The kidneys are paired organs of the human body. Their functionality focuses on filtering metabolic products and electrolytes. Later, these substances are removed from the body in the composition of urine. Sometimes chemical compounds can form crystals and adhere to the walls of the renal cups or the pelvis (a 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 stones are formed and how can they be removed?
What you need to know about kidney disease?
Nephrolithiasis or kidney disease is one of the most common urological pathologies. Its main symptom is the deposition of calculi in the kidneys. What are calculi? These are dense formations that resemble a stone in appearance and structure. Their size, shape and texture are variable. The composition of the stone includes cholesterol, bile pigments, carbon dioxide and calcium phosphate.
How exactly is stone formation? Modern medicine does not give an exhaustive answer to this question. Chemicals that pass through the kidneys usually dissolve in the urine. Some of them once simply cease to dissolve and remain in the organ cavity. At first, they form tiny grains of sand, which gradually group together, become larger and form large stones.
Localization of calculus does not always coincide with the place of its formation. They can move freely in the inner 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. By chemical composition, they are divided into three main groups: phosphates (phosphoric acid), oxalates (oxalic acid), and urates (uric acid).
Symptoms of nephrolithiasis
Symptoms of the disease appear with the development and increase in the number of stones. The calculus itself can form within 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 flow of urine, or causes renal colic.
Small formations are excreted naturally by urine. Most often, they do not cause discomfort to a person. 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 health, but the pain may 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 kidney disease. The problem can be diagnosed only by ultrasound, X-ray examination or by results of urinalysis. Annually undergo a comprehensive inspection of the body (check-up) to monitor and prevent violations in time.
Causes of stone formation
The reasons for stone formation include:
- violation of metabolic processes (insufficient production of substances for high-quality digestion);
- infectious processes in the urinary tract or the gastrointestinal tract, violation of the passage of urine through the urinary system;
- increased urine acidity (pH level above 5.5);
- excessive consumption of purine bases (contained in meat and legumes);
- An excess of calcium and phosphorus in the urine (formed due to excessive concentration of vitamin D, endocrine disorders, injuries of the skeleton of the bone, the use of poor-quality fluids);
- high content of oxalate (salt of oxalic acid) in the urine.
First of all, consult a general practitioner. He will listen to complaints, assess the state of his health and redirect you to a specialist urologist or nephrologist.
To confirm / refute the diagnosis, ultrasound of the urinary system is performed. The ultrasound machine scans the kidneys, bladder, prostate, reveals stones, their size and localization. Additionally, you may need computed tomography. The method estimates the density of stones, the state of the ureter, anomalies of the organism. CT also determines the indications / contraindications to one of the methods for removing stones.
If stones are found, the patient shall pass a general urinalysis, urine culture, biochemical blood test. Urinalysis 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 pathogen and its sensitivity to certain groups of drugs. Based on the seeding, the doctor makes a medical course. Biochemical analysis of blood will give an answer to the cause of stone formation and help to track the functionality of the kidneys. For example, an increase in creatinine level indicates a failure in the filtration of the organ, and an abundance of uric acid in gout (metabolic disease).
Stone removal methods
The main goal of therapy is the neutralization of calculus. Depending on its size, location and features, 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, an exercise scheme and a lifestyle that will minimize the risk of stone formation. If the patient ignores the therapeutic course, the disease enters a chronic stage. This is fraught with a violation of the functionality of the kidneys and irreversible consequences for the body.
Drug therapy is only effective for dissolving small stones (up to 4 millimeters in diameter). In most cases, the doctor prescribes antispasmodics and analgesics. Medications neutralize cramps, allow the calculus to dissolve and leave the body on their own. It should be noted that the medications affect only the ulates (formations based on uric acid). Get rid of folate and oxalate can only be surgically.
The doctors of most modern clinics have refused abdominal operations due to the high risk, trauma, difficulty of conducting and a long rehabilitation period. How exactly is surgery? The surgeon makes a long incision on the body, releases 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 deformity of the urinary tract. Thirty years ago, nephrolithiasis could only be eliminated by abdominal surgery. Now for the removal of stones from the kidneys apply more gentle methods with a smaller list of complications and side effects. The main alternative to abdominal surgery is lithotripsy.
Lithotripsy and its varieties
Lithotripsy - crushing 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 splits it into small fragments, which can naturally leave the body. Remote crushing is used only with full confidence that the fragments will be able to exit on their own.
- Ureterolithotripsy. The surgeon inserts an 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, cuts, eliminates bleeding and other risks.
- Fibrolithotripsy. Used when there are several stones in the kidneys. The surgeon inserts a fibroscope through the natural urinary tract and, using a laser wave, crushes stones into dust.
- Percutaneous lithotripsy. The doctor makes a puncture (about 5 millimeters), inserts an endoscope into it, crushes stones with the help of a laser wave and removes fragments.
- Mini percutaneous lithotripsy. The method is used in modern European clinics. The only difference from the standard percutaneous lithotripsy is that the puncture size does not exceed two millimeters. The effectiveness of the intervention remains at the same level, and the recovery of the patient is much faster and more intensive. The very next day after removal, a person can return to the usual rhythm of life.
Laparoscopic lithotomy is distinguished into a separate category. In some cases, one or another developmental anomaly / disease of the urinary system becomes the cause of stone formation. The surgeon must not only remove the calculus, but also neutralize the developmental anomaly. Previously, abdominal surgery was used. Now most clinics are switching to laparoscopic lithotomy. The advantage of the method consists in minimal cuts (3-4 cuts up to centimeters 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 is always left to a specialist. Do not self-medicate and do not try to dissolve the 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 - medical error or failure to comply with the patient’s prevention. If the doctor did not perform the job properly (he removed the calculus incompletely, and partly, picked up the ineffective treatment), the patient has the right to demand compensation and no-charge therapy. It is important to understand that postoperative care falls on the shoulders of the patient himself. He must comply with the recommendations of the doctor, drink medicines, adjust the diet and limit activity. Failure to follow the rules leads to recurrent nephrolithiasis. Can I fix the situation? Yes, a person will have to undergo the entire therapeutic course anew and more responsibly approach the instructions of the doctor.
Another common complication is infection. Even with minimally invasive intervention, we should not forget about the risk of infection. To predict the reaction of the body is impossible. 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.
Among the possible side effects are also bleeding (most often occur during surgical intervention), the development or exacerbation of renal failure, increased blood pressure or heart rhythm disturbances. Is it possible to avoid them? Yes. Carefully select the clinic and the doctor who will accompany you at all stages of treatment. Incorrect diagnosis can be as dangerous as the surgeon’s mistakes during surgery. Make the right decisions and be healthy.