Kidney stone disease, treatment, symptoms. Kidney stones
Human health largely depends on the activity of the urinary system. After all, it is the kidneys that remove metabolic products from the body, and any disruption to their work quickly affects one’s well-being. So, in some cases, concretions - stones - begin to be deposited in these organs. Doctors call this condition kidney stone disease, the symptoms and treatment of which we will now consider on this page www.site, and also discuss possible complications and folk remedies, which can be used to correct such a disease.
Symptoms of kidney stones
The signs of this pathological condition largely depend on the size of the stones. So, if we are talking about small formations or sand, the disease may not make itself felt at all. Sometimes the disease can manifest as minor pain in the kidney area. In most cases, the pain is characterized by a constant aching character; it can intensify with severe physical exertion or shaking. In this case, absolutely no changes may be observed in the patient’s urine; sometimes a small amount of blood can be seen in it, which can only be recognized by microscopic examination.
If the stones are large in volume or cover the lumen of the ureter, they cause more severe symptoms. With such a course, the disease becomes the cause of renal colic. This pathological condition makes itself felt by pronounced painful sensations of a sharp type, which are localized in the area of one kidney or in the area of both organs. With renal colic, the patient also experiences an unpleasant sensation of nausea, vomiting and a significant amount of blood in the urine. If obstruction (blockage) of both ureters occurs with stones, the patient completely stops urinating. This pathological condition is called anuria.
Of course, if kidney stones develop, you should immediately seek doctor’s help.
Treatment of kidney stones
Therapy for kidney stones may include emergency care(for renal colic), as well as systemic therapy (aimed at preventing relapses).
To provide emergency care, the patient is mainly prescribed antispasmodic medications; they can be easily purchased at any pharmacy. Such remedies are presented, etc., they effectively relax the walls of the ureter, due to which stone formations easily pass into the bladder. Gives a wonderful effect intravenous administration antispasmodics, they can also be administered intramuscularly.
The patient is advised to apply a heating pad to the sore spot, and hot baths will also be beneficial. Such remedies also help relax the ureters. In addition, analgesics can be used.
It is worth noting that such medications provide only a temporary positive effect, since kidney stones often recur. Successful removal stone removal is only possible through surgical intervention.
There are several types of surgical correction. Ultrasound lithotripsy is considered the least minimal intervention. With this therapy, doctors use ultrasound to crush stones inside the kidney, and the remaining stones are then successfully excreted along with urine.
If the stones are large, a more serious surgical correction is performed, for example, nephrotomy.
Conservative treatment methods
Therapy for kidney stones may include diet selection depending on the type of stone. Can also be used vitamin preparations and some medications, they are selected exclusively by the doctor, focusing on the type of disease.
How traditional medicine kidney stone disease is corrected (treatment with folk remedies)
Patients with kidney stones should take medications based on. To prepare one of them, you need to crush a glass of seeds, then combine the resulting raw material with three glasses of homemade milk and boil until the volume of such medicine is reduced three times (to one glass). The strained medicine should be taken in small portions throughout the day. Take for five days.
The reception also gives a wonderful effect. One gram of this substance must be dissolved in a liter of cool, pre-boiled water. Take a tablespoon three times a day immediately before meals for a week and a half. The duration of such therapy is five days. Take three or four courses.
Combine ten teaspoons of crushed sorrel seeds with half a liter of Cahors and leave for five days. Take a teaspoon three times a day, about half an hour before meals.
For the treatment of kidney stones, it is worth combining the juice of one lemon with half a liter of hot water. Take this drink several times a day.
Also, taking carrots and beet juice, connected in a 2:1 ratio. Take half a glass three or four times a day.
What are the risks of kidney stones and what are the complications from it?
Classic complications of kidney stones include pyelonephritis, renal failure, hydronephrosis and arterial hypertension. Successful correction of kidney stones helps prevent such unpleasant and dangerous conditions.
We talked about how kidney stones are treated, folk remedies and medications were given. Folk remedies, diet and drug treatment can contribute to the dissolution and removal of stones from the kidneys. Do not hesitate to contact a medical facility immediately regarding any pain.
Definition
Kidney stone disease(nephrolithiasis) is a common disease that tends to be endemic. With kidney stones, stones form in the kidney calyces and pelvis. They can also be in the lower urinary tract.
Causes
The development of this process is facilitated by both local factors (impaired formation of colloids by renal cells, the phenomenon of secretory neurosis of the kidney, the presence of additional vessels and anomalies that cause urination problems, urinary tract infections, changes in urine pH) and general factors (dietary regimen, use of certain medications, composition drinking water, development of nephrolithiasis in osteopathy, long-term immobilization in case of bone injuries, etc.).
Factors contributing to the development of kidney stones are congenital and acquired changes in the urinary tract, which disrupt normal urination and cause urinary stasis; various neurogenic dyskinesias and urinary tract infections; metabolic disorders (urate, purine, oxalate and phosphorus-calcium diathesis). Undoubtedly, heredity plays some role. Almost every tenth patient had kidney stones in their parents. Nephrolithiasis is found together with other metabolic diseases (diabetes mellitus, cholelithiasis, gout, obesity) in certain families. Great importance is attached to the nature of nutrition (excessive nutrition with consumption of food containing a lot of calcium and little retinol), the use of too mineralized drinking water, when a large amount of mineral salts enters the body. Of great importance are also climatic conditions. In areas with a hot, dry climate, increased fluid loss occurs, which causes a significant concentration of urine. The development of nephrolithiasis is facilitated by prolonged immobility, especially associated with bone fractures, tuberculosis of the bones and spine, which leads to an increase in calcium in the blood, and hypervitaminosis A contributes to the deposition of salts in the kidneys.
The endocrine system (pituitary gland, thyroid gland and especially the thyroid glands) also plays a certain role in the development of nephrolithiasis. With hyperfunction of the parathyroid glands, hypercalcemia, hypercapciuria, and hyperphosphaturia are observed, which can contribute to the formation of kidney stones. An increased concentration of calcium salts in the urine can contribute to the formation of oxalate and phosphate stones. This is also facilitated by a decrease in the content of protective hydrophilic colloids in the urine, as well as an increase in the content of mucopolysaccharides and mucoproteins. Increased concentration in urine is of great importance for the formation of urate stones. uric acid and increased urine acidity. When there is an insufficient amount of protective colloids, several molecules group together and form mycelia, which become the basis for further stone formation. The formation of stones depends on the concentration of salts in the urine, the concentration of hydrogen ions and the composition of urinary colloids. The chemical composition of stones is different, it can be homogeneous or mixed. There are oxalate, urate, phosphate, carbonate, cystine, xanthine, cholesterol and mixed stones. When urine is acidic, urate stones are formed, and when urine is alkaline, phosphate stones are formed. Oxalate compounds can be formed during both alkaline and acidic reactions. The presence of stones can cause secondary changes in the kidneys such as pyelonephritis, pyonephrosis, etc. The development of complications depends on the location of the stone, its size, mobility, and the length of time the stone remains in the kidney.
Symptoms
A characteristic manifestation of renal stone disease is an attack of renal colic, which is manifested by pain, hematuria, pyuria and spontaneous passage of stones during an attack. Pain in the form of acute attacks causes migration of stones, disruption of the normal outflow of urine and spastic contraction of the ureteral muscles. In the presence of large stones (staghorn), a constant dull pain occurs. Increased intrapelvic pressure and stretching of the kidney capsule, which is rich in nerve endings, also contribute to the appearance of pain. Renal colic is accompanied by fairly typical pain in the lower back, radiating along the ureters and into the genitals. The pain is accompanied by frequent painful urination, flatulence, vomiting, and agitation of the patient. An attack can occur without any noticeable cause, but is often preceded by shaking, driving, or physical overload. Sometimes reflex anuria occurs. The pain is often one-sided, but can also radiate to the opposite side, where it can sometimes be more pronounced. Fever of the wrong type is quite often present, which is explained by the pyelovenous reflex. Sometimes the pain radiates extremely widely, covering the entire abdomen. The location of pain, its radiation and duration may be atypical. Typically, an attack of renal colic lasts no more than 1 day. It can be short-lived, and sometimes, on the contrary, long-term. After an attack, there may be no manifestations of the disease, but sometimes there may be a dull pain in the lower back, minor microhematuria. An objective examination of the patient during an attack reveals significant pain in the lumbar region, sharp pain on palpation of the kidney area and along the ureter, Pasternatsky’s sign is positive.
An important symptom of the disease is the appearance in the urine, after an attack of the disease, of unchanged red blood cells, and sometimes macrohematuria. Hematuria is observed in almost all patients with nephrolithiasis (92%) at the end of the attack or immediately after its end. It is caused by damage to the mucous membrane of the urinary tract and small capillaries of the submucosal membrane. Slight proteinuria and leukocyturia are detected in the urine. Pyuria is caused by an inflammatory process in the kidneys and urinary tract. In the peripheral blood during attacks, slight leukocytosis with a shift to the left of the leukocyte formula and a moderate increase in ESR are manifested. The intervals between attacks can vary; sometimes the period without attacks lasts for many years.
An asymptomatic course of the disease is observed in approximately every tenth patient, and then diagnosis is based on additional research methods, such as urography or ultrasonography, or pay attention to this when identifying hematuria. There is no parallelism between the size of the stones and the clinical course of the disease, but pain attacks more often occur in the presence of numerous small stones, and large stones are more common with pyelonephritis. The course of kidney stone disease is generally favorable. Sometimes, after a single attack of the disease, no relapses are observed.
The most common complication of the disease may be the addition of an inflammatory process in the kidneys and urinary tract - chronic pyelonephritis with a corresponding clinical picture (fever, lower back pain, changes in urine, increased AT). Even more unfavorable is the addition of apostematous nephritis, and in the case of blockage of the ureter - the development of hydronephrosis and pyonephrosis.
