Stones in kidneys
Stones in kidneys – the display of an urolithic disease which is characterized by education in kidneys of salt concrements (stones). Stones in kidneys are shown by the aching waist pain, attacks of renal colic, gematuriy, piuriy. Diagnostics of stones in kidneys demands a research of biochemical parameters of urine and blood, performing ultrasonography of kidneys, excretory urography, a radio isotope nefrostsintigrafiya. Treatment of a pochechnokamenny disease can include the conservative therapy directed to dissolution of concrements, or their surgical removal (a piyelolitotomiya, a nefrolitotomiya, a nefrolitotripsiya).
Stones in kidneys
Stones in kidneys are a symptom of a pochechnokamenny disease or a nefrolitiaz. The practical urology quite often faces a pochechnokamenny disease, and stones in kidneys can be formed both at children, and at adults. Among patients with nefrolitiazy men prevail; stones come to light in the right kidney more often, in 15% of cases bilateral localization of concrements meets.
At an urolithic disease, except kidneys, stones can come to light in uric a bubble (), mochetochnik () or an urethra (). Practically always originally concrements are formed in kidneys and from there go down in the lower departments of an uric path. Single concrements and multiple meet; small stones of kidneys (to 3 mm) and large (to 15 cm).Please Help us - click on the advertisement
Process of a kamneobrazovaniye and types of concrements
Formation of stones in kidneys results from difficult physical and chemical process at violations of colloidal balance and changes of a kidney parenchyma.
Under certain conditions of group of molecules it is formed, a so-called, elementary cage – the micelle serving as an initial kernel of future concrement. As "construction" material for a kernel amorphous rainfall, fibrinous threads, bacteria can act, cellular detrit, the foreign matters which are present at urine. Further development of process of a kamneobrazovaniye depends on concentration and a ratio of salts in urine, urine, qualitative and quantitative structure of uric colloids.
Most often the kamneobrazovaniye begins in kidney nipples. Originally in collective tubules microlitas most of which part is not late in kidneys are formed and is freely washed away by urine. At change of chemical properties of urine (high concentration, shift and so forth) there are crystallization processes leading to a delay of microlitas in tubules and incrustation of nipples. Further the stone can continue "to grow" in a kidney or to go down in urinary tract.
On the chemical composition allocate several types of the stones which are found in kidneys – oksalatny, phosphatic, uratny, carbonate, tsistinovy, proteinaceous, cholesteric, ksantinovy. Oxalates consist of salts of calcium of oxalic acid. They have dense structure, black-gray color, a shipovaty uneven surface. Oksalatny stones in kidneys can be formed both at sour, and at alkaline reaction of urine.
Phosphates are the concrements consisting of calcic salts of phosphoric acid. On a consistence they soft, crumbling, with smooth or slightly rough surface, whitish-grayish color. Phosphatic stones in kidneys are formed at alkaline urine, quickly enough grow, especially in the presence of an infection (pyelonephritis).
Urata are presented by crystals of salts of uric acid. Their structure dense, color – from light yellow to brick-red, a surface - smooth or melkotochechny. Uratny stones in kidneys meet at sour reaction of urine. Carbonate concrements are formed at sedimentation of calcic salts of coal (carbonate) acid. They are soft, light, smooth, can have various form.
As a part of tsistinovy stones there are sulphurous compounds of amino acid of cystine. Concrements have a softish consistence, a smooth surface, rounded shape, yellow-white color. Proteinaceous stones are formed mainly by fibrin with impurity of bacteria and salts. Such stones in kidneys soft, flat, the small size, white color. Cholesteric stones in kidneys meet seldom; are formed of cholesterol, have the soft crumbling consistence, black color.
Sometimes in kidneys stones not of the uniform, and mixed structure are formed. One of the most difficult options of a pochechnokamenny disease are korallovidny stones in kidneys which make 3-5% of all concrements. Korallovidny stones of kidneys grow in a lokhanka and by the form represent its mold almost completely repeating the sizes and a form.Please Help us - click on the advertisement
The reasons of formation of stones in kidneys
Kamneobrazovaniye are the cornerstone processes of crystallization of urine, saturated various salts and sedimentation of crystals on a proteinaceous matrix kernel. The Pochechnokamenny disease can develop with a number of contributing factors.
