Urolithiasis: coral stones in the kidneys
Among all the concrements in kidney stones, coral stones in the kidneys occupy a special place. Not only in its significance, as the most dangerous manifestations of pathology. They are formed with the direct participation of bacteria, and, therefore, have not only an exchange, but also an infectious nature.
Short characteristics of urolithiasis
As a basis of the disease, there are disturbances in the metabolism of many certain substances. Because of what occurs the formation of insoluble stones. They are the sources of all clinical manifestations of this pathology.
- Pain. Wear a pulsating character or aching character. Localized in the area of the projection of the location of the calculus. The smaller the lumen of the cavity, the larger the concrement and the more it moves, the higher the intensity and severity of pain.
- Dysuric phenomena. Various disorders of urination: increased frequency, decrease and presence of impurities. First of all, we are talking about hematuria( blood impurities).
- Systemic manifestations. Directly depend on the severity of the pain syndrome. For example, with renal colic, nausea can be disturbed right up to vomiting. Pallor and tachycardia, a sense of fear.
All causes of the disease are divided into internal and external. The first are related to the internal state of the body. These are diseases of the kidneys, gastrointestinal tract, endocrine glands and systemic metabolic disorders. Equally important is hereditary predisposition. Among the external reasons, the quality of drinking water and the ecological situation have a proven impact. Presumptive negative impact has heavy physical activity and prolonged immobilization.
Composition and pathogenesis of coral stones
This is important! Almost all concrements are formed as a result of metabolic disturbances. Only a small part, among them coral or coral stones in the kidneys, are formed with the direct participation of bacterial enzymes.
The name coral occurred on the external similarity of the concrement with colonies of coelenterates( corals).This occurs as a result of the fact that the process of forming stones covers the entire cavity of the pelvis and "penetrates" into the calyx.
From a purely theoretical point of view coral concrements can result from any compound that can form insoluble substances. However, almost always calcium salts, ammonium phosphate take part in the formation of these concretions. And the combination of these substances occurs under the action of urease - an enzyme of a bacterial nature. Therefore, these stones in another way are also called struvite stones.
Clinic In most cases, the detection of coral stones occurs with an ultrasound examination for preventive examinations or ultrasound of the kidneys in order to detect any other pathology.
This is due to the peculiarity of the process of formation of stones. Although they grow fast enough( sometimes an increase to the size of the kidney sinus occurs in a few months and even weeks).At the same time, the risk of digression of the calculus is very minimal. It means that the development of renal colic practically does not happen.
On the other hand, concrement gradually leads to the development of renal failure. Therefore, running a little forward, it should be noted that the treatment of coral stones in the kidneys almost always occurs by methods of surgical intervention. But more on this later. The main thing - concrements become the main cause of development of renal failure due to worsening urodynamics.
Thus, often the only manifestation of coral-like formations is the development of renal failure. Pain in the lower back, if they are, are aching and / or bursting;are localized in the area of the projection of the kidneys and are not expressed in character. Sometimes patients hardly notice it or just experience temporary discomfort, which does not make them consult a doctor.
Methods of treatment
As already mentioned, the treatment of coral stones in the kidneys is mainly performed by surgical methods. And most doctors prefer open methods. That is, through the surgical stratified incision of the tissues and exposure of the calculus. Sam concrement hands. This is largely due to a number of reasons.
- The composition of the concrement does not allow to "dissolve" its preparations and diet.
- Exposure to ultrasound creates the risk of its displacement with damage to the kidney. In addition, its fragments can clog the ureter and even lead to its rupture.
- The presence of branching creates additional "fixation points".Therefore, the extraction of stones must be extremely cautious. This is best done by the surgeon's hand.
In connection with all of the above, the most acceptable operation is lumbotherapy with subsequent utero and nephrotomy. The cut is made in the area of the corresponding side. After that, all tissues are cut layer by layer and the kidney is excreted. And it should be fully allocated. Then the sinus is opened by a longitudinal section. At the same time, the uppermost part of the ureter is cut. And only after this, the extraction of the stone is made. If necessary, it can be destroyed in part. But to perform these manipulations must be very cautious.
The postoperative period can be quite long. Since very often you have to resort to setting nephrostomy. Special thin drainage is stitched into the cavity of one of the cups. Then the other end of the tube is led out. This is done to reduce the compression that occurs when there is a coral stone. If the operation ends with a nephrostomy, after some time, a repeated one will be performed, the purpose of which is to restore the normal outflow of urine. During this intervention, nephrostomy is removed.
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