Many factors of modern life contribute to the development of urolithiasis, suffer with this disease absolutely everything. Among the predisposing factors to the fore the lack of exercise, eating habits, metabolism, adverse ecological conditions. Consequently, there is no single cause of this disease, in this case affects a whole range of factors, both external and internal.
From endogenous causes may be mentioned infections of the urinary tract, which in most cases leads to violation of the outflow of urine and ischemic events in the renal parenchyma. The important role played by hereditary and acquired tubulopathy, structural abnormalities and kidney location, endocrine pathology.
There are several large males predisposition to the disease, but in females the disease is much harder and with a lot of stones. Currently, physicians adhere to several theories of stone formation in the kidneys, but none of them does not shed full light on the mechanisms of urolithiasis. It was found that urolithiasis refers to multifactorial disease, which occurs with a large number of physical and chemical changes in the blood and urine.
Types of kidney stones
To date, accurately known mineralogical structure of virtually all the stones that are found in the urinary system.
Most of rocks containing inorganic calcium compound. These include:
Those stones that contain magnesium salts, are relatively rare, and often they are accompanied with the infectious lesions of the urinary tract. This type of stone is more common in older people.
For even more rare are cystine and xanthine stones. They are found in people with impaired metabolism of proteins, in particular amino acids, and less than 1% of all cases of kidney stones.
The most common type of stones - mixed or polymineral. Such stones are not uniform in their composition and are represented by several kinds of organic and inorganic compounds. Basically, they are accompanied by urinary tract infections, and metabolic disorders.
The primary process is the formation of stones most often begins in the collecting tubules of the kidneys or in the pelvis. Initially, the core is formed of stone, and then layering it occurs various crystals. stone growth occurs due to the growth of the core, and due to peripheral growth due to settling thereon of new crystals. In one stone can detect multiple heterogeneous layers structure. This fact - evidence of adherence of urinary infection.
It is believed that precedes urolithiasis, chronic pyelonephritis, but it can not in all cases be called the root cause.
The severity of the clinical picture depends on many factors - the duration of the existence of kidney stones, their shape and size, their location.
But wherever a hotbed of urolithiasis, kidney stones symptoms are always accompanied by pain. Its intensity and nature of localization depends on the calculus. So, at the location of the stone at the waist or abdomen, pain can be paroxysmal or permanent, if the stone is localized in the bladder - pain will wear cramping in nature, may be given in the groin, hip or genitals. The most strongly expressed pain at the location of calculus in the renal pelvis or ureter passing it on. Painful promotion stones usually cause more than a centimeter in diameter, the rest can go on their own urine.
Renal colic is usually caused by the movement of stone and spasm of the muscle fibers caused by this movement. Colic is very characteristic features:
Severe attacks of pain in the lumbar region;
Frequent urge to urinate, the urine can not get out at all or stand drops;
Tension of the abdominal muscles;
Dyspeptic reactions - nausea, retching, temporary constipation;
A patient tossing on the bed - no posture does not bring relief.
The stone is usually moved from its place after lifting weights, careless and abrupt movements, strong jumps and a long commute (especially on rough roads), lumbar injuries, excessive fluid intake. These factors have an irritating effect on the kidney tissue and the ureters, in response to this they react reflex spasm and "shift" the stone from its place. Sometimes the cause of colic is not getting out of stone, and the elimination of a large number of "sand" - a very small crystals.
However, not all stones are felt, in some cases, they exist for years and are found incidentally during ultrasound of the kidneys of other diseases of the urinary system.
How to diagnose kidney stones
Determination of renal colic is not a big difficulty. The urine will almost always be present blood (micro- or gross hematuria). If the blood analysis is not detected, it is usually regarded as an indirect indication of the overlap of the lumen of the urinary tract calculus. If urine is deeply colored with blood, so when there was a stone motion trauma mucosa pelvis or ureter.