The violation of mineral exchange conducting to formation of stones in kidneys can be genetically caused. Therefore people with family history of a nefrolitiaz are recommended to pay attention to prevention of a kamneobrazovaniye, early identification of concrements by means of control of the general analysis of urine, passing of ultrasonography of kidneys and ultrasonography of a bladder, observation at the urologist.
The acquired violations of salt exchange leading to formation of stones in kidneys can be caused by the external (exogenous) and internal (endogenous) reasons.
Among external factors the greatest value is allocated for climatic conditions and the drinking mode and a diet. It is known that in hot climate at the strengthened sweating and a certain degree of an obezvozhennost of an organism, concentration of salts in urine increases that leads to formation of stones in kidneys. Dehydration of an organism can be caused by the poisoning or an infectious disease proceeding with vomiting and a diarrhea.
In northern regions as factors of a kamneobrazovaniye deficiency of vitamins A and D, the lack of ultraviolet, prevalence of fish and meat of a diet can act. The use of drinking water with the increased content of limy salts, food addiction to sharp, sour, salty also leads to alkalization or acidulation of urine and loss of a deposit from salts.
First of all, distinguish hyperfunction of okoloshchitovidny glands from the internal factors promoting formation of stones in kidneys – . The strengthened work of parathyroid glands increases the content of phosphates in urine and washing away of calcium from a bone tissue. At the same time concentration of phosphatic salts of calcium in urine considerably increases. Similar violations of mineral exchange can arise at osteoporosis, osteomyelitis, fractures of the bones, injuries of a backbone, injuries of a spinal cord which are followed by a long obezdvizhennost of the patient, depression of a bone tissue, violation of dynamics of depletion of uric ways.
Gastrointestinal diseases – the gastritises, stomach ulcer, colitis leading to violation of acid-base balance, the increased removal of salts of calcium, weakening of barrier functions of a liver and change of composition of urine also belong to endogenous factors of formation of stones in kidneys.
In pathogenesis of formation of stones in kidneys the known role belongs to adverse local conditions in uric ways – to infections (pyelonephritis, a nefrotuberkulez, cystitis, an uretrit), prostatitis, anomalies of a kidney, a gidronefroz, the prostate gland adenoma, a divertikulit and other pathological processes breaking an urine passage.
Delay of outflow of urine from a kidney causes stagnation in a cup lokhanochnoy to system, glut of urine various salts and their settling out, an otkhozhdeniye delay with urine of sand and microlitas. In turn, the infectious process developing against the background of an urostaz leads to hit in urine of inflammatory substrata - bacteria, slime, pus, protein. These substances participate in formation of primary kernel of future concrement around which the salts which a lot of are present at urine crystallize.Please Help us - click on the advertisement
Symptoms of stones in kidneys
Depending on the size, quantity and structure stones in kidneys can give symptomatology of various expressiveness. The typical clinic of a nefrolitiaz includes waist pains, development of renal colic, a gematuriya, a piuriya, sometimes – an independent otkhozhdeniye of a stone from a kidney with urine.
Waist pains develop owing to urine outflow violation, can be aching, stupid, and at sharply arisen urostaz, at obstruction a stone of a lokhanka of a kidney or a mochetochnik, to progress to renal colic. Korallovidny stones in kidneys usually are followed by unsharp dull ache, and small and dense give sharp pristupoobrazny pain.
The typical attack of renal colic is followed by the sudden sharp pains in lumbar area extending on the course of a mochetochnik in a crotch and genitals. Reflex against the background of renal colic there are speeded-up painful urinations, nausea and vomiting, a meteorizm. The patient is excited, uneasy, cannot find to himself the pose facilitating a state. The painful attack at renal colic is so expressed that is often stopped only by introduction of narcotic medicines. Sometimes at renal colic the oligouriya and an anury, fever develops.
Upon termination of an attack of renal colic sand and stones from kidneys quite often depart with urine. At an otkhozhdeniye stones can injure mucous uric ways, causing a gematuriya. Damage of mucous is more often cause peaked oksalatny concrements. At stones in kidneys intensity of a gematuriya can be various – from an insignificant eritrotsituriya to the expressed makrogematuriya. Release of pus with urine (piuriya) develops in the presence of an inflammation in kidneys and uric ways.
Existence of stones in kidneys symptomatic does not prove at 13-15% of patients. At the same time, as a rule, pyelonephritis and morphological changes in kidneys are absent.Please Help us - click on the advertisement
Diagnostics of stones in kidneys
Recognition of stones in kidneys is made on the basis of the anamnesis, a typical picture of renal gripes, the laboratory and tool visualizing researches.
