Causes of kidney stones
United adopted the concept of aetiology and pathogenesisdisease exists. Kidney stones or kidney stones is pluricausal disease. Under certain conditions, created in the body, can cause stone formation is one, at least - a few factors. Here are the main ones. It has long been proven that one of the main factors is the high mineral content in drinking water. Therefore, the disease is most common in areas where water is hard.
Urinary stones are formed in the urinary tract: in the cup, pelvis, urinary bladder. Thus, the violation of the outflow of urine is an important etiologic factor in the process of formation of calculus.
It is proved that a lack of vitamin A leads to the formation of stones in the urinary system.
Another important reason is the localurinary tract infection. Moreover, there is no particular microbe, any infection may result in urolithiasis. That is why it is important to promptly and adequately treat the inflammatory process in the kidneys and urinary tract. Be sure to carry out this treatment based on the results of urine tests, bacterial culture and sensitivity of the pathogen to antibiotics.
Often the emergence of the disease to cause endocrine diseases, various metabolic disorders.
Moreover, the cause may be renal injury, bone; contribute to the formation of stones and some drugs.
Clinical symptoms of the disease is largely dependent on the localization of the stone in the urinary tract. So, before you describe the symptoms, it is necessary to present the anatomy of the urogenital system.
Urinary system includes the kidneys, ureters, bladder and urethra.
The kidneys are paired organs are located in the lumbar region. They lie on either side of the spine at the level of the 1st and 2nd lumbar vertebrae. The right kidney is usually a few centimeters below the left.
Kidneys are shaped like a large bean. Their surface is smooth, dark brown, the outer edge convex, inner - concave. In the area of the inner edge of the gate is located, which include kidney Vienna, renal artery, nerves, lymph vessels and ureter. The circulatory system of the kidneys developed very strongly. Renal artery looks like a mighty tree.
Outside the kidney is covered by a fibrous sheath on it is a fatty layer and front and rear fascia is covered by the kidney.
Renal tissue on the cut consists of two layers: the outer - and inner cortex - brain. The cortical layer contains renal corpuscles and divided into slices.
Brainstorming layer consists of collecting ductand is divided into education, called pyramids. Base of the pyramid facing the outer surface of the kidney, and it tops - to the sine. The tops of several pyramids, usually connected to education, called papillae. Each papilla riddled with holes collecting ducts that open into small cups. Several cups are combined into 2-3 large cup, which in turn pass into the pelvis. Renal pelvis continues into the ureter.
The basic structural unit of the kidney is the nephron consisting of the renal corpuscles, convoluted tubules and loop of Henle. Each kidney contains up to 2 million nephrons.
kidney physiology is very complex and has not been studied until the end. The main task of the kidneys is to separate from the body of waste products of protein metabolism, including the nitrogenous substances.
To identify up to 1.5 liters of urine per day, kidneysIt has to be filtered up to 100 liters of blood. The intensity of the blood flow in the kidney is so great that almost 20 times higher than the intensity of circulation of any body. The kidney is passed through themselves every 7 minutes. the entire blood volume.
Returning to the clinical symptoms of kidney stonesdisease. Manifestations of the disease depend on the location of the stone in many ways, but at any location can be pain and pathological changes in the urine. If the stone is in the cup, the pain only appear when you shift a stone to the neck of the bowl, and when there is an increase vnutrichashechnogo pressure. Once a violation of the outflow of wound, pain immediately subsides. If you find a stone in the kidney pelvis pain are absent. Offset stone in the ureter may lead to the development of renal colic - the main manifestations of urolithiasis (stones when it is observed in 50% of patients with kidney and ureteral stones when - at 95-98%). Acute violation of the outflow of urine, caused by blockage of the ureter leads to stretching of the pelvis and the kidney capsule, which causes severe pain that comes from the loin in the course of the ureters radiates into the groin and genitals. The attack of kidney stones or colic occurs, as a rule, suddenly, for no apparent reason; sometimes provocative role playing exercise, shaking while riding a bicycle or a motorbike on rough roads, and others. The pain is so intense that cause the patient to rush in search of poses, allowing them to reduce. Patients undergoing renal colic, for many years, remembers the agonizing pain and is afraid of repetition. A typical manifestation of attack, and is a violation of urination, manifested by frequent painful urging. Renal colic may be accompanied by chills, fever, accelerated erythrocyte sedimentation rate, leukocytosis and hematuria. Often it takes a symptom of acute abdomen that requires differential diagnostic search.
Diagnosis of urolithiasis onlyBased on clinical symptoms is impossible. An accurate diagnosis is established after the X-ray and ultrasonic inspection methods. Radiopaque stones (oxalate and phosphate) are clearly visible to review images. Urate, protein, cysteine and xanthine stones indistinct in the overview image and are therefore called roentgen.
Often, the diagnosis becomes clear afterUltrasonography. When sonography can be detected as a rentgenopozitivnyh and roentgen stones. Ultrasound detection of coral stone is not usually difficult. If it looks like sonography echogenic structure, filling your entire pyelocaliceal kidney system.
