Kidney stone disease

kidney stones
Fig. 1. Kameni in cups (1) and sack (2) kidney

Fig. 2. Place of pain radiation nephrolithiasis (painted black).

Kidney stone disease - a disease characterized by the presence in the pelvis, cups or in the parenchyma of kidney stones (Fig. 1). The cause of kidney stones is still largely unknown.
Urolithiasis often affects men, mostly aged 20 to 40 years.
The formation predisposes hypovitaminosis, injury, inflammatory diseases of the urinary organs, disruption of the liver, endocrine glands (over-functioning of the parathyroid glands). A great role in the origin of stone formation plays a violation of renal blood flow, as well as the stagnation of urine in the urinary tract organic and functional character.
The stones are divided into primary, formed in the renal tubules, and secondary. The last form in the renal pelvis with infected urine.
The chemical composition of the different stones. Urates formed from the salts of uric acid, oxalates - of calcium salts oxalic acid, phosphates - of calcium salts of phosphoric acid, carbonates of calcium salts of carbonic acid. Rare cystine stones, cholesterol, xantinove and protein. The stones are usually formed in one kidney is often right, and in 11 - 17% of cases in both kidneys.
The stone can be small, weighing up to fractions of a gram, and large - up to 2 kg In the form distinguish stones round, oval, Staghorn calculi, with a branching processes within the kidney; in the ureter - cone.
Clinical course. Patients experience pain dull, aching, permanent or ad hoc intensive - the so-called attack of renal colic. Big stone causes dull the pain a little, clogging the ureter, stop the outflow of urine, which increases vnutripolostnoe pressure, causes of acute tension of the renal pelvis and intense pain.
An attack of renal colic usually occurs suddenly and can last for hours. Patients at this time are very restless all the time to change position of a body. Pain that began in the lumbar region, iradionet in the groin, and in men in the penis, testicles (Fig. 2), women in large labia. Often there is bloating. In time colic difficult outflow of urine from the kidneys and urine absorbed back on palavinskas system. The patient begins chills, nausea, vomiting, fever, then there is a headache, weakness, fatigue, dry mouth, thirst. The attack same pain when hardening a stone of any Department of the ureter. When hardening akoloutheo Department of the ureter occurs frequent urination. Nephrolithiasis may receive periodically micro - and makrogematuriya. In those cases, when there is no infection and stone complicates the outflow of urine, pelvis and cups gradually expanding and developing hydronephrosis (see), and the accession of the infection, pyelonephritis. After discharge stone the pain ends. The discharge of stones in the urine is the most characteristic symptom of kidney stones.
For two-sided stones due obturation both ureters may come anuria (excretory anuria). Obstruction of the ureter on one side reflex causes the termination function, the second kidney - secretory anuria.

Kidney stone disease, nephrolithiasis (nephrolithyasis), - education in cavities or kidney parenchyma splices or stones of the substances included in the urine.
Kidney stone disease is a common disease. About 35% of all operations on the kidneys produce about concrements (see). In many parts of the world stone is endemic. Up to 80% of patients - those aged 20-50 years, with a slight predominance of men. The right kidney is affected slightly more often left. Bilateral nephrolithiasis occurs in 9-15% of cases.
The stones of kidneys consist of crystals of uric acid and its salts (uratov), out of calcium oxalate or (ammonium oxalate), calcium phosphate, phosphoric acid ammonia-magnesia (phosphates, tripolyphosphate), calcium carbonate or magnesium (carbonates). Rarely find cystine, xantinove, cholesterol and protein stones. Cystine stones are observed persons with cystinuria, when in urine steadfastly appears cystine - sulfur compound amino acids. Protein stones are mostly composed of fibrin, alkaloid-protein substances, sometimes with admixtures of inorganic substances, bacteria, rarely are pure bacterial stones. Often the stones mixed composition. There are primary aseptic stones of kidneys, resulting in the absence of urinary tract infections (urates, cystine stones), and secondary (phosphates, carbonates), formed by infections of the urinary organs.
The shape and size of kidney stones are very diverse (Fig. 1 and 2). There are pelvis, checkoway (parenchymal) and pelvis-parenchymal stones. Stones, filling the renal pelvis and giving the big chains in a Cup, Staghorn calculi are called (Fig. 3 and 4). From 20 to 50% are multiple kidney stones (Fig. 5).

Fig. 1. Stone right kidney (the survey roentgenogram).
Fig. 2. Stone left kidney (newmedialogia).
Fig. 3. Staghorn calculi stones in both kidneys (review x-rays),
Fig. 4. Staghorn calculi stones in both kidneys: the left kidney is not functioning; the right kidney dystopian, it's an extended cavity (excretory programme).
Fig. 5. Multiple stones right kidney (the survey roentgenogram).

