Kidney stones (kidney stones)

Disease information

Kidney stones (kidney stones)

Kidney stones (Lithotripsy)

Urine is a liquid produced by the kidney that are dissolved in the multiple substances such as calcium, uric acid, phosphate,

If their conditions of concentration, the balance is broken in that meet and combine with other substances to form aggregates whose size will grow, leading to kidney cáculos.

The formation of calculations is called nephrolithiasis or kidney stones.

Causes of kidney stones.

There are four types of kidney stones depending on their composition: calcium (70 - 80%) uric acid (15%) cystine (1%) and (5%) The calculations are the most common calcium. They appear as calcium oxalate, or less frequently as calcium phosphate.

There are many diseases that produce increased calcium in the urine, such as primary hyperparathyroidism, hyperthyroidism, malignant tumors, bone metastases, but. the most frequent cause of formation of calcium calculations is the idiopathic hypercalciuria, which is characterized by increasing calcium urinary calcium with normal blood.

The hyperuricosuria is another frequent cause, since the formation of crystals of uric acid promotes the precipitation of calcium oxalate, acting as the nucleus of aggregation.

Causes more rare are the primary hyperparathyroidism and distal renal tubular acidosis, which increase the calcium in urine.

The calculations of uric acid are characterized as not visible on X - rays simple, unlike the rest. Are due to an increase in the elimination of uric acid in urine and there is a trend familiar.

Struvite crystals are the result of chronic infections by bacteria that produce a substance called urease. They usually grow in the renal pelvis, forming the so - called "kidney calculus. ".

Clinical features.

The most characteristic of kidney stones is the renal colic. The cáculos kidney was formed in the renal pelvis where they grow without producing symptoms at this stage can lead to blood in the urine (hematuria)

The renal colic occurs when a kidney stone moves through the ureter, the tube that connects the kidney to the bladder. Then there is an obstruction to the passage of urine, which distiende above the ureter obstruction. This is an intense pain that typically begins in the back and radiates to the genitals.

Usually there are nausea and vomiting. They can also appear discomfort in urination and difficulty in urination. The fever is exceptional.

Less frequently can cause other medical problems: nephrocalcinosis or depóstios calcium in tissues of kidney, kidney cáculos (calcium molds that fill the renal pelvis) renal failure,

Mechanisms of formation of kidney stones.

The production of estimates is due to the disruption of delicate situations of physical - chemical substances that allow very insoluble dissolved appear in the urine. When one of the components of the solution increases its concentration, a tendency to crystallize and form aggregates that grow progressively until it reaches the solid state and form the calculations.

Treatment of kidney stones.

PREVENTION OF FORMATION OF THE CALCULATIONS.

General measures.

Regardless of the type of calculations, its formation is due to excessive concentration of the substances involved. It is therefore vital to maintain adequate hydration, which produces a very diluted urine and it is recommended to drink at least two liters of water daily.

The diet should also be adequate. Patients with calculations of uric acid should follow a diet low in protein, refrain from drinking alcohol and reduce the intake of certain vegetables such as spinach and tomatoes. If the calculations are calcium should reduce salt intake, as diets rich in sodium increases calcium excretion in the urine, increasing the risk of stones.

It also needs to control the protein in the diet because your metabolism changes the conditions of urine encouraging the formation of stones. However, we must not diminish the calcium in the diet and that paradoxically increases the formation of stones.

Medical treatment.

If we continue to be calculations despite the dietary modifications, it should set up drug treatment. This varies depending on the type of calculations. 1. Calculations calcium: The most common cause is idiopathic hypercalciuria. The treatment is to try to reduce the excretion of calcium in the urine. This is achieved by combining a diuretic (AmerideÒ) and no salt diet. If this measure is insufficient, you must use potassium bicarbonate.

2. Cáculos uric acid: These calculations require a high urinary pH, so it should be alkaline urine. The substance is the proper potassium citrate, as the sodium bicarbonate increases the risk of acid calcium. If the urine pH does not decrease enough should be added acetazolamide, a diuretic. You must use a diet low in purines and if this does not control the excretion of uric acid, allopurinol should be added.

3. Calculations struvite: We must draw the calculation and treat urinary infections with antibiotics trigger the formation of the calculation.

TREATMENT OF Nephritic colic.

Conservative treatment.

Most kidney stones are obstructing the ureter get to be eliminated by the urine flow with two simple steps:

a) To increase urine flow with moisture, which can be oral or intravenous (sera) if the patient has a lot of nausea or vomiting.

b) spasmolytic (muscle relaxants) which help to alleviate muscle contracture of the ureter increasing its size and allowing the passage of most of the calculations. If conservative treatment does not relieve the pain or does not resolve the blockage attempt to extract the most aggressive calculation methods, which are outlined below.

Noninvasive treatment (extracorporeal lithotripsy)

The aim of lithotripsy is fragmenting the calculations smaller pieces so that they get through the ureter.

Lithotripsy is applied to the body shock waves generated by a high - voltage electric current.

The waves are transmitted to the patient through a liquid medium (or bathtub full of water cushions brought with the generator on the airwaves)

After multiple downloads, most of the stones are reduced to dust, so you can easily spend up to the bladder and be expelled in the urine.

Surgical treatment.

It is currently almost out of use by the effectiveness of non - invasive techniques.

There is a minimally invasive surgery that is the percutaneous ultrasonic litrotricia that consists of introducing a catheter to the kidney with a small incision in the back.

Through the catheter is inserted an ultrasonic trasductor that directly applies ultrasound waves to the calculation, fragments applying less energy. The fragments are removed through the catheter.

The laser lithotripsy through ureteroscopy has the same basis, but the source of energy is the laser. With these techniques open surgery (pyelolithotomy or ureterolitotomía) consisting of the opening of the kidney or ureter to extract the calculation has become virtually obsolete.

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