With renal colic, acute oliguria and anuria can develop. Excretory anuria can occur with bilateral nephrolithiasis and bilateral occlusion. Bilateral stone formation can lead to the development of renal failure.
Classification
There are several types of stones located in different areas urinary system:
- Cystine stones: which are rare, are located mainly in the kidneys.
- Calcium oxalate stones: form and develop as a result of living in a certain area; it most often forms in people living in humid, hot climates. They develop in the urinary tract and kidneys.
- Uric acid stones: develop in the urethra and bladder as a result poor nutrition(diet).
Diagnostics
Diagnosis of kidney stones, in typical cases in the presence of attacks of renal colic, especially during the passage of kidney stones, is simple. Additional research methods such as urography and ultrasound significantly help in correct diagnosis. Sometimes, in the case of an atypical course of an attack of colic, it is necessary to carry out differential diagnosis with acute cholecystitis and acute appendicitis. It should be noted that with damage to the biliary tract there is a tendency for pain to irradiate upward - into the shoulder blade, neck, and with renal colic downward - into the genitals, more typical with dysuric phenomena. With appendicitis and cholecystitis, in contrast to renal colic, irritation of the peritoneum is observed. Differential diagnosis with renal infarction is more difficult.
In addition to survey urography, excretory urography and ultrasound, if the disease cannot be diagnosed, retrograde pyslography, isotope renography, ultrasound scanning and computed tomography kidney
Prevention
Treatment of kidney stones includes treatment of an attack of renal colic and treatment in the period between attacks. Treatment during the acute period does not depend on the composition of the stones, but in the period between attacks it should be differentiated depending on the composition of the stones. The first priority during an attack of renal colic is pain relief.
If stone passage is impossible, surgical treatment is used. The latter is also indicated for frequent attacks of renal colic that do not respond to conservative treatment; kidney blockade caused by a stone; ureteral stones that do not migrate; stones in a single kidney.
During the interictal period, proper nutrition is important. With uric acid diathesis, you need to limit the consumption of foods rich in purine compounds (fried meat, broths). Patients are prescribed a dairy-vegetable diet. For oxaluria, products are recommended that remove oxalate salts and help increase alkalinity. For phosphaturia, it is recommended to consume meat products that increase the acidity of urine. If you have urate stones, limit the consumption of foods containing purines. The formation of stones is promoted by a disorder of calcium metabolism caused by adenoma of the parathyroid glands. In this case, surgical treatment of the adenoma is indicated.
All patients should drink more fluids (800-2000 ml per day).
To prevent stone formation, a number of herbal preparations are also used that contain soluble silicic acid compounds (field pine, common knotweed). Cystenal is widely used - a complex preparation consisting of tincture of moraine rhizome, magnesium salicylate, essential oils, ethyl alcohol and olive oil. To eliminate an attack of renal colic, up to 20 drops of this drug with sugar are prescribed in the period between attacks.
Kidney stones are often complicated by a urinary tract infection. In this case, appropriate antiseptic therapy is used, as for pyelonephritis. Treatment at resorts is indicated for patients who have undergone surgery to remove stones, as well as for patients with small stones, when there is hope for the stones to pass on their own. Treatment in Truskavets with its low-mineralized water Naftusya, as well as in the resorts of Transcarpathia, gives the best results.
Urolithiasis disease (other names - nephrolithiasis , kidney stones , urolithiasis ) is a disease during which a person develops stones in the kidneys or other organs of the urinary system. Symptoms of urolithiasis can first appear in a person at almost any age. As diagnostics indicate, the disease can develop in both newborns and the elderly. But depending on the age of the sick person, the type of stone differs. Thus, older patients are more likely to develop uric acid stones . At the same time, protein stones are found much less frequently in patients who require treatment for urolithiasis. Most often, with urolithiasis, stones with a mixed composition are formed. The size of the stones may vary. So, if we are talking about stones up to 3mm in diameter, then it is not stones that are determined, but sand in the kidneys. Sometimes large stones can reach up to 15 cm. There are also descriptions of cases where stones weighed more than 1 kg.
Causes of urolithiasis
Before prescribing therapy for a disease or practicing treatment with folk remedies, if possible, one should determine the probable causes due to which a person has signs of urolithiasis. The main reason for the appearance of kidney stones is serious disturbances in the metabolic process, in particular changes in the chemical and water-salt balance blood. But at the same time important role The presence of certain factors predisposing to the formation of stones plays a role in the development of the disease. First of all, this is the development of gastrointestinal diseases in humans, as well as organ ailments genitourinary system, bone diseases, dysfunction of the parathyroid glands. Vitamin deficiency can also provoke the appearance of stones. It is especially important to make up for the deficiency vitamins of group D , therefore, even disease prevention involves taking them.
Nutrition is an equally important factor. Stones appear more often in those people who consume foods that can significantly increase the acidity of urine. That is why, in case of urolithiasis, salty, sour and too spicy foods are turned off. Another important point is the water that a person regularly consumes. If it is too hard and contains more salts, then the likelihood of stones increasing. More often, stones are found in people who constantly live in very hot climates. But lack of exposure to ultraviolet rays can provoke urolithiasis. During the diagnostic process, the doctor not only prescribes necessary methods research, but also finds out what exactly could have triggered the onset of the disease. Both drug and alternative treatment should be carried out taking into account these reasons.
Symptoms
In most cases, kidney stones manifest themselves with signs that a person cannot help but notice. But sometimes the disease is hidden, and kidney stones can only be detected by chance, when other diseases are diagnosed and treated.
The main symptoms of urolithiasis are the manifestation painful sensations in the lumbar region. A person may experience pain on one side or both. The pain is dull but exhausting; it intensifies with physical activity or when the patient tries to change body position. If a kidney stone ends up in the ureter, the pain becomes more intense and affects the lower abdomen, groin, and genitals. Sometimes it hits my leg. A very severe painful attack often ends with the passage of stones in the urine.
Patients with urolithiasis periodically suffer from. This is a condition in which incredibly severe pain develops in the lower back area. Colic can even last for several days, while the pain subsides a little, then resumes again with new strength. The attack stops when the stone changes position or goes into the bladder.
If you have kidney stones, a person may feel pain when urinating, and may also urinate too frequently. In this case, it can be assumed that there are stones in the ureter or bladder. During urination, the urine stream is sometimes interrupted, and the patient does not feel the bladder completely empty. Doctors define this symptom as “stuffing” syndrome. If a person changes his body position, urination continues.
After a painful attack or physical exertion, blood may be found in the patient’s urine. Also, urolithiasis is characterized by cloudy urine, periodically occurring high arterial pressure. If pyelonephritis is added to the disease, the patient’s body temperature can increase to 38-40 degrees.
Sometimes stones or sand in the kidneys are present in a person throughout his life, and no symptoms appear. Consequently, the patient may not even know about his illness. In general, the symptoms directly depend on the size and type of stone the patient has, where exactly the stone is located, and what problems are observed in the functioning of the genitourinary system. Treatment of sand in the kidneys and stones in the genitourinary system is also carried out taking into account these factors.
Thus, the main objective symptom of urolithiasis is kidney stones. Symptoms of kidney stones are, first of all, cloudiness of the urine, the presence of sediment in it, a change in character (dark and thick urine appears at the beginning of the urination process).
What stones have formed in a person’s kidneys can be determined additional research. They may have different composition. Highlight phosphate, calcium And oxalate stones in the kidneys. But still, diagnostics indicate that most often stones with mixed type.
Removing kidney stones
- the main point of treatment. But initially the doctor must determine all the features of the disease and only then decide what to do. It is important to consider that at the very beginning of the disease, stones may not manifest themselves at all. In this case we are talking about the so-called stone-bearing. But even in this case, it is important to identify the disease and determine how to remove the stones, since at any moment they can provoke. The reasons that influence the manifestation of symptoms are varied: severe stress, a disrupted diet, and intense physical activity. By the way, in most cases, renal colic is caused by small stones. But the presence of large stones in the kidneys, the photo of which is especially impressive, is no less dangerous, since this is a direct path to development renal failure
and kidney death. Therefore it is extremely important point is to conduct a high-quality diagnosis with all the studies, from where the doctor can learn about the characteristics of the disease, and subsequent treatment. Prevention of the disease in those who are prone to stone formation also deserves special attention.
Diagnostics
There are a number of diagnostic methods with the help of which diseases of the urinary system are detected by specialists in the early stages. But the awareness of patients is also important here. Every person, when the first symptoms of pathologies of the genitourinary system appear, should consult a doctor, since he himself will not be able to understand whether he has stones in his kidneys, ureter or bladder.
After interviewing the patient, the urologist prescribes the necessary examination. First of all, a laboratory analysis of urine is carried out to determine the presence of microbial infection, the presence, and also to learn about the nature of salt impurities. Using a general blood test, inflammatory processes are detected. In addition, it is carried out. One of the most important tests for suspected kidney stones is a kidney ultrasound. However, in some cases, ultrasound still does not make it possible to determine the presence of stones in the ureter, since they may be located deep behind the peritoneum.
In order to detect stones, the patient is often prescribed excretory urography. To do this, a contrast agent is injected into a vein, after which x-rays. Studying a general image of the urinary system allows the doctor to identify exactly where the stones are located and find out what their shape and size are. But at the same time, the specialist takes into account that some stones can be missed X-rays. As a result, they are not visible in the photographs.
Another research method is radioisotope nephroscintigraphy . The procedure begins with the injection of a special radiopharmaceutical into a vein. It accumulates in the kidneys and is then excreted through them. At this time, the kidneys are scanned, which makes it possible to determine whether their functions are impaired. The study is informative for a specialist.
Treatment
Renal nephrolithiasis must be treated in several stages. In patients with acute pain, it is necessary, first of all, to relieve the attack acute colic. Further treatment includes stone removal, therapy infectious process and preventing the development of stones in the future.
