What Is Nephrolithiasis?

Renal calculi is caused by the abnormal accumulation of crystalline substances (such as calcium, oxalic acid, uric acid, cystine, etc.) in the kidney. It is a common and frequently-occurring disease of the urinary system. It is more common in men than in women and mostly in youth. In adulthood, there is no significant difference in incidence on the left and right sides, 90% contains calcium, of which calcium oxalate stones are the most common. 40% to 75% of patients with kidney stones have different degrees of low back pain. Large stones, small mobility, manifested by discomfort in the waist, swelling or dull pain when increased physical activity. Colic caused by smaller stones, often with sharp abdomen-like pain in the abdomen and abdomen, is paroxysmal. Stones can occur in any part of the urinary system, but they often begin in the kidney. When kidney stones are formed, they are usually located in the renal pelvis or sacral cavities, which can be discharged into the ureter and bladder. Almost all ureteral stones come from the kidney.

Will I get stones if I drink limescale water?

There are rumors on the Internet that there is a large amount of magnesium carbonate and calcium carbonate in the scale, and long-term drinking can easily cause stomach stones and kidney stones. In fact, drinking qualified tap water does not affect health.

What is scale? More: The main components of scales are carbonates, such as magnesium carbonate and calcium carbonate. After water is absorbed by the body, gastric acid dissolves the magnesium carbonate and calcium carbonate in the scale, and the non-decomposable part will be discharged out of the body with feces. The body has special effects.
Can scale cause stones? More: Kidney stones are formed when the concentration of calcium and magnesium ions in the body is too high and they precipitate in the urine. The formation of lithiasis is related to many factors such as metabolism and diet, and one cannot make a conclusion based on only one factor.

Related entries:: Calcium Oxalate

Content finishing: Mask Beethoven

Basic Information

English name: kidney calculi
Visiting department: Urology
Multiple groups: Young male

Common causes: Caused by abnormal metabolism, urinary tract obstruction, infection, foreign body, etc.
Common symptoms: Abdominal cramps, nausea and vomiting, irritability, bloating, hematuria, etc.

Causes of kidney stones

The formation of kidney stones is that certain factors cause the concentration of crystalline substances in urine to increase or decrease in solubility, which is in a supersaturated state. Crystals precipitate and grow and accumulate locally, eventually forming stones. There are many factors that affect the formation of stones. Age, gender, race, genetics, environmental factors, eating habits and occupations are related to the formation of stones. Metabolic abnormalities in the body (such as hyperparathyroidism, hypercortisolism, hyperglycemia), prolonged bed rest, nutritional deficiencies (vitamin B ₆ deficiency, magnesium deficiency diet), urinary tract obstruction, infection, use of foreign bodies and drugs Common causes of stone formation. It is known that urinary stones have 32 components, the most common component is calcium oxalate, and other components such as magnesium ammonium phosphate, uric acid, calcium phosphate and cystine (an amino acid). Kidney stones rarely consist of a single crystal, most of which have two or more, with one as the main body.

Kidney stones classification

1. Classification based on the composition of stones

(1) Calcium oxalate stones are the most common, accounting for 71% to 84%. Urine is acidic, characterized by hard, non-fragile, rough, irregular, tan, and easily damages tissues and causes hematuria. X-rays are characterized by deeper markings in the stones, irregular edges, and sometimes the shape of a renal pelvis or calyx.

(2) Calcium Phosphate Stones The urine is alkaline, characterized by fragile, rough, irregular, off-white, yellow or brown, often caused by urinary tract infections and obstructions. Mostly mixed with calcium oxalate or magnesium ammonium phosphate into stone. X-ray imaging is clear, the lamellar pattern is more obvious, and the staghorn shape is filled when filling the whole renal pelvis and kidney.

(3) Uric acid stones Urine is continuously acidic, characterized by hard, smooth, granular, yellow or brownish red, and abnormal metabolism of uric acid. Most of them consist of a single uric acid, with lighter or no development under X-ray.

(4) Magnesium ammonium phosphate stones are infectious stones, which are characterized by smooth, polyhedral or vertebral bodies, which increase rapidly, and are mostly related to repeated urinary tract infections and abnormal urinary tract anatomy. X-ray development is clear and the stone density is uneven.

(5) Cysteine stones is a rare genetic disease. Cystine stones occur in 82% of cystineuria patients, and 35% occur in infants or children. Features are soft, smooth, waxy, light yellow to yellow brown, and its crystals are hexagonal. It is easy to develop on X-ray films due to sulfur.

2. Classification based on the location of the stones

Can be divided into renal pelvis stones, kidney calves stones, renal parenchymal stones. Pelvis stones are most common, and parenchymal stones are rare.