The etiology and pathogenesis. There are two most common theory of formal Genesis kidney stones: crystallization and matrix. According to the first stone formation is due to the initial drop in urine salts, forming the nucleus of the later stone, without direct participation in this process of organic substances. The appearance in the last stone is seen as a secondary phenomenon.
The presence in the urine of a special protein that has lyotropic character and called protective colloids, prevent under normal conditions salting and the formation of urinary stones.
On crystallization theory for the formation of the stone must change of ratio between colloids urine and crystalloids, resulting in the adsorption and accumulation in a saturated solution of urine crystalloids and drop them into the sediment and subsequent atypical crystallization around crystallization center. The latter may be lowered urinary tract epithelium, the accumulation of bacteria, leukocytes, erythrocytes.
According to matrix theory for stone formation must primary existence of protein backbone (matrix), which again postponed the crystals of uric salt. Located in the urine stabilizers (magnesia, lemon and glucuronic acid, glycine and alanine) have the ability to engage with calcium complex in the relationship, therefore prevents precipitation of calcium salts. Prerequisite for every stone formation is the appearance in the lumen of the tubules of the urinary special mucoprotein, which has a strong affinity for in the urine calcium ions and form insoluble calcium connection (micelle), becoming the matrix (the skeleton) the future of the stone.
The process of stone formation begins in the renal tubules. Hypercalcemia and hypercalciuria have an accelerating effect on the process of stone formation. In this respect has value and nephrocalcinosis, which many authors as the prestage of kidney stones.
Role in the formation of kidney stones infection, changes in acid-base balance of the body, disorders of calcium and purine (protein) of the currency. In this respect, account should be taken of the role of the kidney stone diathesis, which are significant and persistent shift reaction urine acidic or alkaline side (normal urine is acidic or weak acid reaction (pH = 5.5 to 6) with the constant precipitation uratov (oratoria), oxalates (oxaluria), phosphates (phosphaturia) and cystine (zistinurija). Well known for the role of the primary giperparatireoidizm violations of calcium and phosphorus metabolism and occurrence of kidney stones. You need to consider is the Central nervous system that regulates the function of urine formation and rochevilaine, the autonomic nervous system and endocrine organs.
Contribute to the formation of kidney bone damage and all diseases requiring long-term immobilization of the patient. Growing in these conditions, pyelonephritis, demineralization of damaged bones with endogenous saturation of organism with calcium salts with hypercalcemia and hypercalciuria, deterioration of urodynamics are predisposing factors for occurrence of kidney stones. One of these may include gastro-intestinal tract and liver. It is necessary to consider the impact of hyperacid gastritis on acid-base balance of the body, the role of the small intestine in the excretion of calcium salts, the value of impaired liver function for the activity of the kidneys (renal syndrome).
Along with the General reasons for the occurrence of kidney stones play an important role of local changes in the kidneys and ureters (inflammatory, degenerative circulatory disorders, urinary flow, congenital abnormalities, trauma). These changes are explained by the fact that kidney stone disease is often one-sided disease.
In some kidney under the epithelium tops of papillae found little plaque, consisting of deposits of calcium between the tubules of the kidneys. Sometimes these plaques izyaslau epithelium. In these conditions, when in contact with urine on the plaque deposited salt, and plaque is the basis for the formation of microcontinent. Also installed the accumulation of calcium salts in the renal tubules and in the soft tissues of the kidney. These salts are carried away by the lymphatic vessels of the kidneys. If due to some reasons lymph outflow in the kidney violated, it accumulates excess amounts" microliths and can form stones.
Important in the etiology of kidney stones are exogenous factors, which include water, food and climate. For occurrence of kidney stones is not enough reason is a disease polietiologic.

Over and symptoms. Kidney stone disease is manifested renal colic, hematuria (usually mikrogematuria), sometimes a discharge of stones in the urine and dysuric phenomena.
The most characteristic symptom is a renal colic, with its typical irradiation in the testicles groin area, the thigh. Sometimes a fever, leukocytosis, delay gas, bloating, voltage anterior abdominal wall, which can create a picture of acute abdomen (see). Occasionally there are so-called "silent stones of kidneys, causing no pain relief. The clinical course of kidney stones is often complicated pyelonephritis (see), hydronephrosis (see), pyonephrosis (see). The most rare complication is anuria (see).
The diagnosis. In typical cases of renal colic diagnosis of problems is not. When kidney stones in 80-90% of cases detected in the urine of a red blood cells (usually leached), protein, salt, and the development of kidney infections has Peoria. Large differential diagnostic value in acute cases has chromatotherapy (see), which allows to communicate diseases of kidney and ureter and differentiate it from acute diseases of the abdominal cavity. In 60-80% of cases the patient's kidney if chromolithography or has not allocated the Indigo Carmine or marks it with great delay. Very important in the diagnosis of kidney stones is x-ray examination.