Kidney stones are treated conservative And operational methods. The conservative method of therapy includes drug treatment, as well as a strict diet and a certain drinking regimen. However, pill therapy, as well as some folk remedies, can be effective if the patient has only very small stones or sand in the kidneys. The drugs prescribed by the doctor in such cases help dissolve kidney stones and sand. However, in no case should such drugs be used without the supervision of a specialist. It is he who must decide how to treat urolithiasis and how to dissolve stones. When practicing traditional treatment, the patient should also first consult with a doctor, since any traditional medicine can negatively affect the patient’s health.
If an inflammatory process has begun in a person with kidney stones, then antibacterial treatment is mandatory. After this, the doctor decides how to remove the stones.
In modern medicine, stone crushing is practiced using a laser. Laser treatment involves a combination of endoscopy and the use of the laser itself.
The endoscope is inserted into the urethral canal, after which crushing is carried out with a laser attachment. The method is not painful and sometimes allows you to remove stones in just one procedure. In addition, it can be used to get rid of stones of different shapes and sizes.
The crushing of kidney stones is also carried out using the capabilities of ultrasound. In this case, the shock wave crushing principle is used, which is provided by a special apparatus. Ultrasound crushing makes it possible to remove stones whose diameter does not exceed 2 cm. The patient is treated, and the stones are crushed to such an extent that they can pass through the ureter without difficulty. When crushing large stones, several such procedures are required. Negative influence Ultrasound has no effect on the body as a whole.
If a person has large stones and there are certain complications, then surgical treatment is practiced by performing abdominal surgery. This is the most traumatic method.
The doctors
Medicines
Prevention
As a measure to prevent urolithiasis, it is necessary balance your diet to make it as healthy as possible. You should drink at least two liters of fluid per day and under no circumstances allow the lumbar area to become hypothermic. It is also worth taking care to get rid of. If a person feels that there are swellings in the lumbar region discomfort or pain, then under no circumstances should you delay your visit to the urologist.
Diet, nutrition for urolithiasis of the kidneys
For patients diagnosed with urolithiasis, it is very important to constantly adhere to a special diet. The patient’s diet is developed depending on the composition of the stones and what reasons provoked the development of urolithiasis. Nutrition is organized so that the diet contains a minimum of foods that contribute to the formation and growth of stones.
If a person is diagnosed phosphate urolithiasis , then an alkaline reaction of urine is noted. Therefore, it needs to be acidified. Such patients are not recommended to eat a lot of vegetables and fruits, and dairy products should not be included in the diet. Recommended meat, fish, vegetable oil, flour. You need to drink a little less than when oxalate and urate stones are detected.
If found carbonate stones
, then it is important for the patient to limit the consumption of foods that are rich in calcium. The acidity of urine is increased by eating fish, meat, eggs, butter, and flour.
In the presence of urate stones You should consume as little as possible foods that provoke the formation of uric acid. These are kidneys, liver, meat broths. Fish, meat, and vegetable fats are also limited. Such patients need to drink fresh lemon juice, but grapefruit juice is not recommended.
When identifying oxalate stones You need to remove from your diet those foods that contain oxalic acid and calcium. These are sorrel, potatoes, spinach, oranges, dairy products.
There are also a number of general recommendations for patients with urolithiasis. Every day you need to drink at least two liters of liquid, and in the hot season you need to drink so much liquid that you never experience. Taking infusions and decoctions of diuretic herbs has a positive effect on the body. It is important to limit sour, spicy, salty foods and avoid overeating. You should not drink alcoholic beverages. Doctors also recommend that patients with stones keep active life, but avoid heavy loads. Can't be allowed severe stress, hypothermia.
If renal colic begins suddenly in a person, then a warm bath or a heating pad, which should be applied to the lumbar region, can relieve the pain.
Complications
If treatment for urolithiasis was not carried out in a timely manner, both acute and chronic complications may soon develop. If the patient never seeks help, then eventually purulent melting of the kidney is possible. In this case, the patient loses the kidney.
If stones are present in the bladder, the person may suffer from persistent and very painful acute attacks. Also, complications of nephrolithiasis often become, chronic renal failure .
List of sources
- Alyaev Yu.G. Urolithiasis disease. Modern methods diagnosis and treatment. - 2012;
- Olefir Yu.V. Minimally invasive methods for the treatment of complex forms of nephrolithiasis: Dis. M.; 2008;
- Dzeranov N.K., Lopatkin N.A. Urolithiasis: Clinical guidelines. - M.: Overley, 2007;
- Reznik M.I., Novik E.K. Secrets of urology. - Per. from English - 3rd ed., revised. and additional - M.: Binom, 2003;
- Tiktinsky, O.L. Urolithiasis / O.L. Tiktinsky, V.P. Alexandrov. - St. Petersburg: Peter, 2000.
“Stone disease” has been known since ancient times, as evidenced by written monuments Ancient Egypt, Persia, China, India and others Bladder and kidney stones were found in mummies with a burial date of 3500-4000 BC. The first description of the stone cutting operation belongs to the Roman physician A. Celsus (1st century AD). There is information about the treatment of kidney stones during the Middle Ages. At the end of the 17th century, data on the structure of urinary stones and crystals was published urinary salts. Since the second half of the 19th century, thanks to the development of morphology, topographic anatomy, the introduction of laboratory and X-ray research methods, ideas about kidney stone disease have gained scientific basis. In Russia, the first operation for kidney stone disease was performed by N. V. Sklifosovsky in 1883. Significant contributions to the doctrine of kidney stone disease were made by S. P. Fedorov, R. M. Fronshtein, M. A. Mir-Kasimov, G. S. Grebenshchikov, Randall (A. Randall), Carr (J. A. Carr), Boyce (W. N. Vause) and others
Statistics
Kidney stones occur in all areas of the world, but their distribution is uneven. Relatively low incidence is observed in some areas of the North, Africa and other areas with frequent incidence (endemic foci) are located in the Middle East, India, China, Australia, Latin America and certain regions of Europe. In the USSR, this disease is also unevenly distributed. Thus, in areas with cold and temperate climates, the annual incidence is 0.19 - 1.0 or higher per 10,000 inhabitants, in endemic areas of the republics Central Asia and the Caucasus, the annual incidence ranges from 2.5-3.6 or more per 10,000 inhabitants. According to most urologists, kidney stones account for 25-35% of all surgical kidney diseases. The disease occurs with almost equal frequency in men and women. Stones are localized somewhat more often in the right kidney than in the left, more often in the pelvis than in the calyces, or simultaneously in the pelvis and calyces. The incidence of stones in the kidneys and urinary tract is presented in Figure 1. However, these data may vary depending on the age of the patients, climatic zone and other reasons. According to the chemical composition, stones are oxalate - up to 40% of cases, phosphate - in 27-30%, urate - in 12-15%, cystine and protein - up to 1%, mixed composition - in 20-30% of cases. The ratio of stones of different chemical compositions in patients is also different; it depends on the climatic and geographical zone, conditions environment, salt content in drinking water and food products, diet, age.
Etiology
In old age, urate and phosphate stones are more often detected, in young people - oxalate stones.
Kidney stone disease can occur as a result of exposure to single or multiple factors, and have exogenous and endogenous origin. Chem. The composition and microstructure of urinary stones largely depend on the reasons for their formation. Thus, if purine metabolism is disrupted, urate stones can form, and if oxalic acid metabolism is disrupted, oxalate stones can form; Phosphate stones appear mainly when there is a disturbance in phosphorus-calcium metabolism and in the presence of a urinary tract infection, causing an alkaline reaction in the urine.
Violation of the phosphorus-calcium balance in the body is possible due to several reasons. The parathyroid glands play the main regulatory role in the exchange of calcium and phosphorus. When parathyroid hormone enters the blood excessively from the parathyroid glands (due to adenoma, hyperplasia, etc.), patients develop hypercalcemia (over 11.5 milligrams/100 milliliters), hypophosphatemia (below 2.5 milligrams/100 milliliters), hypercalciuria (over 250 milligrams per daily quantity urine). In these patients, other manifestations of phosphorus-calcium metabolism disorders are possible; decalcification of bones, dyspeptic disorders, muscle pain and others Primary hyperparathyroidism (see full body of knowledge) as a cause Kidney stone disease was detected in 2.8-10% of patients. Hypercalcemia can also be idiopathic, occurring with bone injury, Recklinghausen's disease, Paget's disease, Beck's sarcoidosis, hypervitaminosis D, long-term intake of alkalis, calcium salts, hard drinking water, and others. Hypercalciuria of any origin contributes to nephrocalcinosis (see full body of knowledge) and lithogenesis (stone formation ).
Violation of the metabolism of oxalic acid (see full body of knowledge) plays a certain role in the occurrence of kidney stones with the formation of oxalate stones or salts. Normally, the daily excretion of oxalic acid in the urine is 30–15 milligrams; in pathological conditions it can be 200 milligrams or more. Oxalaturia (see full body of knowledge: Oxaluria) also develops as a result of increased adsorption of oxalic acid in the gastrointestinal tract, especially when it is consumed in excess with food. According to A. F. Hofman, R. N. Dowling and others, oxalic acid can be synthesized by some microorganisms and intestinal fungi. Long-term use of ascorbic and citric acid in some patients contributes to the development of oxalaturia. The endogenous source of oxalates in humans is glyoxylic acid, formed mainly from glycine. Excess glycine in the body can occur due to impaired carbohydrate metabolism and other pathological conditions. A deficiency of vitamins B 6 and A in the body increases the excretion of oxalic acid by the kidneys, which combines with calcium (at pH 5.5-5.7), crystallizes and precipitates in the form of calcium oxalate.
