitholysis - dissolution of stones, removal of spasm of muscle fibers and elimination of inflammatory phenomena. Also phytopreparations and herbal preparations are used( madder dye, cowberry, parsley, St. John's wort, rue, bearberry, burdock, ayr, birch leaf, dill, strawberry, horsetail), which enhance the effectiveness of tableted products.
The following are the most commonly prescribed herbal remedies for the treatment of kidney stones:
These are complex phytopreparations having diuretic, antispasmodic, litholytic, antimicrobial and anti-inflammatory effects. Usually they are prescribed for 1-2 tablets( 15-20 drops or 1/2 teaspoon of the paste diluted in a glass of water) for half an hour before each meal, the course can last up to three months. When treating these drugs is mandatory to comply with diet and proper drinking regimen. If necessary, the course of treatment can be repeated several times a year.
Also, depending on the type of stones, various medications can be prescribed:
- With the urinary acid structure of the stones:
- A mixture of Eisenberg;
- With calcium urolithiasis:
- Methylene blue;
- Furosemide( according to Tiktinsky scheme).
- With oxalate stones:
- Vitamin B6;
- With oxalate-urate concretes:
- With a mixed structure of stones:
- Mareni dyeing;
- Cystenal, enatin, olimetin
For the expulsion of stones in renal colic, a warm bath of no more than 42 ° C, intravenous injection of baralgina or intramuscular injections of no-shpa, papaverine with platyfilin can be used as an antispasmodic.
In case of ineffectiveness of conservative methods operative treatment by one of the following methods is shown:
- shock wave lithotripsy;
- endourological method;
- traditional surgical methods - use only in the presence of coral stones, acute pyelonephritis and edema of the kidney.
Laparoscopic and endoscopic stone removal operations have recently become widespread. The main methods of surgical treatment at the moment are remote lithotripsy, percutaneous dissolution and removal of stones, which can be combined with each other or reinforced with the treatment of kidney stones with the help of medications. Also used is contact litholysis combined with laser treatment of stones. Such treatment has multiple effects - analgesic, decongestant, stimulating the immune system, improving microcirculation and nutrition of the kidney tissue.
What kind of treatment of kidney stones to choose depends largely on the shape of the calculus, its location and size. Naturally, the smaller the stone, the easier it is to extract and the less traumatic methods of treatment are used. The laser method is most preferable, because it can destroy stones of any structure and localization. As for the treatment of kidney stones by ultrasound, it is used in cases of the size of the calculus not more than 2 centimeters. At large sizes, contact crushing of stones or open surgical methods is indicated.