Contents
Kidneys are paired organs of the human body. Their functionality is focused on filtering metabolic products and electrolytes. Later, these substances are excreted from the body in the urine. Sometimes chemicals can form crystals and attach to the walls of the calyces or the pelvis (the cavity in the kidney that is connected to the ureter). Gradually, their number increases, which leads to the formation of stones. What you need to know about the disease, how exactly are stones formed and how can they be removed?
What you need to know about kidney stones?
Nephrolithiasis or nephrolithiasis is one of the most common urological pathologies. Its main symptom is the deposition of stones in the kidneys. What are stones? These are dense formations that resemble stone in appearance and structure. Their size, shape and consistency are variable. The composition of the stone includes cholesterol, bile pigments, calcium carbonate and calcium phosphate.
How exactly does stone formation occur? Modern medicine does not give an exhaustive answer to this question. Chemicals passed through the kidneys usually dissolve in the urine. Some of them once simply cease to dissolve and linger in the cavity of the organ. At first, they form tiny grains of sand, which gradually cluster, become larger and form large stones.
The localization of the calculus does not always coincide with the place of its formation. They can freely move around the internal space, move from the kidneys to the urinary tract and vice versa. The size of the stones can vary from an inconspicuous grain of sand to the size of a large chicken egg. According to their chemical composition, they are divided into three main groups: phosphates (phosphoric acid), oxalates (oxalic acid), urates (uric acid).
Symptomatic nephrolithiasis
Symptoms of the disease appear as the development and increase in the number of stones. The calculus itself can form in a few months and exist inside the body without causing anxiety or discomfort in a person. Many people live with kidney stones for several years, completely unaware of their presence. As a result, the stone grows rapidly, disrupts the outflow of urine or causes renal colic.
Small formations are excreted from the body naturally with urine. Most often, they do not cause discomfort in humans. Stones ranging in size from 2-3 millimeters can cause acute pain in the lumbar region, cause nausea, vomiting, hematuria (blood in the urine). Attacks of the disease are episodic, which creates a false impression of the state of health, but the pain can return at any time – after morning yoga, a long walk or a trip in public transport (due to shaking).
Doctors often record cases of asymptomatic nephrolithiasis. Diagnosis of the problem can only be done with an ultrasound, x-ray, or urinalysis. Annually undergo a comprehensive examination of the body (check-up) to monitor and prevent violations in time.
Causes of stone formation
Causes of stone formation include:
- violation of metabolic processes (insufficient production of substances for high-quality digestion);
- infectious processes in the urinary tract or gastrointestinal tract, impaired passage of urine through the urinary system;
- increased acidity of urine (pH level above 5,5);
- excessive consumption of purine bases (found in meat and legumes);
- an excess of calcium and phosphorus in the urine (formed due to an excessive concentration of vitamin D, endocrine disorders, injuries of the bone skeleton, the use of low-quality liquids);
- increased levels of oxalates (salts of oxalic acid) in the urine.
Diagnostic features
First of all, contact your general practitioner. He will listen to complaints, assess the state of health and redirect you to a specialized specialist – a urologist or nephrologist.
To confirm / refute the diagnosis, ultrasound of the urinary system is performed. An ultrasound machine scans the kidneys, bladder, prostate, detects stones, their size and localization. Additionally, computed tomography may be needed. The method evaluates the density of calculi, the state of the ureter, anomalies in the development of the body. CT also determines the indications/contraindications for one of the stone removal methods.
If calculi are found, the patient takes a general urinalysis, urine culture, and a biochemical blood test. A general urine test will help identify the presence of infection and the degree of intensity of the inflammatory process. Moreover, the doctor will receive information about the chemical composition of the stone due to specific substances dissolved in the liquid. Urine culture indicates the type of infectious agent and its sensitivity to certain groups of drugs. Based on the sowing, the doctor draws up a medication course. A biochemical blood test will give an answer to the cause of stone formation and help track the functionality of the kidneys. For example, an increase in creatinine indicates a failure in organ filtration, and an abundance of uric acid indicates gout (metabolic disease).
Stone removal methods
The main goal of therapy is the neutralization of the calculus. Depending on its size, localization and characteristics, the doctor selects the most effective method of removal. After extraction, the calculus must be sent for diagnosis. This will help identify the cause of stone formation and prevent the development of nephrolithiasis in the future. A person is selected an individual diet, a scheme of physical activity and a lifestyle that will reduce the risk of stone formation to a minimum. If the patient ignores the therapeutic course, the disease passes into the chronic stage. This is fraught with a violation of the functionality of the kidneys and irreversible consequences for the body.