In the development of kidney stones with the formation of urate stones and urinary salts, the etiological role is played by a violation of purine metabolism (see full body of knowledge). Uric acid enters the blood from two sources: exogenous - from food protein and endogenous - from purine bases formed during the breakdown of DNA and RNA under conditions of protein catabolism and the treatment of cytoproliferative processes (blood diseases, some systemic diseases and others). Sometimes hyperuricemia (increased levels of uric acid in the blood) is familial and hereditary. In addition, hyperuricemia can occur due to impaired reabsorption of uric acid (see full body of knowledge) with nephropathies, toxic effects on the kidneys and others. Uricemia over 4.5 milligrams/100 milliliters and uricuria over 400 milligrams in the daily amount of urine with pathological changes in the kidneys can lead to the formation of urate stones or uraturia (see full body of knowledge).
Infectious lesions of the urinary tract are the etiological factor of kidney stones. Chronic pyelonephritis (see full body of knowledge), according to most clinicians, often occurs with kidney stones. In many patients it is primary, that is, it precedes the development of kidney stones, in some patients it joins existing kidney stones disease In pyelonephritis, microcirculation, lymphatic drainage from the kidney and urodynamics are disrupted. Most microorganisms that cause pyelonephritis ( coli, Proteus, Pseudomonas aeruginosa, Staphylococcus, Enterococcus and others), decomposes urea in urine, and the resulting ammonia alkalinizes urine (see full body of knowledge). Due to the products of inflammation (urothelium, red blood cells, leukocytes, mucus and others), hydrophobic colloids accumulate and urine viscosity increases. IN alkaline environment phosphates easily precipitate, and there is a possibility of developing phosphaturia (see full body of knowledge) or the formation of phosphate urinary stones.
A certain etiological connection exists between kidney stones and certain diseases. Thus, with anomalies in the development of the kidneys and urinary tract, stone formation occurs mainly in the presence of urinary stasis (see full body of knowledge), or urostasis, and the addition of an infection. Pelvic tumors and urinary tract obstruction also contribute to urostasis and stone formation. With gastric ulcers and chronic enterocolitis, increased adsorption of calcium, oxalic acid and other compounds is possible, followed by their excretion by the kidneys and stone formation. Malaria predisposes to the formation of oxalate and urate urinary stones due to increased biosynthesis of uric and oxalic acids.
In some endemic areas, the development of kidney stones is seasonal: in people in the summer, the concentration of salts in the urine sharply increases, and at the same time morphological and functional changes are observed in the kidneys, which can serve as a trigger for stone formation.
Urinary stones can form (as secondary ones) in the urinary tract on foreign bodies.
Pathogenesis
The pathogenesis of kidney stones is complex and largely depends on the characteristics of the etiological factors, which can change during the course of the disease. There are a number of theories of the pathogenesis of kidney stones. According to the colloid-crystallization theory, for the formation of a stone, a certain situation is needed, in which a high concentration of salts and the presence of hydrophobic colloids in the urine are combined, as well as the urine pH value corresponding to the crystallization point of the existing salts and urostasis. In the absence of urostasis and pathological changes in the colloidal system of urine, the process ends with the formation of free crystals.
The beginning of the formation of the primary center of the stone can be either the crystallization of salts or the conglomeration (co-precipitation) of organic substances; this depends mainly on which of the two urine media (colloidal or saline) the changes are initially more pronounced. The growth of stones occurs rhythmically, with alternating processes of salt crystallization and precipitation organic matter(see full body of knowledge: Urine stones). Stone formation can also begin at the level of the tubules, where microliths are found in the form of spheres and other shapes. The colloidal crystallization theory is considered the most scientifically substantiated and proven.
According to another theory, the authors of which are Randell and Carr, the formation of urinary stones can occur on the renal papillae. Carr discovered microparticles (nodules) containing calcium and glycolysoaminoglycans in the kidney tissue. In his opinion, there is a constant movement of the formed nodules into the lymphatic system of the kidney. When lymphatic drainage is impaired due to pyelonephritis, pedunculitis, as well as when the kidney is overloaded with calcium salts and others, conditions arise for the development of nephrocalcinosis and stone formation. The nodules migrate towards the renal papillae, forming plaques on them, which Randell described. These plaques compress the capillaries of the papillae and can cause necrotizing papillitis (see full body of knowledge: Renal papillary necrosis). Salts crystallize on necrotic renal papillae and stones form (about 8-10% of stones).
Other previously created theories of stone formation (nutritional, infectious) have lost their significance and only complement the theories described above.
Pathological anatomy
Morphological changes in kidney stone disease are varied and depend on the location of the stones, their size, duration and type of pathological process, the presence of infection, etc.
In the initial phases of the disease, so-called minimal changes in the glomeruli are detected in the nephron system (see full body of knowledge: Glomerulonephritis, pathological anatomy), accompanied increased permeability glomerular filter. Microscopically, a protein-carbohydrate effusion is detected in the lumen of the glomerular capsules and proximal tubules, which is reabsorbed by the proximal tubules in the form of PAS-positive granules. Electron microscopy reveals a large number of phagosomes and lysosomes in nephrocytes, including resorbed protein-carbohydrate complexes. These complexes, both in the lumen of the tubules and intracellularly, are an organic matrix for subsequent lime deposition. Calcium salts are also deposited in significant quantities in the mitochondria of nephrocytes.
Lysosomes (see full body of knowledge) with lime inclusions and necrotic nephrocytes are released into the lumen of the tubules and move to the distal parts of the nephron as microlites. Calcified lysosomes can penetrate through the basement membrane of the cell into the intercellular substance and form the basis of intercanalicular lithogenesis. The described changes develop against the background of a sharp decrease in the activity of oxidoreductases, glycolytic enzymes and enzymes that catalyze reactions of the pentose pathway in the nephron epithelium.
Dystrophic and histochemical changes affect mainly the proximal tubules and gradually decrease towards the distal parts of the nephron. In parallel with changes in the tubuloepithelial component of the nephron, inflammatory changes in the intercellular substance increase in the form of alterative-exudative and productive processes; lymphoplasmacytic infiltrates are detected, localized mainly in the area of deeper damage to the nephron in areas of calcification (see full body of knowledge).
The addition of a purulent infection is manifested by the formation of limited ulcers and diffuse leukocyte infiltration of the stroma.
Often, with kidney stones, foci of dystrophic calcification are found in the papillae of the pyramids (Randell's plaques). Sequestration of these plaques together with the organic matrix of the papilla can form the core of a free intrapelvic stone.
Further changes in the kidneys are caused by progressive pyelonephritis and impaired urine outflow due to an increase in the size of the stone. An obstructing stone in the pelvis can cause dilation of the calyces (hydrocalicosis) or pyelectasia, and subsequently hydronephrosis (see full body of knowledge). In this case, the kidney parenchyma undergoes gradual atrophy and sclerosis, ultimately forming a thin-walled fluid-filled sac. With hydrocalycosis, gradual expansion is observed renal tubules respectively, in the obstruction zone. Subsequently, such tubules gradually lose their epithelial lining, and retention cysts form in their place. Obstruction of the ureter with a stone causes expansion of its proximal part, as well as the pelvis and calyces (hydroureteronephrosis). In the area where the stone is located, bedsores and inflammation of the wall of the ureter may occur (see the full body of knowledge: Ureter, ureteritis), and subsequently its stricture, rarely perforation. Calculous aseptic hydronephrosis is extremely rare, since impaired urine outflow is most often complicated by ascending or hematogenous infection; in this case, calculous pyonephrosis and pyoureteronephrosis occur. With relative preservation of the renal parenchyma, apostematous nephritis and renal carbuncle develop. Inflammation often spreads to the perinephric tissue with the formation of acute purulent or chronic paranephritis (see full body of knowledge). In chronic paranephritis, the kidney is immured in a thick capsule consisting of granulation tissue and sclerotic fatty tissue. Much less common is the replacement of an atrophied kidney with fatty tissue (fat replacement of the kidney).
With bilateral kidney damage, renal failure gradually develops, which is the immediate cause of death.
Clinical picture
Manifestations of kidney stones are varied and depend on kidney function, the degree of urodynamic disturbance, the number, shape and location of stones, the duration of the disease, the presence of complications (pyelonephritis, renal failure, arterial hypertension and others). Subjective signs of kidney stones are pain - dull, aching, constant, periodically acute, caused by renal colic, which can be one-time or repeated many times without any patterns. Colic most often occurs when stones are localized in the ureteropelvic segment or in physiological narrowings of the ureter (ureteric colic). An acute painful attack is caused by a sharp disruption of the outflow of urine from the kidney, an increase in intrapelvic pressure, stretching of the fibrous capsule of the kidney, and disruption of blood and lymph circulation in it. The pain is localized in the lumbar region and can spread to the lateral and lower abdomen, accompanied by reflex intestinal paresis. With renal colic, patients are restless and often change position. Nausea and vomiting accompany renal colic in approximately 1/3 of patients, sometimes there are chills and increased body temperature due to urine resorption. These manifestations are more pronounced with concomitant acute pyelonephritis (see full body of knowledge), in which, due to reflux into the venous and lymphatic systems, inflammatory products penetrate from the kidney along with the urine. In acute calculous pyelonephritis, bacteremic shock may develop. With stones in the only (or only functioning) kidney with renal colic, obstructive anuria may occur (see full body of knowledge), which, according to M. D. Javad-Zadeh and others, occurs in 1-2.7% of patients with kidney stones
Asymptomatic course of kidney stones, especially with coral stones, is observed in 7-10% of patients. The first signs of the disease in them can be detected only on the basis of urine analysis data (leukocyturia, microhematuria, alkaline urine reaction and others).
Clinically, the picture for the localization of stones in the ureter is almost the same as for kidney stones. The main differences between ureteral colic are the localization of pain along the ureter, irradiation of pain to the groin area, genitals, inner thigh, and often dysuria.
Clinical, picture Kidney stone disease in elderly and senile people has some features: it is less pronounced; renal colic occurs 3 times less often than in patients at a young age; in almost 30% of cases there is a painless course due to decreased tone of the urinary tract; calculous pyelonephritis and renal failure are more common. The symptoms of acute calculous pyelonephritis can also be atypical and erased.
