Kidney stone disease

Medicine1

Kidney stone disease is a chronic disease characterized by the formation of kidney stones. Initially, the presence of "sand" is noted in the urinary tract, from which stones are subsequently formed. The infringement of the stone in the urinary tract leads to convulsive contraction of the muscles, and renal colic begins. During an attack, acute, throbbing pains localize in the lumbar region, then irradiate into the groin. Men suffer from kidney stone disease more often than women.

Renal stone disease, or nephrolithiasis, is a relatively common disease. The formation of kidney stones can be a primary process, to which infection of the kidneys and urinary tracts subsequently joins, or, conversely, the infection occurs at the beginning, and stones are formed on its background again. Among patients with kidney stone disease, men predominate, stones are more often localized in the right kidney, a bilateral process is observed in about 15% of patients. Mostly people aged 20 to 50 years are ill. Kidney stones can sometimes be an accidental finding and can be identified by examining the patient for some other reason, for example, with fluoroscopy of the gastrointestinal tract.

Various factors are involved in the formation of kidney stones. Stones consist of an organic structure, or matrix, and a mineral, or crystalline, part. The matrix is 2-3% of the dry mass of the stone, the rest is in its mineral part. The matrix is composed of mucoproteins formed by the cells of the tubules, or, perhaps, they are the substance binding, cementing these cells. The matrix can play the role of a nucleus in the precipitation of crystals from a solution.

Symptoms of nephrolithiasis

  • Pain in the lumbar region, radiating to the groin.
  • Nausea and vomiting.
  • Feeling of heaviness in the stomach, stupor (stupor).
  • Temperature, fatigue, weakness.
  • Hematuria (blood in the urine).

Causes of kidney stone disease

The causes of nephrolithiasis are not completely clear. It is assumed that it is based on a violation of metabolic processes. The formation of stones in the urinary tract is promoted by an elevated calcium content in the blood. The disease is often observed in people who consume large amounts of milk, as well as suffering from a rare disease - hyperparathyroidism. The cause of the formation of kidney stones can be gout, as well as various diseases of the intestine. In addition, the acid-base balance of urine is important. It depends on the nature of the food, the presence of other diseases, medications taken. An important factor is also the hereditary predisposition to this disease.

The mechanism of the appearance of stones of different types is not the same. Stones consisting mainly of calcium salts (oxalates, phosphates, etc.), are formed when the mucoproteins are redundantly released into the urine. In urine, such patients have a special fraction of mucoproteins, capable of binding calcium. In addition, in these patients, the concentration of calcium in the urine is increased. Calcium is filtered in the glomeruli and reabsorbed in tubules. Reduction of reabsorption of calcium leads to an increase in its concentration in the urine and promotes stone formation. In addition, the crystallization of calcium contributes to a decrease in urine content of magnesium and citrates, which under normal conditions keep ionized calcium in a dissolved state. Violation of calcium metabolism, resulting from the destruction of bone tissue (with severe injuries, myeloma, lesions of parathyroid glands, etc.), promotes stone formation.

Stone formation can occur when taking large doses of sulfonamide and some other drugs. In the formation of kidney stones, geographical factors play a role (hot and dry climate, which contributes to significant sweating, leads to a decrease in the volume of urine and an increase in the concentration of salts in it, which promotes stone formation). This is also favored by the use of highly mineralized (hard) water containing a significant amount of calcium salts. Unilateral nutrition, poor in vitamins A and B, also leads to stone formation in the kidneys. Often there is a family predisposition in kidney stone disease. Infection of the urinary tract leads to a violation of urodynamics, a change in the reaction of urine, a decrease in its colloidal stability and thereby promotes the formation of stones. Stagnation of urine, which occurs with various disorders in the urinary system (with constriction and kink of ureters, etc.), is also a predisposing factor to the formation of urolithiasis.

Stones are most often formed in the kidneys, although they can be localized in the ureters and bladder. The size of the stones varies considerably - from a small grain of sand to tens and even hundreds of grams. They can be single and multiple and the most diverse form.

Large motionless or inactive stones located in the renal pelvis often manifest blunt pain in the lumbar region, which increase with movement, physical exertion and diminishing at rest. Often there is a urinary tract infection. Pains are caused by the dilatation of the renal capsule and irritation of the nerve endings caused by stagnation of urine.