At height of renal colic sharp pain on side of the affected kidney, a positive symptom of Pasternatsky, morbidity of a palpation of the corresponding kidney and a mochetochnik is defined. The urine research after an attack reveals existence of fresh erythrocytes, leukocytes, protein, salts, bacteria. The biochemical research of urine and blood to some extent allows to judge structure and the reasons of formation of stones in kidneys.
Right-hand renal colic needs to be differentiated with appendicitis, sharp cholecystitis in this connection performance of ultrasonography of an abdominal cavity can be required. By means of ultrasonography of kidneys anatomic changes of body, existence, localization and the movement of stones are estimated.
As the leading method of identification of stones in kidneys serves x-ray diagnostics. The most part of concrements is defined already at survey urography. However proteinaceous and mochekisly (uratny) stones of kidneys do not detain beams and do not give shadows on survey urogramma. They are subject to identification by means of excretory urography and a piyelografiya. Besides, the excretory urography gives information on morfo-functional changes in kidneys and uric ways, localizations of concrements (a lokhanka, a cup, a mochetochnik), a form and the sizes of stones in kidneys. If necessary urological inspection is supplemented with a radio isotope nefrostsintigrafiya, MRT or KT of kidneys.Please Help us - click on the advertisement
Treatment of stones in kidneys
Treatment of a nefrolitiaz can be conservative or quick and in all cases elimination of an infection and the prevention of repeated formation of concrements is directed to removal of stones from kidneys.
At small nephroliths (to 3 mm) which can be removed independently, the plentiful water loading and a diet excluding meat and an offal is appointed. At uratny stones the dairy and vegetable diet alkalizing urine, alkaline mineral waters (Borjomi, Yessentuki) is recommended; at phosphatic concrements – reception of acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets) etc. In addition under control of the nephrologist the medicines dissolving stones in kidneys, diuretics, antibiotics, nitrofurans, spazmolitik can be applied.
At development of renal colic medical actions are directed to removal of obstruction and a painful attack. Injections of a platifillin, metamizol of sodium, morphine or the combined analgetics in a combination are for this purpose applied by atropine solution; the heat sedentary bath is carried out, the hot-water bottle is put to lumbar area. At not stopped renal colic carrying out novokainovy blockade of a seed kanatik (is required from men) or a round ligament of a uterus (from women), carrying out a kateterization of a mochetochnik or a section of the mouth of a mochetochnik (at infringement of a concrement).
Expeditious removal of stones from kidneys is shown at frequent renal gripes, secondary pyelonephritis, large concrements, striktura of a mochetochnik, a gidronefroza, blockade of the kidney menacing to a gematuriya, stones of the only kidney, korallovidny stones.
In practice at a nefrolitiaza the noninvasive method – the remote lithotripsy allowing to avoid any intervention in an organism and to bring splinters of stones out of kidneys in uric ways is often applied. In some cases as an alternative of open surgery serves the hi-tech procedure - a perkutanny (chreskozhny) nefrolitotripsiya with a litoekstraktion.
On extraction of stones from kidneys – to a piyelolitotomiya (a lokhanka section) and a nefrolitotomiya (a parenchyma section) resort to open or laparoscopic interventions in case of inefficiency of low-invasive surgery. At the complicated course of a pochechnokamenny disease and loss of function of a kidney the nefrektomiya is shown.
After removal of concrements resort treatment, lifelong observance of a diet, elimination of contributing factors of risk is recommended to patients.Please Help us - click on the advertisement
The forecast and prevention of formation of stones in kidneys
In most cases the current of a nefrolitiaz predictively is favorable. After removal of stones from kidneys on condition of observance of instructions of the doctor-urologist, the disease can not recur. In adverse cases kalkulezny pyelonephritis, a symptomatic hypertension, a chronic renal failure, can develop.
At any kinds of stones in kidneys increase in volume of drink up to 2 l a day is recommended; use of special grass collecting; exception of spicy, smoked and greasy food, alcohol; exception of overcoolings; improvement of an urodinamika by means of moderate physical activity and physical culture. Prevention of complications of a nefrolitiaz comes down to early removal of stones from kidneys, to an obligatory prolechivaniye of the accompanying infections.