Kidney stones

Kidney stones

Description of kidney stones

Urolithiasis (urinary stones) is characterized by the formation of stones in the urinary tract. It is very common kidney disease.

Stones (calculi) may occur anywhere in the urinary tract. Most commonly in the kidneys, ureters, and further in the bladder. They are made of substances (salts, minerals), which are normally soluble in urine, but under certain circumstances leads to their crystallization and gradual transformation into insoluble concrement.

There are several kinds of stones, according to the main structural components. The most common stones are calcium oxalate, uric acid, struvite (hořečnatoamonný phosphate), infectious stones, are rare cystine and xanthine.

Urolithiasis affects about 4% of the population in the Czech Republic, two to three times more men than women.


Causes of Kidney Stones

Formation of stones (calculi) is caused by a combination of factors. They occur when supersaturation of urine kamenotvornými substances. This occurs either at a reduced urine production atlow intake of fluids or working in the heat, or elevated secretion kamenotvorných substances such as calcium, urate, oxalate. Great impact and changes in urinary pH.

The emergence stones also applies shortage of substances that prevent urolithiasis. Such substances include citric acid, magnesium.

On urolithiasis are also involved in urinary tract infections. Here are applied in particular species of bacteria produces the enzyme urease, which consists of ammonia and thus increases the pH of urine. This creates infectious stones.

Increased susceptibility to urolithiasis has also been observed in patients eg. An enlarged prostate, or other conditions which occur as a result of any obstructions in the urinary tract to reduce or slow down the outflow of urine. This constitutes its stagnation (stagnation).


Risk factors for kidney stones

Factors that may increase the risk of stone formation is more. These include inadequate fluid intake, especially clean water. When the body lacks fluids must save water and thus her urine profiltruje less. The urine is then more concentrated, and contains relatively more substances capable to crystallize and form stones.

Another factor is the presence in the family. If someone in the family suffers from bladder stones, there is an increased risk that it will affect you as well. And when you’ve experienced one urolithiasis, there are about 5O% risk that the disease will recur.

Regarding sex and age, males are 2-3 times more frequently affected than women, and the disease can occur at any time between the 20th and 80th year.

Eating habits also influence the formation of stones. Mainly diets increased consumption of protein,sodium (salt) and a reduced consumption of calcium may be helped to stone formation.

Another factor is the incorrect use of certain medications, high blood pressure, obesity and low physical activity. For individuals with little movement habits, long sedentary and immobile individuals as a result of limited physical activity leads to greater release of calcium from boneand renal excretion with an increased risk of stone formation.

Also, patients suffering from various diseases of the digestive tract leads to changes in calcium absorption with subsequent amendments to its concentration in urine.


Preventing Kidney Stones

Basis constitutes an adequate fluid intake. Daily should drink at least two liters of water. Best pure water. It is also recommended to drink one cup of homemade fruit, preferably lemon juice.

If you once had bladder stones, and you know what kind of been recommended for prevention of recurrence of stones to hold a special diet.

Individuals with hyperoxaluria should avoid diet high in oxalate. They should not eat spinach, peanuts, almonds, rhubarb, soya, sesame seeds. They should reduce drinking coffee and teas.

For hypercalciuria is recommended to reduce salt intake. Salt is also pulls calcium to renal elimination. The consumption of salt should be about 6 g / day.

Hyperuricosuric Patients should reduce meat consumption.


Signs and symptoms of kidney stones

Urinary stones can be when in the kidney and do not prevent a steady outflow of urine without any symptoms. Sometimes it can be demonstrated in urine blood. Usually the bleeding is so small that it proves only under a microscope. Rarely is such intensity that colors the urine, it can be seen with the naked eye. Because of the presence of blood in urine is the result of injury to the lining of the urinary tract stone.

When the stone comes from the kidneys to the urinary tract narrower space can have an intense flank pain, usually on one side. It’s called. Colic, colicky pain. It radiates into the groin. It is usually intermittent with intervals of pain from 20 to 60 minutes, depending on the length of stay of stone in a narrow space.

If the stone passes into the bladder until colicky pain disappears. It is also a strong pain when urinating and frequent urge to urinate. Urine may be colored in red blood may still be present in flakes mucosa.

Colic is usually accompanied by malaise, nausea and vomiting, sometimes diarrhea.

If a stone gets from the urethra up to the transition into the bladder, which is very narrow, there may hack stone and prevents the outflow of urine. It then presents a risk of infection manifested by general symptoms like fever and chills. When the involvement of both sides can lead to kidney failure.


Examination of kidney stones

It begins with a history of doctor asking about family history of urolithiasis on eating habits, fluid intake, medications and frequency of urological infections.

From the examination is performed urinalysis, which show the presence of blood and various minerals. Also performs urine culture, urine pH measurement.

The basis of examination and diagnosis are imaging. Stones containing calcium and / or cystine are radiopaque and therefore their display sufficient plain radiograph abdomen.

For urate stones, which are not radiopaque, before imaging is supplied to the body a contrast agent, which is then excreted from the body.

Stones in the renal pelvis can be demonstrated by ultrasound.


Treatment of Kidney Stones

Renal colic is pain relieving administering painkillers (analgesics) and drugs that relax smooth muscle contractions in the ureters (spasmodic). When present, nausea and vomiting, dehydrated patients, given sufficient fluid.

For more serious conditions associated with fierce pains that do not want to let up, after severe vomiting, signs of infection and urinary obstruction, hospitalization is necessary. Approximately 80% of stones from the body leaves. It’s mostly stones sizes up to 4 mm. If the stones are larger, the best method of treatment is to destroy the stones extracorporeal shock wave lithotripsy.

In patients with urolithiasis subject has experienced in the past as part of the treatment and also prevention of relapse recommended dietary diet, depending on the type of stones excluded (see dietary recommendations prevention).

The treatment includes, in some cases pharmacological treatment. Thiazides reduce excretion of oxalate and calcium by about half. Allopurinol is administered in patients with hyperuricosuric, which is an increased excretion of uric acid. In patients with struvitovými concretions should be experimentally deployed long antibiotics, at least 6 weeks, followed by weighing lithotripsy continued therapy or surgery.

Patients with urolithiasis subject has experienced in the past should be monitored regularly by a doctor (urologist or nephrologist) at least once a year.


How can I help myself

The respect of a healthy lifestyle with a large intake of fluids, preferably clean water (at least 2 liters per day).

The daily program to include regular exercise, try to reduce overweight. What’s eating concerns adhere to dietary recommendations (see prevention).


Complications of kidney stones

Early diagnosis and treatment should prevent the penetration of complications. One of the complications is bleeding due to trauma mucosa urinary passage stone formation and infection.

When stone clog the urinary tract and prevents the outflow of urine (obstruction), increases the susceptibility of the organism to infection. May develop inflammation of the bladder, ureters, but the main risk of the infection to the kidneys with the emergence of inflammation of the kidneys(pyelonephritis) to the whole body of sepsis (sepsis).

When disability urolithiasis on both sides with the establishment of bilateral obstruction at risk ofkidney failure.

Although rare, but also dangerous is the possibility of rupturing the wall of the ureter and falling stone into the abdominal cavity with the development of peritonitis.

Other names: urolithiasis, urinary stones, bladder stones, kidney stones, urolithiasis, renal colic

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