Complications
The main complications of kidney stones are pyelonephritis, renal failure, hydronephrosis, arterial hypertension (see full body of knowledge: Arterial hypertension). Acute calculous pyelonephritis, with improper or delayed treatment, quickly passes from serous to purulent - apostematous nephritis (see full body of knowledge), renal carbuncle (see full body of knowledge: Kidneys, pathology). At the same time, there is a real danger of developing bacteremic shock and urosepsis (see full body of knowledge: Sepsis).
Chronic pyelonephritis leads to nephrosclerosis (see full body of knowledge), sclerosis of perinephric fatty tissue; when the outflow of urine is disrupted, infected hydronephrosis (see full body of knowledge) and pyonephrosis (see full body of knowledge) develop.
Renal failure (see full body of knowledge) can be acute with a sudden block of the urinary tract and chronic due to prolonged disruption of the outflow of urine and pyelonephritis.
Diagnosis
The diagnosis is made on the basis of anamnesis, clinical pictures, laboratory and x-ray studies. The history establishes the duration of the disease, the frequency of passage of stones, urinary salts (sand), renal colic, and others. Subjective and objective signs of the disease, pyelonephritis, and renal failure are identified. During the examination, attention is paid to the etiological factors of kidney stones, disturbances of phosphorus-calcium and purine metabolism, manifestations of oxalaturia, the presence of urinary tract infection, and urinary stasis.
Laboratory tests include urine tests (see full body of knowledge) and blood (see full body of knowledge), examination of the functional state of the kidneys (urea content, creatinine in the blood, Zimnitsky, Rehberg tests).
Hematuria (see full body of knowledge) with kidney stones is detected in 80-90% of patients, and it can be both micro- and macroscopic. Hematuria often occurs after physical activity. In patients with stones, elevated levels of uric acid are found in the blood serum and daily urine volume. For multiple and coral-shaped stones, for re-emergence stones, phosphorus-calcium metabolism is examined, and if hyperparathyroidism is suspected, special tests are used. For all patients, the microflora of the urine is examined, the degree of bacteriuria and other changes in the urine of an inflammatory nature are detected in 60-85% of patients. Kidney stone disease
The absence of infection in the urine during kidney stones occurs on average in 25% of patients, mainly with oxalate and urate stones of the kidneys and ureters. It is advisable to dynamically determine the pH of urine.
Diagnosis of typical renal colic is not difficult. Acute sudden pain in the lumbar region with a certain irradiation, restless behavior of the patient, microhematuria, on a survey image and excretory urogram (see the full body of knowledge: Urography) an enlarged kidney (a symptom of nephrography is the absence of an image of the collecting system on the affected side due to its blockage with a stone) - the most characteristic signs. In doubtful cases, renal colic must be differentiated from acute diseases of the abdominal organs and acute gynecological diseases(see full body of knowledge: Acute stomach, Pseudoabdominal syndrome). Laparoscopy (see full body of knowledge: Peritoneoscopy), puncture helps in differential diagnosis posterior arch vaginas in women, local thermometry, thermography.
The X-ray method is the main one in the diagnosis of kidney stones. It allows one to identify not only the presence of stones, but also to establish their shape, size, location, structure, and also to get an idea of changes in the anatomical and functional state of the kidneys and urinary tract. The study begins with a survey X-ray of the abdominal cavity, starting from Th Xl to the symphysis pubis. The detection of a shadow suspicious for a stone on a plain radiograph does not require differential diagnosis only in the case of a coral stone, which is a cast of the pyelocaliceal system (Figure 2). Kidney calyx stones are casts of them or have an irregular, round shape; renal pelvis stones are often round or triangular; ureteral stones - cylindrical, spindle-shaped or irregular in shape. With abnormalities of the urinary tract, the calculus may be located outside the usual location of the kidneys and other organs of the genitourinary system. The detection of a stone in an image depends on its size, chemical composition and location. The most intense images are produced by oxalates, followed by stones of mixed composition and phosphates. Oxalates have spiky, scalloped outlines and resemble mulberries. Coral stones are most often compact, but can be layered, like other stones of mixed composition, sometimes they reach gigantic sizes. The layered structure of stones in X-ray images is due to the different permeability of their constituent salts to X-ray radiation. About 10% of stones with low atomic weight (urate, protein, cystine and xanthine stones) are not visible or give an indistinct shadow. It is especially difficult to identify stones projecting onto the bone skeleton (ribs, transverse processes of the vertebrae, sacroiliac joints). To detect them, targeted images are taken in oblique and atypical projections, tomo or zonography. Tomography (see full body of knowledge), used alone or in combination with contrast studies, is indicated when the patient is insufficiently prepared for x-ray examinations, renal colic accompanied by intestinal paresis, or when the stones are small. Since in kidney stones quite often stones spontaneously pass away from the collecting system, they can be projected along the ureter paravertebrally and tend to linger above one of its anatomical narrowings. Most important information about the identity of the identified shadow to the urinary tract, about the localization of the stone, the violations of renal function caused by it, urodynamics, the anatomical state of the urinary tract (hydrocalicosis, pyelectasia, hydroureteronephrosis - expansion of the calyces, pelvis, ureter and kidney) are detected during excretory urography (Figure 3, b) with preliminary survey radiography (Figure 3, a). It allows you to establish the type of pelvis (open or closed, intrarenal or extrarenal), the state of the ureteropelvic segment (see the full body of knowledge: Pyelography). Usually, an X-ray positive stone is detected in the urinary tract, but sometimes its image is blocked, as if drowned against the background of contrasted urine, especially when the stone is small or its image intensity is low. With X-ray negative stones, a defect in the filling of the urinary tract (including the pelvis) with clear contours is visible (Figure 4). Unlike a tumor of the pelvis, in oblique projections a rim of contrast material is preserved around the stone. Typically, with pelvic stones reaching a diameter of 3 centimeters or more, pyelectasia and hydrocalycosis are observed. Television pyeloureteroscopy performed during excretory urography in combination with cinematography or videotape recording of images makes it possible to assess disturbances in the tone and motor function of the upper urinary tract due to stones, and to distinguish spastic, functional processes from organic ones. If a stone descending into the ureter partially covers it, then dilation of the ureter and pelvis (pyeloureterectasia) is noted above the level of the stone. Excretory urograms performed during renal colic reveal an enlarged kidney with an enhanced nephrographic effect without contrasting the collecting system and ureter - the so-called large white kidney. This X-ray picture indicates that kidney function is preserved. With prolonged complete stone blockage (more than 3-4 weeks), kidney function decreases due to atrophy and may be completely lost. On excretory urograms performed after renal colic, penetration of contrasted urine beyond the urinary tract, as well as renal pelvic reflux, is sometimes observed. Retrograde pyeloureterography with liquid contrast agent or oxygen is produced only when there is a significant decrease in renal function, when there is doubt about the diagnosis, especially in cases where excretory urography does not reveal an x-ray negative stone. X-rays of the ureter after inserting a catheter into it are performed in direct and oblique projections. If, in this case, a shadow suspicious for a stone is located next to the catheter in both images or merges with its shadow, then the diagnosis of kidney stone disease is beyond doubt. A shadow not related to the ureter is determined at some distance from the catheter. On retrograde pyelograms with a low concentration of liquid contrast agent, X-ray negative stones are detected as a filling defect. Such stones become especially demonstrative during pneumopyeloradiography or pneumopyelotomography (Figure 5). Using retrograde ureterography, it is possible to identify an X-ray negative stone in the ureter; the upper boundaries of the defect have a concave shape (Figure 6).
To finally resolve the issue of the advisability of surgical removal of occlusion and the possibility of restoring kidney function after stone removal, to clarify the vascular architecture, if kidney resection, multiple nephrotomy and removal of coral stones are planned, renal angiography is used (see full body of knowledge). Caliber reduction renal artery 50% or higher with a reduction in intraorgan branches indicates a sharp, often irreversible dysfunction of the organ. Due to the possibility of stone migration, immediately before surgery it is necessary to repeat a survey of the urinary system to clarify its location. In the process of surgical stone removal, television pyeloureteroscopy or radiography of the exposed kidney is used to control the removal of all stones or their fragments. In some patients, after pyelo or ureterolithotomy, strictures and ureteral deviations with urodynamic disturbances and dilatation of the upper urinary tract may occur.
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Scintigrams of the kidneys in case of nephrolithiasis, obtained on the SEGAMS computer using the method of dynamic renoscintigraphy with radioactive technetium (99 Te - DTPA). |
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For special indications, especially for X-ray negative stones in patients with intolerance to iodine drugs, computed tomography is used (see full body of knowledge: Computer tomography), as well as ultrasound diagnostics (see full body of knowledge).
In the diagnosis of kidney stones, radioisotope research methods are used to determine kidney function, blood supply and urodynamics (color figure 1-6): renography (see full body of knowledge: Radioisotope renography) and dynamic scintigraphy (see full body of knowledge).
Treatment
Treatment is conservative and surgical. Conservative treatment- dietary nutrition, medication, sanitary-chickens. treatment, exercise therapy, physiotherapeutic procedures. Diet food(see full body of knowledge: Medical nutrition) are prescribed taking into account the etiology of kidney stones, disorders of phosphorus-calcium metabolism, oxalic acid metabolism, purine metabolism, the chemical composition of urinary stones or urinary sand, urine pH, functional state of the kidneys and others
For oxalaturia and oxalate stones, it is necessary to limit the consumption of foods containing excess oxalic and citric acid (lettuce, spinach, sorrel, pepper, rhubarb, legumes, gooseberries, currants, strawberries, citrus fruits and others). In case of carbohydrate metabolism disorders, carbohydrates are limited (sugar, grapes and others). Patients are recommended mainly boiled meat, fish, vegetable oils, flour, cereal dishes, vegetables (beets, cucumbers, cabbage, melons, watermelons), fruits (apples, pears, cherry and others). Since magnesium ions block the crystallization of calcium oxalates, magnesium preparations are prescribed for a long time (magnesium oxide, magnesium thiosulfate, magnesium carbonate 0.5 grams 2-3 times a day after meals). Methylene blue is also used in capsules of 0.1 grams 2-3 times a day. Vitamin B 6 is periodically prescribed orally (pyridoxine 0.01 grams 2-3 times a day). To reduce the concentration of oxalates in the urine and increase the pH of the urine, it is recommended to increase fluid intake to 2-2½ liters per day.