Ultrasound and X-ray studies are complementary methods in unclear cases should be carried out in parallel.
urolithiasis Treatment most often complex: medical, surgical, tool, physiotherapy, spa, diet. However, in recent years, doctors usually recommend a strict diet stopped. For drugs that are used in all forms of urolithiasis refer angioprotectors, antiplatelet, anti-inflammatory, diuretic, antispasmodic, herbal preparations. In addition, the federal industry standard for kidney stones include vitamins B, E and K, protivogistaminnye and sedatives. Only highly professional doctor and a clear view of the stage of disease will allow to select the correct therapeutic tactics and avoid polypharmacy, leads to the high cost of a course of treatment and the appearance of unwanted and dangerous complications.
In case of detection of urate stones carriedcorrection of disorders of purine metabolism, and appoint litholytic funds. To do this, use drugs that reduce the formation of uric acid, stimulate its excretion, and citrate mixture, increasing the pH of urine. The most prominent representative of the first group of drug is allopurinol, which has the ability to inhibit the enzyme xanthine oxidase, and reduce the formation of urate in the blood serum, preventing their deposition in the kidney. Benzobromaron has a pronounced uricosuric effect due mainly inhibition of absorption of uric acid in the proximal renal tubules and increase in its allocation of kidneys. In order litholysis kidney stones composed of urate, citrate appoint mixture (blemaren, URAL), the use of which is often successful. With respect to the other types of stones saxifragant drugs use is impractical.
renal colic attack Treatment is aimed atelimination of reflex spasm of smooth muscles of the renal pelvis and ureter, pain relief. For these purposes, thermal treatments, analgesics (before their appointment is necessary to exclude the presence of other diseases and complications of urolithiasis, for example, pyelonephritis) and antispasmodics. Traditionally used as a last m-holinoblokatory (atropine, platifillin, metacin) and preparations myotropic action (Drotaverinum hydrochloride). They are often prescribed in combination with an analgesic metamizol and administered parenterally. In the absence of the effect of using opioid analgesics (preference is given to drugs that have antispasmodic effect on the ureters - promedol omnopon). With the ineffectiveness of conservative therapy to restore the passage of urine is performed catheterization ureter and endoscopic removal of stone or surgical treatment.
When infectious and inflammatory processesurinary system, be sure to antibiotics after a urine culture and sensitivity of detection of pathogen isolated to a particular drug. Courses of antibiotic therapy without these techniques are often completely useless and lead to the development of dysbiotic effects and persistent decrease in immunity.
In the future, it is desirable to assign a patientherbal medicines. The most common charges used, components are selected based on the pharmacological effects. Apply herbs that have diuretic, anti-inflammatory, antiseptic, and helps to eliminate the small size stones or sand. The diuretic effect of juniper, parsley, birch leaves, horsetail is caused by the presence of essential oils, saponins, silicates. The presence of tannins and arbutin in the bearberry leaves, pear and cranberries provide anti-inflammatory effect. Chamomile and half-floor, containing volatile, have antiseptic properties, and rose, cornflower, madder dyeing and nettle, thanks to the removal of salts and uric acid - litholytic. The duration of the course of therapy is strictly individual. Performance criteria necessarily assess the adequacy of methods.
At the spa resorts should be sentOnly those patients in whom the size and shape of the stones do not interfere with the normal passage of urine, as well as patients after 1.5-2 months after the removal of stones operative or conservative manner.
Until 1980 priority treatment of nephrolithiasis has been surgical removal of the stone. High-trauma and low efficiency, high rate of relapse were the motive to seek fundamentally new approaches to solving this problem.
Since 1980 in Germany (as from 1987 and Russia) has been applied a fundamentally new method of treatment of urolithiasis - Remote shock-wave lithotripsy. To date, the method has become a leading company in the treatment of this patient population and is used in 80-90% of patients. Open surgical procedures make up only 10-15%.
Further progress of treatment of urolithiasis was the implementation in practice of minimally invasive endoscopic techniques.
In the last three years, Russia has become widelyapplied a new non-invasive treatment of urolithiasis, developed by the Russian company "Fizomed". The essence of the method is to apply for the destruction of stones specially treated paraffin. Unique technological processing has significantly strengthened and fully realize its ability to positively affect the urinary system. The plates of this stuff superimposed on the body in the kidneys for a long time (from several months to a year or more). As a result of continuous therapeutic effects increases the functional capacity of the kidneys, improves urodynamics, cropped manifestations of inflammation. Stone inserts paraffin exposed gradually collapses as sand and excreted in urine. No harmful effects on the human body in conjunction with the maximum therapeutic effect allows you to apply the method without any restrictions, and the possibility of its use in the outpatient setting can significantly expand the arsenal of Urology clinics.
Urology of the millennium will undoubtedlywear preventive in nature and rely on methods of prevention and early detection of diseases. The advent of new technologies in the treatment of urolithiasis allows to note trends that will dominate in the coming years. Their main focus, according to the chairman of the Russian Society of Urologists Acad. RAMS NA Lopatkin, can be determined by the formula: "Achieving the best results with minimal invasion and the cost of the procedure."