More than half of the cases except hematuria leukocytes in urine found in large quantities, up to pyuria, but this feature is not considered as characteristic for renal colic and indicates a pronounced inflammation in the kidneys.
To learn how to look like kidney stones, go the whole story in the first place this is due to their rather bizarre form and difficulty of their exit from the urinary tract. Released concrement typically examined by spectroscopic analysis and optical crystallography, in order to determine its structure.
On the plain film of kidney stones are quite well rendered in various shades of various shapes and various localization. Kidney stones can also be determined with the help of a contrast urography . In this case, special radiopaque substance is injected and using sequential x-rays was observed for its promotion of the urinary system. Where is calculus, usually a full or partial stasis x-ray contrast agent that indicates the presence of obstacles.
When renal ultrasound picture may be very different, but in most cases, is detected in renal colic expansion of the urinary tract calculus localization zone.
Also, an auxiliary method of research is Doppler blood vessels of the kidneys. The main symptom of kidney stones in this study is the change in the ratio of blood flow in the area of obstruction. Another method to determine the condition of microcirculation, is the method of radiometry. In renal colic local vasospasm is observed in the stone location area, respectively, it is changing and temperature behavior.
All of these methods make it possible not only to identify and clarify the location of the stones, but also to identify the tactics of treatment.
How to treat urolithiasis
It is extremely important in the treatment of urolithiasis try to eliminate the root cause of the disease. All treatments are pided into conservative and surgical. For surgical interventions usually move only in extreme cases, when conservative measures have not led to improvement. When renal ultrasound picture may be very different, but in most cases, is detected in renal colic expansion of the urinary tract calculus localization zone.
Is dominated by preparations for litolitoliza - dissolution of stones, removal of spasm of the muscle fibers and eliminate inflammation. Also used herbal remedies and herbal teas (madder dyeing, cranberries, parsley, St. John's wort, root, bearberry, burdock, sweet flag, birch leaf, fennel, strawberry, horsetail), which enhance the effectiveness of tablet vehicles.
The most commonly prescribed following herbal preparations for the treatment of kidney stones:
This herbal complex, a diuretic, antispasmodic, litholytic, antimicrobial and anti-inflammatory action. They are usually prescribed 1-2 tablets (15-20 drops or ½ teaspoon of paste, diluted in a glass of water) for half an hour before each meal, a course can last up to three months. In the treatment with these drugs is mandatory adherence to diet and proper fluid intake. If necessary, treatment can be repeated several times a year.
Also, a variety of drugs may be prescribed depending on the type of stone:
When mochekisloy structure of stones:
The mixture Eisenberg;
When calcium urolithiasis:
Furosemide (scheme according Tiktinsky).
When oxalate stones:
When uric acid oxalate calculi:
When the mixed structure stones:
Cystenalum, enatin, olimetin
To expel stones in renal colic could be used as antispasmodic warm bath not exceeding 42 ° C, intravenous or intramuscular injection baralgina shpy, papaverine with platifilinom.
When conservative methods inefficiency operative treatment by one of:
shock wave lithotripsy;
traditional surgical methods - is used only in the presence of coral rock, acute pyelonephritis and renal edema.
Recently, widespread laparoscopic and endoscopic surgery to remove the stones. The main surgical methods are currently the extracorporeal shock wave lithotripsy, dissolution and transcutaneous removal of stones that can be combined among themselves or be supported by treatment of kidney stones using drugs. Also used pin litholysis in conjunction with the treatment of stones with a laser. Such treatment has multiple effects - analgesic, decongestant, stimulating the immune system, improves microcirculation and nutrition of kidney tissue.
What type of treatment for kidney stones to choose depends on the form of calculus, its location and size. Naturally, the smaller the size of the stone, the easier it is to remove and the less traumatic methods of treatment used. Most preferred laser method, because it can destroy the stones of any structure and localization. As for the treatment of kidney stones with ultrasound, it is used in cases of calculus size is not more than 2 centimeters. For large amounts shown in the contact lithotripsy or open surgical techniques.