Conservative treatment of patients with urate stones and uraturia is aimed at limiting foods containing purines (cocoa, coffee, chocolate, liver, meat). Protein composition food should be no more than 1 gram per 1 kilogram of the patient’s weight. Meat broths are contraindicated; Meat and fish are recommended to be consumed mainly boiled. The diet is dominated by dairy and plant products. For hyperuricemia and uricuria, drugs are used that reduce the synthesis of uric acid (allopurinol 0.1 grams 2-3 times a day), under the control of serum uric acid levels. For uraturia and the passage of stones, citrate preparations are periodically prescribed at the same time. To reduce the concentration of uric salts, increase fluid intake to 2-2½ liters.
Patients with urate (X-ray negative) stones with satisfactory renal function and urodynamics, and the absence of acute pyelonephritis are prescribed so-called solvents - citrate preparations (magurlit, soluran and others). Their dosage is individual and is adjusted during the treatment process depending on the pH of the urine (it is necessary to maintain the pH within 6.2-6.9). The course of treatment is 1½-2½ months followed by control x-ray examination. In some cases, treatment gives positive result(Figure 7). If there is no effect, repeated courses of treatment are not advisable.
The principles of treatment for cystine stones are the same as for military stones.
For phosphate stones and phosphaturia, limit calcium in food (dairy products, potatoes, eggs and others), exclude foods and medications that alkalinize urine (lemons, alkalis and others). They recommend products that promote urine oxidation (meat, fish, fats, vegetable oils, butter and others). Drug antibacterial treatment is aimed at suppressing the infection that alkalinizes the urine; they use agents that promote urine oxidation (glutamic acid, methionine 0.5 grams 3 times a day, ascorbic, boric, benzoic acids 0.2 grams 2-3 times a day and others). Fluid intake up to 1.5 liters.
In patients with stones of mixed and changing chemical composition of urinary salts, the diet should be varied, limiting foods that contribute to the formation of salts.
All patients simultaneously undergo treatment aimed at restoring urodynamics, eliminating urostasis, and normalizing blood and lymph circulation in the kidneys.
To expel small stones of the kidneys and ureters, Avisan, olimetin, cystenal and others are also used, physiotherapeutic procedures, exercise therapy and balneotherapy. Water loading, or the so-called water shock, is prescribed 1-2 times a week with satisfactory urodynamics: patients take antispasmodic drugs and 1.5 liters of weak tea or warm water for 1-2 hours Treatment with water loading is contraindicated in case of renal colic, impaired urodynamics , cardiovascular diseases, hypertension and others. If there is no effect, catheterization of the ureter is performed (see full body of knowledge: Catheterization of the urinary tract), usually in combination with chromocystoscopy.
To relieve renal colic, antispasmodics (papaverine, no-spa, baralgin, atropine and others), painkillers (promedol and others) are used; for ureteral colic, novocaine blockade of the spermatic cord (in men) or the round ligament of the uterus (in women) is performed according to Lorin-Epstein (see full body of knowledge: Novocaine blockade). During an attack of renal colic, in order to eliminate spasm of the ureter, stop pain and to pass stones, heat is used in the form of general baths at a water temperature of 38-39° for 10-20 minutes, irradiation of the lumbar region with a Sollux lamp for 20-30 minutes, paraffin or ozokerite applications at a temperature of 48-52° on the lumbar region, heating pads, inductothermy (see full body of knowledge) or exposure for 15-20 minutes to decimeter waves at such an energy intensity that the patient experiences a feeling of moderate warmth (see full body of knowledge: Microwave therapy). In the interictal period (most effective immediately after colic), if there are conditions for the passage of stones (absence of sharp protrusions at the stone, low location, size up to 10 mm, absence of pronounced dilatation of the ureter), in order to enhance the contraction of the ureter, stimulate the passage of the stone through the urinary paths, exposure to sinusoidal modulated currents is used (see full body of knowledge: Pulse currents) in combination with water load and heat. The patient drinks at least ½ liter of liquid, after 30-40 minutes, inductothermy or exposure to decimeter waves is performed on the area of the kidneys and ureter for 20 minutes. In this case, the patient should feel moderate warmth. Another option is possible: the patient takes a warm bath, then is exposed to sinusoidal modulated currents for 10-15 minutes. When stones are localized in the upper and middle third of the ureter, an electrode measuring 4 × 6 centimeters is placed on the projection area of the pelvis, and a second one measuring 8-12 × 12-15 centimeters is placed above the pubic symphysis on the corresponding side. When a stone is localized in the lower parts of the ureter, sinusoidal modulated currents are first applied for 5-8 minutes, placing the electrodes as indicated above, and then for the same time, placing a small electrode above the pubic symphysis, and a large electrode on the lumbar region.
Balneological treatment (see full body of knowledge: Balneotherapy) is carried out at the resorts of Truskavets, Zheleznovodsk, Berezovsky, Shklo, Jermuk, Essentuki and others. The main indications for referring patients to sanitary resort treatment: small stones that can pass away on their own and do not disturb urodynamics, urinary diathesis (uraturia, oxalaturia, phosphaturia, cystinuria); Besides, spa treatment Patients are subject to surgical removal of stones or ureterolithoextraction (after 1 -1½ months in the absence of acute pyelonephritis). They use mineral waters that have a diuretic effect, have antispasmodic and anti-inflammatory effects, affect the pH of urine and reduce its viscosity. For urate and oxalate stones or uric salts and acidic urine reaction, Essentuki water No. 4, Slavyanovskaya, Smirnovskaya, Berezovskaya, Naftusya and others are indicated, helping to reduce the acidity of urine. For patients with phosphate stones and phosphaturia with an alkaline urine reaction, Dolomite Narzan, Arzni, Marcial Waters, Naftusya and others are appropriate
For kidney stones, exercise therapy is widely used to promote stone passage, improve urination, and stimulate metabolism. Physical exercises, causing fluctuations in intra-abdominal pressure, change the tone of the smooth muscles of the ureter, stimulate its peristalsis and promote the passage of stones. The indication for prescribing exercise therapy is the presence of a stone in any part of the ureter that completely obstructs its lumen, and the size of the stone should not exceed 1 centimeter, since larger stones cannot pass away on their own.
Contraindications to exercise therapy are obstruction of the ureter, accompanied by increased body temperature and pain, renal failure, as well as stones located in the calyx or pelvis. The main form of exercise therapy is gymnastics. Before exercise, diuretics and antispasmodics are prescribed, taking large quantity liquids. They use special exercises for the abdominal muscles, bending, bending and turning the body, movements with sudden changes in body position, running, jumping, jumping off equipment; frequent changes of starting positions (standing, sitting, lying on your back, on your side, on your stomach, kneeling, etc.). These exercises alternate with muscle relaxation and breathing exercises. Lesson duration 30-45 minutes In addition to therapeutic exercises, it is recommended to independently perform special exercises throughout the day; include 2-3 exercises in the morning hygienic exercises. special exercises, walking, jumping off stairs and others
If there is no effect from drug treatment and physiotherapy and acute disorder for urine outflow, endovesical ureterolithoextraction can be used, for which several extractors have been proposed - Johnson, Dormia, Pashkovsky, Zeiss (Figure 8) and others Components they are a catheter, a guidewire and a gripping device (loop, basket), some of them have devices for controlling the extractor and fixing the stone in the basket.
The main indications for ureterolithoextraction are stones of the lower ureter small sizes(up to 0.8 centimeters), no signs of periureteritis, preservation of satisfactory ureteral tone.
Contraindications for the removal of ureteral stones - acute pyelonephritis, pyonephrosis, hydronephrosis, anuria, urosepsis, stricture, inflammatory diseases of the urethra and others. In men, ureterolithoextraction should be used with extreme caution due to the possibility of developing acute prostatitis, urethrorrhagia and other complications.
Ureterolithoextraction is performed in a hospital. The patient should be examined completely due to the possibility of emergency surgery. Before stone extraction, the patient is prescribed antispasmodics and painkillers (platyphylline, atropine, promedol and others), and an x-ray of the urinary tract is performed. After applying various methods of anesthesia, including anesthesia, the extractor is inserted into the ureter through a cystoscope so that its loop or basket is passed into the closed above the stone. Then the extractor basket is opened and lowered. At the same time, light rotational movements are performed, trying to grab the stone and remove it. In cases where it is impossible to remove a stone from the ureter, the extractor is left in a state of tension, which is achieved by hanging a load of up to 200 grams (through a block) for a period of 1-4 days until the stone passes. Antibacterial and antispasmodic drugs are used at the same time. After stone removal, ureteral catheterization for 2-3 days and anti-inflammatory treatment are recommended.
The main complications of ureterolithoextraction can be technical, traumatic and inflammatory in nature (separation, “fracture” of the extractor, stone entrapment, exacerbation of pyelonephritis, perforation of the ureteral wall, and others). If it is impossible to extract the stone, ureterolithotomy is used.
