The stones of kidneys and ureters

The stones of kidneys and ureters are on average about 30% of surgical diseases of the upper urinary tract. Often the stones are formed in one kidney, and in the right more often. Stones in both kidneys are found only in 11-17% of cases. Ureteral stones are, as a rule, secondary, i.e. descended from the kidneys. Men suffer from stones of kidneys and ureters slightly more often than women. Nephrolithiasis occurs in people of all ages, but most often, the disease is seen in people aged 20-40 years. The stones of kidneys and ureters are single and multiple. There are cases when in the kidney were found 3000 and even 5000 stones. Stones can be placed in the renal pelvis, Cup first and second order or in the ureter.
Stones cups are usually rounded stones pelvis - rounded or oval, flattened. Stones pelvis, giving branching processes in a Cup, Staghorn calculi are called stones (Fig. 88). The ureter stones for the most part have a cone-shaped or oblong shape.

Staghorn calculi stone left kidney
Fig. 88. Staghorn calculi stone left kidney.

The value of point stones of different - from hemp grain to male fist. The weight varies from a fraction of a gram to 2 kg In the kidney can be formed simultaneously large and small stones. The ureter stones also sometimes reach large sizes, performing clearance him to a considerable extent.
The chemical composition of rocks divided into urates, consisting of salts of uric acid, oxalates - of calcium salts oxalic acid, phosphate of calcium salts of phosphoric acid, carbonates of calcium salts of carbonic acid. These stones are most often. Much less frequent stones 1of clean uric acid, cystine, cholesterol, xantinove and protein. The composition of the stones are usually mixed. Speaking about the lithate, phosphate, and so on, mean prevailing in stone mineral component.
Urates are yellow, light to dark brown; a consistence of their solid, surface smooth or slightly grainy. Phosphates and carbonates grayish-white in color, their surface is rough, the consistency of loose. They easily crumble. Oxalates have a dark color from brown to black, they are very dense, their surface is covered with thorns (Fig. 89). They are easily hurt mucous membranes, and settling on them blood pigment paints it black (natural color - grey). Cystine stones almost colorless, their surface is glossy, texture is dense. Xantinove the reddish stones, the surface is smooth. Cholesterol stones black, fragile. Protein stones of white, soft, layered, consist mainly of fibrin mixed with salt and bacteria. They are usually multiple, small size.

the stones of kidneys
Fig. 89. The stones of kidneys.
a - lithate; b - phosphate; in - oxalate.

Modern characteristics of stones can be represented in the following form.
1. Urates. Response acidic urine:
a) stones of pure uric acid;
b) urine acid sodium;
C) urine acid ammonium. May fall in alkaline urine.
2. Oxalates. Reaction urine acidic or alkaline:
a) wavelet, monohydrate of calcium oxalate;
b) weddelli, dehydrate of calcium oxalate.
3. Phosphates:
a) Apatite. Sa - complex phosphates of calcium in pure form or in mixtures with urates and oxalates falls in acidic urine. In the mixture with struvite falls in alkaline urine;
b) carbon dioxide Apatite. Is rare;
in) brucite. Dehydrate calcium phosphate. Response acidic urine. Often mixed with oxalates and Apatite;
d) struvite. Tripolifosfat, ammonia phosphate-magnesia. Falls in an alkaline urine.
4. Cystine stones. Fall in the acidic urine, found in pure form or in mixtures with Apatit.
5. Xantinove stones. Found in pure form or in mixtures with Apatit. Fall in the acidic urine.
Any stone pelvis as a foreign body, stimulating nerve receptors in the kidneys, violates its function and trophism, promotes sclerosis renal tissue. Violations of the outflow of urine caused by stone, can be permanent or temporary, the outflow of urine can be broken completely or partially. In the first case renal pelvis is gradually expanding (pyelectasis), and then expand, and the cups; renal parenchyma atrophied, develops hydronephrosis. Complete cessation of urine outflow is observed more often in small stones pelvis, which due to their small size easily clog the ureter. If such attacks are rare and last longer, they do little to harm the kidney, but the long and often repeated bouts detrimental impact on its condition, especially in the presence of infection. Last accompanies the stones of kidneys approximately 80% of cases.
There are stones aseptic and infected. Aseptic stones lead to hydronephrosis or atrophy of the kidneys, when infected attached to this phenomenon pyelitis, pyelonephritis, Pioneros or apostatizing jade. When infected with the stones of kidneys along with atrophy of the renal parenchyma observed growth ecolological fatty tissue; the latter sometimes completely replaces that of the parenchyma dormant buds (fat replacement kidney, Fig. 90).

stones and fatty replacement kidney
Fig. 90. Stones and fat substitute kidneys.

The ureter stones, creating a partial or total disruption of the flow of urine, causing the kidney is the same changes as the stone of the pelvis. The stone of the ureter, also causes the expansion of the overlying Department.
At long stay of stones in ureter on the same place there are phenomena of uretrita, sclerosis wall, periarteritis and stricture of the urethra. Rarely formed bedsore with perforation of the ureter.
The symptomology. The most common symptom of kidney stones are a pain. The complete absence of pain at stones of kidneys and ureters is rare (latent stones). In 75% of cases at stones of kidneys and ureters are regularly repeated episodes of renal colic due to a sudden interruption of the flow of urine, causing acute tension of the renal pelvis and a sharp increase vnutripuzarnogo pressure. All this annoyed receptors sensitive nerves, which the wall of the pelvis, fibrous capsule kidneys and the surrounding fatty tissue is extremely rich. Among the causes of the pain syndrome, renal colic are in hemodynamic disturbances of kidneys in the form of venous hyperemia with the extension of the fibrous capsule and spasmodic contractions of the pelvis and ureter, caused by infringement of a stone and acute urine retention.
The nature of the attack at the same obturation stone top, middle, or akoloutheo Department of the ureter. In the latter case is more pronounced dysuria.
Dull pain in the lower back can be permanent or temporary. In most cases, they periodically aggravated, taking account of the nature of renal colic. Dull pain occur most often when large sedentary, especially when Staghorn calculi, stones, and if hypotension pelvis and ureter.
At stones of kidneys and ureter is often observed hematuria. It is due to the trauma of the mucous membrane stone. Approximately 80-90% of cases can be detected in urine sediment 20-30 erythrocytes in the field of vision, particularly when you walk or exercise. Gross hematuria occurs less frequently; it is also the result of damage to the mucosa, but the reason it can be and congestion in the kidney, so it is sometimes observed after the attacks of renal colic. Makrogematuriya usually has a temporary nature and is not profuse. During the attack in the Deposit urine can not find erythrocytes due to the blockade of the ureter.
As a result of merger of infection develops calculous pyelitis or pyelonephritis, urinary appear leukocytes. Peoria can temporarily disappear when the obstruction of the ureter and reappear after its termination.
The combination of infection with the blockade of the ureter is accompanied by rise of temperature up to 39-40°, spectacular chills, dry mouth, increased thirst, interesetu sclera, i.e. phenomena of urosepsis. This pattern may depend on the development of acute pyelonephritis or pustular jade.
When placing stones on two sides may experience chronic renal failure: dry tongue, thirst, nausea, vomiting, headache, drowsiness, hyposalemia, increased blood levels of residual nitrogen, urea, indican.
Calculous anuria may develop in the following cases: 1) if a bilateral stones kidney or ureter; 2) when ureteral stone on one side and a knee-jerk off buds on the other; 3) if the obstruction of the stone ureter or pelvis only kidneys.