Kidney stone

一、Pathogen

The formation of kidney stones is a result of certain factors that cause the concentration of crystalline substances in urine increased or decreased solubility , was saturated state , precipitation and crystallization in the local growth , accumulation and ultimately the formation of stones . There are many factors that affect the formation of stones , age , sex , race , genetic , environmental factors , eating habits and occupation associated with the formation of stones . The body’s metabolic abnormalities ( such as hyperparathyroidism , cortisol hyperlipidemia , hyperglycemia ) , long-term bed rest , nutritional deficiencies ( vitamin B6 deficiency , magnesium deficiency diet ) , urinary tract obstruction infection , foreign body and the use of drugs is a common cause of stone formation .

二、Symptoms

The symptoms of kidney stones depends on the size of the stone , shape , location and with or without infection , obstruction and other complications . Most patients with kidney stones have no symptoms unless the kidney stones fall from the kidneys to the ureter causing ureteral obstruction . Common symptoms are waist and abdomen pain , nausea , vomiting , irritability , bloating , hematuria and so on . If combined with urinary tract infection , may also appear chills and fever and so on . Acute renal colic often pain in patients with pain .

1. No symptoms

Smooth surface of small stones , can be discharged with the urine without causing obvious symptoms , fixed in the renal pelvis , the next calyx and no infection of the stones can also be without any symptoms . Even if the large antlers , if not caused by calyces , renal pelvis obstruction or infection , but also long no obvious symptoms , or only mild renal discomfort or soreness .

2. Pain

(1)Pain or dull pain : mainly due to larger stones in the renal pelvis or calyx pressure , friction or caused by water caused .

(2)Colic : by smaller stones in the renal pelvis or ureteral movement , to stimulate the ureter caused by spasm caused . Pain often sudden attack , began in the back , waist or ribs abdomen , along the ureter down the abdomen , thigh medial , genital radiation , may be associated with dysuria , nausea and vomiting , sweating and so on .

3. Blood in urine  

Hematuria often accompanied by pain . Sometimes patients without pain , only hematuria or blood is very small , the naked eye can not see . Most of the medical examination included urine examination , and microscopic examination of urine after centrifugation sedimentation , if you see too many red blood cells that have hematuria , and sometimes is the early signs of kidney stones .

4. History of stone

In the pain and hematuria attack , there may be sand or small stone with urine excretion . Stones though the urethra when there is congestion and urinary tract tingling sensation , stones immediately after the recovery of urine immediately after the smooth , patients feel relaxed and comfortable .

5. Infection symptoms

Combined infection can occur when the pyuria , acute attack may have chills , fever , low back pain , frequent urination , urgency , dysuria symptoms .

6. Renal insufficiency

Side of the kidney stones caused by obstruction , can cause the side of the hydronephrosis and progressive renal dysfunction ; bilateral kidney stones or isolated kidney stones caused by obstruction can be developed for renal insufficiency .

7. Urinary closure

Bilateral renal stones caused by urinary tract obstruction on both sides , isolated kidney or the only function of renal calculi obstruction can occur occlusion , side of the kidney stones obstruction , contralateral can occur reflex urinary closure .

8. Waist mass

Stone obstruction caused by severe hydronephrosis , the waist or upper abdomen palpable mass .

三、Treatment

1. General treatment

(1) A lot of drinking water : smaller stones may be subject to a large number of urine push , rinse and discharge , increased urine also helps to control infection .

(2) Adjust the diet : diet should be based on the type of stones and urine PH may be , calcium oxalate stones should avoid high-oxalic acid diet , limit the intake of spinach , sugar beet , tomato , nuts , cocoa , chocolate and other food . Low salt diet , control of sodium intake . High uric acid to eat low purine diet , to avoid eating animal offal , eat less fish and coffee .

(3) Removal of incentives : for pathological factors caused by urinary tract stones , but also should actively treat the primary disease . Active treatment of the reasons for the formation of stones to prevent the formation and recurrence of stones .

2. Symptomatic treatment

(1) Antispasmodic pain

(2) Control of infection : stones caused by urinary tract obstruction prone to infection , infection often occurs in the urine magnesium phosphate stones , this vicious cycle exacerbates the condition . In addition to actively remove the stones to lift the obstruction , should use antibiotics to control or prevent urinary tract infection .

(3) Elimination of hematuria : obvious gross hematuria available hydroxybenzylamine or tranexamic acid .

3. According to different ingredients and causes of treatment

(1) High calcium urine

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

(3) High oxalic acid : the treatment of primary high oxalic more difficult , try vitamin B6 , starting from a small dose , with the effect of diminishing and continue to increase , while a large number of drinking water , limited to foods rich in oxalic acid , urine levels can be reduced to normal .

(4) High uric acid : low purine food , a large number of drinking water can reduce urinary uric acid concentration .

(5) High cystine urine : appropriate restrictions on protein diet , the use of cystine-lowering thiols to be treated .

(6) Infection stone : according to the patient to remove the stones , select the appropriate antibiotic control urinary tract infection .

4. Surgical treatment

Pain can not be drug relief or stone diameter larger , should consider taking surgical treatment .

5. Emergency treatment

Renal colic and infection should be treated immediately . Infection should be timely application of antibiotics , if necessary feasible renal puncture drainage . Renal colic can be used anticholinergic , progesterone , calcium channel blocking drugs . If necessary can be injected with pethidine analgesic . Bilateral ureteral calculi with obstruction of patients with anuria can be considered immediately surgery stone .