The most characteristic symptom of nephrolithiasis is an attack of renal colic. It is characterized by the sudden appearance of severe pain in the lumbar region, often spreading over the upper half of the abdomen and radiating down the ureter, into the bladder, external genitals, and the inner thigh. Pain can be of one- or two-sided nature. During an attack the patient is restless, does not find a comfortable position. Appear dysuric phenomena in the form of rapid and painful urination. Often there are nausea, vomiting, flatulence, which makes diagnosis difficult, simulating a picture of an acute abdomen. The body temperature rises, chills appear.

In an objective study, there is a mild pulse, tachy- or bradycardia, breathing becomes more frequent, painful lumbling in the lumbar region on the patient side (a positive symptom of Pasternatsky), palpation along the ureter and above the pubis in the bladder area is sensitive.

The attack of renal colic is caused by a blockage of the pelvis or ureter, which is accompanied by an acute retention of urine leading to stretching and spasm of the musculature of the pelvis and ureter. Colic lasts from a few hours to several days, the pain then intensifies, then wanes. Cessation of pain occurs after the restoration of the outflow of urine, this can occur suddenly or gradually and is associated with a change in the position of the stone.

Kidney colic can cause not only stone, but also any other small formation in the urinary tract, for example, a blood clot or pus. The cause of colic may be increased mobility of the kidney (a wandering kidney).

Treatment of nephrolithiasis

First of all, the doctor prescribes painkillers in combination with antispasmodics. The colic disappears, and the stone (if it is of small diameter) can spontaneously come out when urinating. With stones of large sizes, the most effective method is remote shock wave lithotripsy. The procedure usually lasts about 30-40 minutes.

To avoid stone formation in the kidneys, it is recommended to lead an active lifestyle, use more liquid, get rid of excess weight. This is especially true for people who previously suffered from this disease. The diet should be prescribed by a doctor, since the variety of forms of kidney stone disease causes the use of various diets.

Consult a doctor if there are regular long-term pain that does not stop even after taking painkillers. If they are accompanied by an increase in temperature, then you should consult a doctor immediately.

To establish an accurate diagnosis, a thorough examination of the patient is required, since the symptoms of kidney stone disease are very similar to those of other diseases. The temperature is measured, blood and urine are analyzed, and X-rays are taken. It is important to establish the size of the stone and its location. After studying the X-ray picture, the doctor will tell you what the probability of spontaneous removal of the stone. Most often, the ureter is obstructed and closed by stones larger than 5 mm in diameter.

Treatment of nephrolithiasis is carried out jointly by urologist and nephrologist. In the absence of a violation of the outflow of urine, conservative treatment is performed. To increase the diuresis, the patient is advised to drink up to 2 liters / day, drinking mineral water. Mineral water, in addition to enhancing diuresis, helps reduce inflammation in the urinary tract and regulates the acid-base state of the body. With an alkaline reaction, urine is prescribed acidic mineral waters, with acidic - alkaline. Therapeutic water is consumed by 200-400 ml per reception for 45-60 minutes before meals.

Nutrition for kidney stones should be varied and vitaminized. With urate stones, products containing uric acid (meat, liver, broths, etc.) are limited, a milk-vegetable diet is prescribed. When oxalate stones are prescribed food, poor in calcium and oxalic acid. Limit the use of spinach, sorrel, beans, chocolate, cocoa, milk and dairy products. With phosphaturia, a protein and fat diet is recommended, and the use of dairy products is limited.

Course of the disease

The disease can proceed in different ways, sometimes asymptomatic. But in most cases, nephrolithiasis is accompanied by permanent or temporary pain in the lumbar region, radiating into the groin. Pains weaken after taking painkillers and antispasmodics, which help relax muscles, which can serve as an impetus to spontaneous movement of the stone. In severe cases, if there are large stones in the kidneys, surgery is necessary.

Is kidney stone disease dangerous?

Renal stone disease is a dangerous disease, as the presence of stone leads to stagnation of urine and the occurrence of infection. This can cause kidney failure. Spontaneous removal of stones is quite a frequent phenomenon, therefore in most cases the patient does not need an operation. It should be noted that the kidney is usually not damaged when the stone is removed.

Prevention of nephrolithiasis

  • Active lifestyle
  • Drinking lots of fluids.
  • Refusal of calcium-rich beverages and foods.

 

Related:
1. Acute Renal Failure
2. Polycystic kidney disease
3. Chronic Renal Failure
4. Inflammation of renal pelvis