Kidney stones
Summary/Definition
Kidney stones are a disease in which substances present in the urine form crystals and settle inside the kidneys, forming stone–like formations that can cause a variety of symptoms and complications. Even with a small size, these stones can increase over time if you do not start treatment. For accurate detection and subsequent treatment strategy, it is necessary to conduct an appropriate examination. There are different types of kidney stones, including calcium stones, uric acid stones, struvite stones and cystine stones. Calcium oxalate stones are the most common in the category of calcium stones, followed by calcium phosphate stones. The level of calcium and oxalates in the urine may increase due to the consumption of certain foods, excessive intake of vitamin D, surgical interventions on the intestines and metabolic disorders. Basically, this happens when the urine level remains low and the urine has an alkaline reaction. Uric acid stones are formed due to excess uric acid in the urine and often occur with excessive production or excretion of uric acid. Gout can also contribute to their formation. Genetic factors or metabolic disorders can lead to an increase in the level of uric acid in the urine due to an increase in its concentration in the blood. Struvite stones are more common in women and are often associated with urinary tract infections. They can reach a sufficiently large size and fill the space where urine is collected in one kidney, while acquiring a characteristic shape resembling a deer horn, reproducing the contour of the renal pelvis. Cystine stones, relatively rare, are formed in individuals with a genetic disease that leads to excessive excretion of a certain amino acid (cystine) through the kidneys.
The causes of kidney stones vary and include the following factors: insufficient urinary excretion, changes in the acidity and alkalinity of urine, excessive use of certain substances, malabsorption of certain substances, genetic predisposition, urinary tract infections and exposure to medications.
Symptoms
Typical symptoms include pain, the presence of blood in the urine, etc. Pain with kidney stones is usually localized in the back or side and often occurs suddenly, it increases and can be accompanied by nausea and vomiting. Hematuria involves the presence of blood in the urine, which can be seen with the naked eye or detected with a microscope, even if it is invisible to the eye. Other symptoms include upset stomach, loss of appetite, fever, chills, discoloration of urine to cloudy and bloating.
Diagnostics
First, it is necessary to analyze risk factors using data from anamnesis. This includes an assessment of the patient’s age, gender, eating habits, water intake, the presence of cases of kidney stones in the family, as well as the history of the presence of kidney stones in the patient himself. Particular attention should be paid to the nature of the pain, the presence of pain in the lower back or side, whether it started suddenly and its intensity. During a physical examination, the area in which the patient feels pain should be checked, especially for the severity of pain when tapping on both sides of the lower back. When analyzing urine, you should pay attention to the color and smell of urine. Even if the blood is not visible to the naked eye, it is necessary to conduct a microscopic examination to detect the presence of red blood cells in the urine, which may be invisible visually. A blood test allows you to assess the level of substances that can contribute to the formation of kidney stones, for example, uric acid. If necessary, you can conduct special tests for minerals, amino acids, etc. To determine the location and size of kidney stones, various procedures may be required, including computed tomography (CT), abdominal radiography, abdominal ultrasound and urography. It is important to remember about possible side effects when using contrast agents in urography.
Treatment and course of the disease
Pain caused by kidney stones usually appears suddenly and is extremely intense, but in most cases it disappears on its own or can be relieved without the need for specific treatment. Kidney stones rarely pose a serious threat to life, but if they block the flow of urine, it can lead to irreversible damage to the kidneys and requires medical intervention. Treatment of kidney stones depends on their location, size, quantity, mobility, composition, presence of infection and kidney function. Analgesics and medications that help relieve spasms are used to relieve pain. Measures to restore urination include intravenous fluid administration and an increase in the volume of fluid consumed by the patient. Extracorporeal shock wave lithotripsy (ESWL) is a treatment method that is used to break kidney stones into small particles by ultrasound followed by natural excretion. During surgery, a nephroscope is used to remove the stone through a small incision in the kidney. Additional treatment methods may include the use of a ureteroscope to remove stones and the use of drugs that help dissolve the components of stones and then remove them through the urinary tract.
Complications
Complications may occur due to blockage of kidney stones in the channels through which urine passes. One of these complications is hydronephrosis, which is the accumulation of fluid in the kidneys and can lead to deterioration of kidney function. Pyelonephritis, in turn, is an inflammation of the kidneys and, in the case of concomitant infection, can also provoke a violation of their function. An abscess is an accumulation of pus around the kidney, which can also lead to a violation of its function. In case of complications, immediate treatment is necessary, aimed at relieving blockage of urine outflow or urine withdrawal from the body. If there is an infection, antibiotic therapy is required, and if an abscess forms, it may be necessary to install a catheter or perform an operation to drain pus.