Clinical manifestations of kidney stones

The symptoms of kidney stones depend on the size, shape, location of the stones, and the presence of complications such as infection and obstruction. Most patients with kidney stones are asymptomatic unless they fall from the kidneys into the ureter and cause ureteral occlusion. Common symptoms include cramps in the lower abdomen, nausea, vomiting, restlessness, bloating, and hematuria. If urinary tract infection is combined, chills and fever may also occur. Acute renal colic often makes patients unbearable.

Asymptomatic

Small stones with smooth surface can be excreted with urine without causing obvious symptoms. Infectious stones fixed in the renal pelvis and lower calves can also be without any symptoms. Even large staghorn stones can cause no symptoms for a long period of time, or cause only mild renal discomfort or soreness, if they do not cause kidney calyces, pelvis obstruction or infection.

Pain

(1) Swelling or dull pain is mainly caused by the compression, friction, or stagnant water in the renal pelvis or calves of larger stones.

(2) Colic is caused by the movement of smaller stones in the renal pelvis or ureter, which stimulates the ureter and causes spasms. Pain often begins suddenly, starting from the back, waist, or ribs, radiating down the ureter to the abdomen, the inner thighs, and the vulva. It can be accompanied by dysuria, nausea, vomiting, and sweating.

3. Hematuria

Hematuria is often accompanied by pain. Sometimes the patient has no pain, only hematuria or minimal blood volume, which is invisible to the naked eye. The physical examination usually includes a urine test, and the sediment after centrifugation of the urine is examined with a microscope. If you see too many red blood cells, it means hematuria, which is sometimes the early sign of kidney stones.

4. History of Pai Stones

During the onset of pain and hematuria, sand or small stones may be excreted with the urine. When the stones pass through the urethra, there is a blockage of urinary flow and a tingling sensation in the urethra. After the stones are discharged, the urinary flow immediately returns to unblocked, and the patient feels relaxed and comfortable.

5. Symptoms of infection

Pyriasis can occur during infection, and chills, fever, low back pain, frequent urination, urgency, and dysuria can occur during acute attacks.

6. Renal insufficiency

Obstruction of kidney stones on one side can cause hydronephrosis and progressive renal dysfunction on that side; obstruction caused by bilateral kidney stones or isolated kidney stones can develop into renal insufficiency.

7. Urinary closure

Bilateral kidney stones can cause urinary occlusion on both sides, solitary kidney or the only functional kidney stone obstruction, urinary occlusion on one side, and reflex urinary occlusion on the opposite side.

8. Waist block

When the stone obstruction causes severe hydronephrosis, it can be lumped and massed in the waist or upper abdomen.

Kidney stones

Urine test

Can detect the presence of urine sugar, urine protein, red blood cells, white blood cells, crystals, bacteria, etc.

Blood test

If the blood routine shows that a high white blood cell count indicates a possible infection, blood can also be drawn to check renal function and calcium concentration in the blood.

3.X- ray inspection

X-ray examination is the most important method to diagnose urinary tract stones. Including plain urinary tract films, excretory urography, retrograde pyelography, percutaneous nephrography and so on.

4.B -ultrasound

Diagnosis can be made on the presence of stones in the kidney and other concomitant lesions to determine if there is hydronephrosis in the kidney. In particular, stones with X-ray transmission can be found, and it can also provide some evidence for kidney damage caused by stones and the cause of some stones. However, B-mode ultrasound also has certain limitations. It cannot identify kidney calcifications and stones, cannot intuitively understand the relationship between stones and kidneys, and cannot see the specific impact of stones on kidneys. More importantly, B-mode ultrasound cannot Treatment of calculi provides sufficient evidence.

5.CT inspection

CT examination is currently the first choice for the diagnosis of stones. CT examination can show kidney size, contour, kidney stones, hydronephrosis, renal parenchymal lesions, and residual renal parenchyma. It can also identify renal cysts or hydronephrosis; it can identify the causes of urinary tract obstructions other than the urinary tract, such as Retroperitoneal tumors, pelvic tumors, etc .; enhanced angiography can understand the function of the kidney; CT is helpful for the establishment of diagnosis of acute renal failure caused by stones.

6. Magnetic resonance

The combination of MRI water imaging and MRI original images is more accurate and comprehensive, which is very effective for diagnosing urinary tract dilatation, especially for those with renal impairment, contrast agent allergies, and contraindicated X-ray examination. It is also suitable for pregnant women and children.

7. Physical examination

During the onset of renal colic, there was throbbing pain and tenderness in the renal area of the affected side. In cases without obstruction, the physical examination may have no positive signs or only mild throbbing pain in the ward.

