Kidney stone disease

X-ray diagnostics. X-ray plays a leading role in the diagnosis of kidney stones. Frequency x-ray detection stones urolithiasis depends on the composition, size, location of the stone, and the methods and techniques of research. In most cases, to recognize a shadow of suspicion on a stone or a rock, on a sightseeing photographs, radiographs should be presented to the entire area of the urinary tract from XI thoracal vertebra to the pubic joint inclusive. Especially visible stones composed of phosphate, carbon dioxide and of ammonia-magnesia, however, approximately 10% of cases, the stones are not visible on the overview radiographs. It rocks, consisting of uric acid, protein, xantinove, cholesterol and bacterial. Such stones, little absorbing x-rays are "radiolucent". To translucent belong cystine stones. Recognition translucent and transparent stones must artificial contrasting urinary tract.
The radiological examination of urinary system for kidney stones. great importance is the preparation of the patient with the aim to avoid the accumulation of gases in the intestines.
Within 2-3 days of the diet are excluded milk, black bread, vegetables, fruit, especially legumes (beans and peas), and before and before the study is cleansing enema of 0,5% aqueous solution of tannic acid.
The stones in the urinary tract can be taken calcified lymph nodes and vessels, globality, heterogeneous calcification in the internal genital organs of women, tuberculosis, tumors and cysts of kidneys, dense inclusion in the content of the intestine, foreign body, the stones in the bile ducts, pancreas, small Islands compact tissue in the skeleton, calcification in teratogenic and dermoid tumors, etc.
The shape of the stones to a certain extent depends on their location and chemical composition. So, urates, and a large part of phosphates have homogeneous structure, smooth surface, oxalates remind mulberry berries, their surface is uneven, with many awl-shaped projections. The layered rocks are formed from different salts of uric acid, phosphoric acid, oxalic and others)with different permeability for x-rays. The stones in the kidney, typically, have rounded or oval form, settle the long axis towards the pelvis. Pelvis stones, as a rule, repeat its shape (i.e., can be round, oval, triangular in shape, but almost always flattened in the front to the rear), sometimes stones pelvis can have the process, turned into the ureter (Fig. 6). Often the stones are located in the pelvis, increasing in size, subject to the side of cups, gradually fulfilling them. Such stones are called Staghorn calculi and have so typical structure and form, which is almost never require differential diagnosis (Fig. 7).
The stones in ureter is usually descended small stones cups or pelvis. They often have oblong-cylindrical and spindle shape.
In most cases, a presumptive diagnosis of kidney stones can be set on the basis of the review radiography, however, it cannot be considered complete, as it is also important to establish the presence of secondary changes and complications of urinary tract infections (pyelectasis, hydro - and Pioneros, hydroureter). To address these questions in all cases shown excretory urography (see Kidney, x-ray diagnostics of diseases).
Excretory urography nephrolithiasis allows to obtain sufficient information as about the functional and morphological state of both kidneys, on the motility of the renal pelvis and ureter. In acute obstruction of the urinary tract on programme manage to get a clear picture of programme on the affected side, as this is clearly visible, as a rule, an intensive shade of kidney, rich in contrasting substance in the absence of filling Cup-pelvis system and ureter (Fig. 8). Rentgenografiya and rentgenonegativee help to identify the violation of peristaltic functions of pelvis and ureter if they have the stones.
In cases, when by the excretory urography to solve all the issues related nephrolithiasis, fails, same as in case of problems for differential diagnosis of papillary tumors shown catheterization ureters and retrograde pyelography with weakly concentrated contrasting solutions (5%), and with radiolucent stones with the introduction of air or oxygen (pneumophysiology). On pyelogram the filling defects caused by stones, are relatively clear, smooth contours, around an invisible stone circle is determined shadow of a contrast agent. With papillary tumor filling defects are always rough, rutted, jagged contours and a honeycomb pattern.
In the diagnosis of ureteral stones, some support has catheterization ureters (see Catheterization).
Conducting ureteric catheter is usually meets an obstacle respectively location stone in the ureter.
When catheterization ureters, followed by x-rays in two projections (direct and oblique) shadow urinary calculus will merge with the image of the catheter (Fig. 9), shadow, simulated stone, will be determined at different distances from the catheter.
Overview tomography and level-by-level study in combination with contrasting methods help in the diagnosis of kidney stones, especially when there are clear for x-rays stones and in bad preparation of the patient. X-ray examination on the operating table, including rentgenoterapii, faster discovery of stone, accelerates its finding and deleting, especially if it is time for the surgical intervention has moved to another Department of the urinary tract.

Fig. 6. On the background of the left kidney can see two shadows stones. Top great, " cast pelvis with the "spur" in the ureter and processes in a Cup I order; lower, lower, in one of the small cups.
Fig. 7. Emerging Staghorn calculi stone.
Fig. 8. Excretory programme during an attack of renal colic on the left. Full obstruction of the ureter stones (small shadow on the left in the pelvis) caused a reflex supernanny anuria on the same side. A clear contrast of the parenchyma of the left kidney.
Fig. 9. Lanceolate shadow stone in predposylki part of the right ureter near the shadow of a catheter.