Surgical treatment is the main method of removing stones from the kidneys and ureters. Feasibility proven early removal stones, the size of which does not allow hope for their spontaneous passage, especially with stones from a single kidney. The absolute indications for surgical treatment of kidney stones are obstructive stones, calculous anuria, frequent constant pain, severe hematuria, frequent attacks of renal colic, pyonephrosis and purulent paranephritis. Indications for planned operations are strictly individual in patients with concomitant diseases and in old age. Thanks to the development of anesthesiology, nephrology, the possibility of using hemodialysis (see full body of knowledge), improvement of surgical techniques (renal hypothermia, temporary occlusion of the renal artery, extracorporeal surgery and others), the indications for surgical treatment of patients with staghorn stones are expanding.
Contraindications to surgical treatment are caliceal stones and renal parenchyma without significant clinical manifestations.
Preoperative preparation depends on the patient’s condition, the course of kidney stones, the presence of complications (pyelonephritis, renal failure, etc.) and concomitant diseases.
In patients with chronic pyelonephritis in the acute stage, especially with alkaline urine reaction, preoperative preparation includes antibacterial therapy.
In case of chronic renal failure, anti-azotemic and detoxification therapy is used (intravenous glucose solutions, electrolytes, plasma expanders, anabolic hormones, cardiovascular drugs, vitamins and others). In some cases, especially with bilateral coral stones and chronic renal failure, hemodialysis may be used.
In case of acute obstructive purulent pyelonephritis, catheterization of the ureter is urgently performed, and if it is impossible to perform it, emergency surgery is indicated. Since these patients may develop bacteremic shock, in the preoperative period they undergo a complex of anti-shock measures, including the administration of corticosteroids, plasma expanders, cardiovascular drugs, vitamins and others.
Before surgery, patients with diabetes mellitus are switched to simple insulin (instead of long-acting insulin preparations and tableted antidiabetic drugs).
Anesthesia - intubation anesthesia with muscle relaxants or epidural anesthesia; other types of pain relief are rarely used.
Operative approaches are usually extraperitoneal lumbar according to Fedorov and Bergmann (see full body of knowledge: Lumbotomy). If surgery on the ureter is necessary, an Israel incision or a pararectal extraperitoneal incision can be used; for stones in the lower third - a Pirogov incision and other single ureteral stones can be removed through intermuscular approaches. There are also more rare surgical approaches - transperitoneal pyelolithotomy or ureterolithotomy and others
For kidney stones, perform the following types operations: pyelolithotomy, pyelocalithotomy, nephrolithotomy, calicotomy, kidney resection, nephrostomy (see full body of knowledge) and nephrectomy (see full body of knowledge). Apply different kinds pyelolithotomy (Figure 9). The most widely used is posterior longitudinal or transverse pyelolithotomy; for small pelvises, this incision is performed subcortically. Lower pyelolithotomy is recommended for intrarenal pelvis; upper transverse pyelolithotomy is rarely used. Anterior pyelolithotomy is indicated primarily for abnormalities in the shape and position of the kidneys. After removing the stone, most urologists consider it advisable to tightly sutured the pelvis incision with catgut.
Along with pyelotomy, for multiple caliceal stones and staghorn stones, an additional nephrotomy is performed. The stone is felt with a needle and a nephrotomy is performed along it; U-shaped catgut sutures are placed on the kidney incision. The operation is often completed with nephrostomy.
Kidney resection is used mainly for hydrocalyxes filled with fixed single or multiple stones, narrowed calyx necks with symptoms of segmental nephrosclerosis. For this purpose, planar and wedge resection of the kidney is used. The operation is often completed by draining the kidney.
Nephrostomy for kidney stones for temporary drainage of the kidney is indicated for operations accompanied by renal fornical bleeding, in the absence of certainty of removing all stones (multiple, coral-shaped) from the kidney, purulent inflammation, impaired outflow of urine from the kidney, and others. In acute calculous apostematous nephritis, renal carbuncle additionally it is decapsulated, the carbuncle is dissected, and the perirenal tissue is extensively drained.
The timing of removal of the nephrostomy tube depends on the postoperative course of the disease, restoration of normal urine passage, passage or removal of small stones, salts and inflammatory products. According to A. Ya. Pytel, I. P. Pogorelko, the average period of preservation of a nephrostomy is 1-2 months. However, in case of severe destructive changes in the kidney and ureter, there is no possibility to perform repeated operations nephrostomy can remain for a longer period.
Nephrectomy, despite the tendency to perform organ-preserving operations for kidney stones, is often used (10-15% or even more of all operations in patients with kidney stones). The main indications for it are calculous pyonephrosis, a non-functioning kidney in the presence of nephrosclerosis, a kidney carbuncle with extensive destruction of its parenchyma, profuse bleeding and others. In the case of the development of severe sclerosing paranephritis, it is advisable to use subcapsular nephrectomy.
The postoperative period for kidney stones has a direct connection with the etiology, pathogenesis of the disease and the nature of the surgical intervention. Antibacterial treatment is carried out depending on the results of bacteriological studies, the sensitivity of microbes to antibiotics and chemotherapy. Nutrition and drug treatment are carried out depending on the disorders metabolic processes in the body, kidney function, chemical composition of urinary stones, urine pH and others; in case of renal failure, oazotemic treatment, detoxification agents and anabolites (5-20% glucose solution, retabolil, hemodez, vitamins B and C) are used against it; in cases of acidosis - alkalis (4% sodium bicarbonate solution and others).
After the operation, early activation of patients and exercise therapy is indicated, which improves urodynamics, eliminates intestinal paresis, prevents the development of pneumonia and others
The renal pelvis through the nephrostomy is periodically washed with antiseptic solutions. After removal of multiple phosphate and coral stones, some urologists recommend long-term irrigation of the pelvis with antiseptic solutions (furatsilin 1: 5000), and from the 10-12th day they additionally prescribe drugs that help dissolve phosphate salts and reduce urine viscosity (trilon-B, chymotrypsin and others ). Irrigation is carried out through a two-channel drainage or a specially installed thin catheter.
Forecast
The prognosis with timely conservative and surgical treatment of kidney stones is relatively favorable. It is worse in coral, multiple and bilateral phosphate stones. Negative effects on the course of kidney stone disease are disturbances in urodynamics and urostasis, and a persistent alkaline reaction of urine.
Postoperative mortality averages 1-2.5%. Its main causes are end-stage renal failure, uremia, urosepsis, thromboembolic and other complications.
Recurrence of stones in kidney stones can be true or false, the latter more often occurring after the removal of multiple and staghorn stones. True relapses of stones are observed in 3-5% of cases with aseptic stones, in 10-12% with infected stones, 20-46% with staghorn, multiple and bilateral stones.
Prevention
Prevention depends on the etiology and pathogenesis of kidney stones and is individual. Preventive actions are carried out taking into account violations of those metabolic processes in which stone formation occurs. When prescribing diet and drug treatment, urine pH should be taken into account (maintain within 6.2-6.9). With increased concentrations of urinary salts and salt diathesis, it is necessary to increase fluid intake to 2-2.5 liters. Patients must be on dispensary registration e, the main objectives of which are observation, anti-relapse treatment, labor recommendations, selection of patients for sanitary care. treatment and timely hospitalization.
Kidney stone disease in children accounts for 15-48% of all diseases of the genitourinary organs, and in endemic foci - 55-76%. Children more often than adults experience kidney stones with bilateral lesions, staghorn and multiple stones.
In the etiology of kidney stones, along with metabolic disorders in the body, an important role is played by anomalies and malformations of the genitourinary system, dysplasia, disproportionate development of various parts and organs, creating conditions for urostasis. Among the acquired factors in the development of kidney stones, inflammatory diseases of the urinary tract are important. They contribute to the development of lithogenesis processes or urostasis phenomena. In children, stones made from oxalic acid salts are more common, less often phosphoric and mixed.
At older ages, the course of the disease in children usually does not differ from its course in adults, but leukocyturia and hematuria are observed more often and may be the only manifestation of the disease, with microhematuria predominating. Pain symptom It is less common, it can manifest itself in the form of renal colic or be in the nature of dull pain. The pain is localized in the navel or spreads throughout the abdomen, often accompanied by disorders of the gastrointestinal tract. When examining a child, you can identify scoliosis, rigidity of the abdominal wall muscles on the side of the stone.
Kidney stone disease in children
Kidney stone disease in children is usually combined with pyelonephritis, the course of which is usually chronic. The combination of kidney stones and hydronephrosis is rare.
The most common complication of kidney stones is renal failure, which develops in more than 1/3 of children, mainly with bilateral lesions. Chronic renal failure begins to develop in early childhood, reaching its maximum manifestations by the age of 7 years. Complications such as pyonephrosis, paranephritis, and calculous anuria are much less common.
In the diagnosis of kidney stones in children, the main place belongs to x-ray methods. In children, especially in early age, excretory urography is the most accessible and informative, and sometimes the only research method. In cases of severely reduced or absent renal function, ascending ureteropyelography can be used.
Differential diagnosis is carried out with Wilms tumor (see Wilms tumor), in cases of acute stone obstruction - with acute appendicitis (see full body of knowledge: Appendicitis), acute obstruction intestines (see full body of knowledge), peritonitis (see full body of knowledge).
Treatment of kidney stones in children is predominantly surgical. Conservative treatment is acceptable if the kidneys are in good functional and morphological condition, if the stone is small in size and can pass on its own. Age-related anatomical, physiological and immunobiological characteristics of the body of children in the first years of life are characterized by the extreme activity of the fibroblastic reaction of kidney tissue to the inflammatory process (pyelonephritis), which in a short time leads to the development of nephrosclerosis. Therefore, surgical treatment should be as early as possible, regardless of age and the degree of pathological changes in the kidneys. When choosing the type of operation, you need to take into account the general condition, location, number and size of stones, their combination with malformations of the urinary tract, functional state kidneys, pyelonephritis activity, stage of chronic renal failure. Along with the removal of stones, if possible, the causes of urostasis are eliminated, that is, they produce and reconstructive surgery. In a bilateral process surgery First, it is carried out on the side of the better functioning kidney, with the same changes - on the side with more severe pain. A serious condition caused by acute obstruction of the urinary tract is an indication for two-stage treatment: by emergency indications nephrostomy is performed, then the patency of the urinary tract is restored as planned. Multiple and coral stones are removed by nephrolithotomy, while the pelvis is dissected in the transverse direction away from the ureteropelvic segment. Nephrectomy is performed only in cases of significant destruction of the kidney. In the pre- and postoperative periods, attention is paid to correction metabolic disorders, treatment of pyelonephritis.