Medication Therapy
Drug therapy is only effective for dissolving small stones (up to 4 millimeters in diameter). In most cases, the doctor prescribes antispasmodics and analgesics. Medicines neutralize spasms, allow the calculus to dissolve and exit the body on its own. It should be noted that medications only affect ulates (formations based on uric acid). The only way to get rid of folates and oxalates is through surgery.
Abdominal surgery
Doctors in most modern clinics have abandoned abdominal operations due to the high risk, trauma, complexity and long rehabilitation period. How exactly is surgery carried out? The surgeon makes a long incision in the body, removes the kidney from the surrounding tissue and removes the calculus. Manipulations are fraught with the development of urinary fistulas, infection, the development of an inflammatory process, or deformation of the urinary tract. Even 30 years ago, it was possible to eliminate nephrolithiasis only by abdominal surgery. Now, more gentle methods are used to remove kidney stones with a smaller list of complications and side effects. The main alternative to abdominal surgery is lithotripsy.
Lithotripsy and its varieties
Lithotripsy – crushing the stone. There are several variations of the intervention, which differ in the type of surgical access to the calculus. Types of lithotripsy:
- Remote crushing of stones. The method is based on the functionality of the ultrasonic wave. It passes through the stone and crushes it into small fragments that can leave the body naturally. Remote crushing is used only with full confidence that the fragments can come out on their own.
- Ureterolithotripsy. The surgeon inserts the endoscope into the kidney through the urinary tract. The endoscope captures the state of the internal cavity and transmits its image to the computer. The doctor fixes the localization of the calculus, conducts a laser fiber to it and erases the stone into dust. The method does not leave scars, incisions, eliminates bleeding and other risks.
- Fibrolithotripsy. It is used in the presence of several stones in the kidneys. The surgeon inserts a fiberscope through the natural urinary tract and, using a laser wave, crushes the stones into dust.
- percutaneous lithotripsy. The doctor makes a puncture (about 5 millimeters), inserts an endoscope into it, crushes the stones with a laser wave and removes the fragments.
- Mini-percutaneous lithotripsy. The method is used in modern European clinics. The only difference from standard percutaneous lithotripsy is that the size of the puncture does not exceed two millimeters. The effectiveness of the intervention remains at the same level, and the patient’s recovery is much faster and more intensive. The very next day after removal, a person can return to the usual rhythm of life.
In a separate category, laparoscopic lithotomy is distinguished. In some cases, one or another anomaly of development / disease of the urinary system becomes the cause of stone formation. The surgeon is obliged not only to remove the calculus, but also to neutralize the developmental anomaly. Previously, this was done through an abdominal operation. Now most clinics are switching to laparoscopic lithotomy. The advantage of the method is minimal incisions (3-4 incisions up to a centimeter in size), less blood loss and tissue trauma. Inpatient therapy takes 2-3 days, and the recovery period is about 10 days.
The choice of removal method always remains with the specialist. Do not self-medicate and do not try to dissolve stones with herbal infusions / other folk remedies. They can aggravate the situation and provoke a number of complications.
Possible complications and side effects
Often, patients experience a relapse of the disease. Re-formation of stones is possible only in two cases – a medical error or non-compliance with prophylaxis by the patient. If the doctor performed the work poorly (removed the calculus not completely, but partially, picked up an ineffective treatment), the patient has the right to demand compensation and free therapy. It is important to understand that postoperative care falls on the shoulders of the patient. He must follow the recommendations of the doctor, drink medicines, adjust the diet and limit activity. Failure to comply with the rules leads to a relapse of nephrolithiasis. Can the situation be corrected? Yes, a person will have to go through the entire therapeutic course again and more responsibly approach the doctor’s instructions.
Another common complication is infection. Even with a minimally invasive intervention, one should not forget about the risk of infection. It is impossible to predict the reaction of the body. It depends on the protective function of the immune system and the specificity of the pathogen. Acute pyelonephritis may also develop. This is an inflammation of the renal pelvis, which occurs due to the displacement of stones.
Possible side effects also include bleeding (most often associated with surgery), the development or exacerbation of kidney failure, increased blood pressure, or abnormal heart rhythms. Can they be avoided? Yes. Carefully select a clinic and a doctor who will accompany you at all stages of treatment. Misdiagnosis can be as dangerous as surgeon errors during surgery. Make the right decisions and be healthy.