Kidney stones diagnosis

The diagnosis of kidney stones should include determining the presence of stones, determining the complications, and the cause of stone formation. The diagnosis is not difficult for those with typical clinical manifestations or stones excreted from the urine. By knowing previous medical history, eating habits, family history, medication, and various laboratory and auxiliary examinations, the cause and pathophysiology diagnosis can be made, and whether there are complications.

Kidney Stone Treatment

First treat the symptoms. If analgesic drugs are used during the onset of colic, if a combined infection or obstruction is found, the infection should be controlled first according to the specific situation, and if necessary, ureteral intubation or pyelostomy should be performed to ensure the smooth drainage of urine to control infection and prevent renal function damage . At the same time, actively look for the cause, formulate treatment and prevention programs according to different components and causes, and fundamentally solve the problem to prevent the recurrence of stones as much as possible.

General treatment

(1) Drinking a lot of water Small stones may be pushed out and flushed by a large amount of urine, and an increase in urine also helps to control the infection.

(2) Adjusting the diet The composition of the diet should be based on the type of stones and the pH of the urine. Patients with calcium oxalate stones should avoid a high oxalic acid diet and limit the intake of spinach, beets, tomatoes, nuts, cocoa, chocolate and other foods. Limit calcium intake in patients with idiopathic hypercalciuria. Low-salt diet to control sodium intake. People with high uric acid should eat a low purine diet, avoid animal viscera, and eat less fish and coffee.

(3) Removal of incentives For urinary tract stones caused by pathological factors, the primary disease should also be actively treated. Actively treat the causes of stone formation to prevent stone formation and recurrence.

Symptomatic treatment

(1) Antispasmodic and analgesic M-type choline receptor blocker, which can relax ureter smooth muscle and relieve spasm Intramuscular injection of progesterone can inhibit the contraction of smooth muscles and relieve spasm, which has a certain effect on analgesia and row stones; the calcium blocker nifedipine has a certain effect on the relief of renal colic; alpha receptor blockers are in Ureter smooth muscle spasm has a certain effect in the treatment of renal colic.

(2) Control of infections Infections are prone to occur when urinary tract obstructions are caused by stones. Magnesium ammonium phosphate stones are often formed in infected urine. This vicious cycle aggravates the condition. In addition to actively removing stones to remove obstruction, antibiotics should be used to control or prevent urinary tract infections.

(3) Elimination of hematuria Obvious hematuria can be used with hydroxybenzylamine or tranexamic acid.

3. Treatment according to different ingredients and causes

(1) Hypercalciuria Primary hypercalciuria thiazide drugs and potassium citrate can be used. Absorptive hypercalciuria can not tolerate the needs of these drugs except thiazines and potassium citrate. If you use sodium phosphate, you should switch to orthophosphate if you have lower blood phosphorus. Hypercalcemia Active treatment of concomitant diseases, when hypercalcemia crisis occurs, emergency treatment is required. First use saline to expand the volume as soon as possible, and use diuretics such as furosemide to increase urinary calcium excretion; diphosphate is the main treatment for hypercalcemia, which can effectively inhibit osteoclast activity and reduce bone resorption. In patients with primary hyperparathyroidism with symptomatic hypercalcemia or asymptomatic kidney stones, surgical removal of the parathyroid glands is the first choice. When a patient has symptomatic or obstructive kidney stones, first treat the stones when there is no hypercalcemia crisis.

(2) Renal tubular acidosis Mainly use alkaline drugs to slow down the growth of stones and the formation of new stones, and to correct metabolic disorders.

(3) High oxalate urine Treatment of primary high oxalate urine is difficult. Try vitamin B6, starting from a small dose, and increasing the amount as the effect diminishes, while drinking a lot of water, limiting foods rich in oxalic acid, which can make urine Oxalic acid levels dropped to normal.

(4) High uric acid, low purine food and plenty of drinking water can reduce the concentration of uric acid in urine.

(5) Homocystinuria Appropriately limit the protein diet and treat with thiol drugs that lower cystine.

(6) Infectious stones Remove the stones according to the patient's condition, and choose appropriate antibiotics to control urinary tract infections.

4. Surgical treatment

When pain cannot be alleviated by medication or the diameter of the stone is large, surgical treatment should be considered. These include: Extracorporeal shock wave lithotripsy (ESWL) treatment. Placing a stent in the ureter can also cooperate with ESWL treatment. Lithotripsy through ureteroscopy. percutaneous nephrolithotomy. Laparoscopic incision and stone removal.

5. Emergency Management

Renal colic and infection should be treated immediately. Infection should be treated with antibiotics in time, and renal puncture and drainage may be performed if necessary. Renal colic can be treated with anticholinergic, progesterone, and calcium channel blocking drugs. If necessary, pethidine can be injected for analgesia. In patients with bilateral ureteral stones and obstructed anuria, immediate surgical stone removal may be considered.