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With kidney stones, the metabolism in the body is disrupted. May be characterized by infectious processes, including those associated with urinary tract infections. Nervous and endocrine regulation is disrupted.
Often there is a disorder of emptying or an abnormality of the urinary system. Stones in the ureter are formed from urinary salts, mainly in the renal pelvis. Salts precipitate and promote inflammatory processes in the pelvis.
Relapses often occur with kidney stones. Relapses are due to the fact that the pathological process is extensive, affecting not only the kidneys, but also the bladder. The disease is widespread.
What it is?
Kidney stone disease is the formation of stones in the kidney system. The disease is common due to the presence of unfavorable factors external environment. Although the etiology of the disease is not fully understood.
It should also be noted that the stones have different origins. Including a certain classification of stones. In first place, inorganic compounds. In second place are magnesium compounds.
The third place is occupied by uric acid derivatives. Sometimes patients are diagnosed with polymineral stones. Usually leads to relapses urinary infection. This is due to the vital activity of infectious agents; their waste products are excreted in urine, which means its composition and characteristics are disrupted.
Causes
The main causes of kidney stones include external and internal factors. Chronic pathologies also play a role in the etiology of the disease. As a result, the causes of the disease are divided into the following groups:
- Lifestyle;
- nutrition;
- vitamin deficiency;
- harmful working conditions;
- medications
The lifestyle is most often passive, that is, without the necessary physical activity. A person leads a sedentary lifestyle, including poor nutrition. Nutrition must be complete and must include vitamins and microelements.
Harmful working conditions also play an important role. Kidney stones are often a consequence of unfavorable working conditions. Some medications affect pathological changes in the kidneys and stones form. Mostly ascorbic acid and antibiotics.
The causes of kidney stones can be an abnormal development of the urinary system. The following diseases also play a role:
- poisoning;
- pathology of the gastrointestinal tract;
- infectious diseases.
Symptoms
The clinical picture of kidney stone disease is determined by the course pathological process. The pathological process may have a protracted course. There is also a chronic course, which is accompanied by periods of exacerbation and remission.
Stones can be localized in the right or left kidney. In some cases, a bilateral process is observed, that is, stones are located in both the right and left kidneys. The main symptoms of the disease are:
- sharp and dull pain;
- hematuria;
- purulent phenomena.
Sometimes kidney stones are asymptomatic. Renal colic is the main symptom of the disease. The symptoms of the disease also include the following signs:
- severe pain in the lower back;
- lower abdominal pain;
- patient's anxiety
Sometimes kidney stones are characterized by frequent urination. This includes vomiting and nausea. There is also an intestinal cut. Positive Pasternatsky syndrome occurs.
A complication of the disease is acute renal failure. In the presence of large stones, severe symptoms occur. However, in the initial period there are no symptoms. Then the patient complains of fatigue and weakness.
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Diagnostics
Diagnosis of kidney stones is based on medical history. Taking an anamnesis involves finding out necessary information. Including possible causes and a history of underlying disease.
Clinical studies can determine inflammatory responses. Urine tests also show hematuria and pus in the urine. A clear diagnostic method is the presence of stones in the urine.
X-ray examination methods are widely used. A clear picture of the disease is revealed by survey urography. However, not all stones are detected by radiography.
Ultrasound diagnostics allows you to determine the condition of the organs of the renal system. Ultrasound diagnostics of the bladder is also very relevant. Additional method Diagnosis of kidney stones is excretory urography.
Excretory urography allows you to assess the functional characteristics of the kidneys. And also determine the location of the stones. In the photographs, the stones appear as a filling defect.
Diagnosis is also based on consultation with specialists. In this case, it is a nephrologist and urologist. These specialists can not only determine the diagnosis, but also prescribe appropriate treatment.
Prevention
How can you prevent kidney stones? Prevention should be aimed at healthy image life, active physical exercise. Also for good nutrition. Including prevention of this disease include:
- elimination of infections;
- treatment of gastrointestinal tract pathologies;
- prevention of poisoning.
Eliminating the infectious agent not only reduces the risk of developing this disease, but also prevents complications. Infection most often leads to relapses. Relapses tend to recur. Which is kidney stone disease.
Pathology of the gastrointestinal tract must be treated in a timely manner. This is due to the fact that this pathology progresses quite quickly. Banal leads to stomach ulcers. Poisoning causes intoxication of the body.
Due to the resulting intoxication, metabolism is disrupted. As a result of metabolic disorders, irreversible processes occur. Stones and excrement form in the urine.
It is also necessary to work in favorable conditions. Hard work in hazardous work contributes to the development of various diseases. Including the development of kidney stones.
It is also important to consume the required amount of vitamins. Including excluding the use medications if there are kidney pathologies. If there are abnormalities of the urinary system, you must follow all the doctor’s recommendations.
It is necessary to treat the underlying diseases only under medical supervision. Self-medication is excluded! On initial stage disease, medical examination is relevant.
Treatment
In the treatment of kidney stones, conservative and surgical methods are used. It should be remembered that treatment is prescribed directly by a urologist. Usually the stones are removed surgically. However, in the presence of uric acid derivatives, conservative treatment methods are used.
The conservative technique uses citrates. They allow you to dissolve stones. And thereby improve the patient’s condition.
Patients with kidney stones are advised to follow certain measures. These measures include measurement water balance. Also, the methodology that must be followed includes:
- diet;
- herbal treatment;
- drug therapy;
- physical training.
It is also often necessary to resort to physiotherapeutic procedures. The method of sanatorium-resort treatment is also widely used. Typically, surgical intervention is gentle, but in the presence of a severe process, kidney surgery is used to remove stones.
The diet should be selected individually. However, there are principles of diet therapy for patients. They include the following provisions:
- varied food;
- taking a certain amount of liquid;
- exclusion of some products.
There is another treatment method. But it applies to people who develop small crystals instead of stones. In this case, the following actions are taken:
- one liter of liquid on an empty stomach;
- usually seven to ten times a day.
A liter of liquid includes mineral water, tea with milk, and a decoction of dried fruits. This liquid is the most effective. Promotes the removal and dissolution of crystals.
In adults
Kidney stone disease in adults is observed in various age category. Mostly in people between twenty and forty years old. Most often, stones form in the kidneys of middle-aged and young people.
It should also be noted that men get sick more often than women. But if women get sick, the disease is quite severe. Stones in women usually occupy the entire kidney cavity.
Large stones in women cause relapses. But at the initial stage the disease occurs without symptoms. However, nonspecific complaints are significant. Women make the main complaints about certain conditions:
- fatigue;
- weakness;
- lower back pain.
These conditions lead to the development of pyelonephritis. The risk of developing kidney failure begins to increase. Therefore, it is necessary to promptly begin treatment for symptoms that predispose to complications.
In adults, kidney stones develop quite severely. Performance decreases and general condition worsens. What are the main symptoms of this disease? The main symptoms of the disease include:
- pain;
- increased urination;
- vomit;
- nausea.
If the patient is elderly, stones usually affect the bladder. The bladder produces excrement of various origins. However, the elderly age of the patient in the presence of an infectious agent aggravates the disease process.
In children
Kidney stones in children are usually a recurrent disease. This is due not only to the localization of the pathological process, but also to the condition of the child. Girls and boys are equally susceptible to the disease.
Stones in children are also localized in the bladder. The disease is quite common in children. This is due to metabolic disorders. Especially at the age of hormonal changes. Then, over time, the disease worsens.
The etiology of the disease in children is associated with various diseases. Hereditary pathology and developmental anomalies also play a role. There is also a high probability of an infectious process. Infection in combination with kidney stones is a more dangerous symptom.
What are the main symptoms of the development of the disease in children? The main symptoms of the development of the disease in children include:
- urinary disturbance;
- lower back pain;
- fever;
- dyspepsia.
It should also be noted that excrement in children is quite frequent than in adults. However, renal colic is practically not observed in children. Unlike adults.
Very young children also have no symptoms of renal colic. But the following clinical signs are observed:
- anxiety;
- nausea;
- vomit;
- fever;
- intoxication.
Immediate diagnosis is required for these conditions. Laboratory research is very relevant. After diagnosis, it is necessary to apply a treatment method.
Forecast
In case of kidney stones, the prognosis depends on many circumstances. Including the age of the patient. And also from possible causes of the disease.
The prognosis is worst if the disease is complicated by infections. Often a more severe complication may occur. There is a high probability of a recurrent course of the disease.
If a relapse occurs, the disease may develop into a chronic stage. Accordingly, the prognosis is unfavorable. Relapses should be prevented!
Exodus
The outcome of the disease may be kidney failure. But in order to prevent its development, it is necessary to adhere to therapeutic therapy. This helps promote favorable outcomes.
Besides conservative technique surgical intervention is necessary. It depends on the type of stones. Larger stones lead to poorer outcomes.
Surgery helps to improve the healing process. However, treatment must be comprehensive. This contributes to the development of favorable outcomes.
Lifespan
The earlier treatment is started, the more options there are to exclude the chronic stage of the disease. This also helps to increase life expectancy. In addition, its quality improves.
If the disease develops in women, the size of the stone will affect life expectancy. If the size is large, it is necessary to urgently resort to surgical techniques. This improves the picture of the disease.
But the operation should be prescribed according to indications. Otherwise things may turn out adverse consequences. Be treated under medical supervision!