Renal Calculi (Nephrolithiasis)
A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
Causes
Kidney stones can form when urine contains too much of certain substances. These substances can create small crystals that become stones.
The biggest risk factor for kidney stones is dehydration.
Some types of stones tend to run in families. Certain kinds of stones can occur with bowel disease, ileal bypass for obesity, or renal tubule defects.
There are different types of kidney stones. The exact cause depends on the type of stone.
* Calcium stones are most common. They occur more often in men than in women, and usually appear between ages 20 - 30.
* Cystine stones can form in people who have cystinuria. This disorder runs in families and affects both men and women.
* Struvite stones are mostly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder.
* Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy.
* Other substances also can form stones.
Symptoms
The main symptom is severe pain that starts suddenly and may go away suddenly:
* Pain may be felt in the belly area or side of the back
* Pain may move to groin area (groin pain) or testicles (testicle pain) Other symptoms can include:
* Abnormal urine color
* Blood in the urine
* Chills
* Fever
* Nausea
* Vomiting
* Colicky pain: "loin to groin". Often described as "the worst pain.The pain is elicited by contractions of the ureter in response to the stone, causing severe, crampy pain in the flank or lower back, often radiating to the groin or, in men, to the testes. The pain typically comes in waves, with a typical wave lasting 20 to 60 minutes.
* Nausea/vomiting: embryological link with intestine– stimulates the vomiting center.
* Hematuria: blood in the urine, due to minor damage to inside wall of kidney, ureter and/or urethra.
* Pyuria: pus in the urine.
* Dysuria: burning on urination when passing stones. More typical of infection.
* Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone.
* Postrenal azotemia: the blockage of urine flow through a ureter.
* Hydronephrosis: the distension and dilation of the renal pelvis and calyces.
* Colicky pain: "loin to groin". Often described as "the worst pain.The pain is elicited by contractions of the ureter in response to the stone, causing severe, crampy pain in the flank or lower back, often radiating to the groin or, in men, to the testes. The pain typically comes in waves, with a typical wave lasting 20 to 60 minutes.
* Nausea/vomiting: embryological link with intestine– stimulates the vomiting center.
* Hematuria: blood in the urine, due to minor damage to inside wall of kidney, ureter and/or urethra.
* Pyuria: pus in the urine.
* Dysuria: burning on urination when passing stones. More typical of infection.
* Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone.
* Postrenal azotemia: the blockage of urine flow through a ureter.
* Hydronephrosis: the distension and dilation of the renal pelvis and calyces.
Signs and tests
Tests for kidney stones include:
* Analysis of the stone to show what type of stone it is
* Uric acid level
* Urinalysis to see crystals and red blood cells in urine Stones or a blockage of the ureter can be seen on:
* Abdominal CT scan
* Abdominal/kidney MRI
* Abdominal x-rays
* Intravenous pyelogram (IVP)
* Kidney ultrasound
* Retrograde pyelogram
Tests may show high levels of calcium, oxylate, or uric acid in the urine or blood.
Complications
* Decrease or loss of function in the affected kidney
* Kidney damage, scarring
* Obstruction of the ureter (acute unilateral obstructive uropathy)
* Recurrence of stones
* Urinary tract infection
Prevention
If you have a history of stones, drink plenty of fluids (6 - 8 glasses of water per day) to produce enough urine. Depending on the type of stone, you might need to take medications or other measures to prevent the stones from returning.
You may need to change your diet to prevent some types of stones from coming back
CASE -
A boy came to see me with his parents. He had colic pain. Difficult urination, vomiting, burning pain during urination, he advised for USG abdomen and urine C/E
His USG report was 3.5mm calculi in Rt, 4.5mm calculi in Lt, mild haepatomegaly,
On 01/10/10 prescribed following medicines
[caculina, cantharis, belladona, pyrogenum,colo, dios]for two months.
He came on 10/01/11 with no pain, vomiting.
Repeat same medicines as 01/10/10 for two months.
On 28/02/11 he came with no symptoms. He advised for USG abdomen.
0n 27/05/11 he came with USG [no calculus in both kidney, mild haepatomegaly]
CURED
Dr. G. S. Bhatnagar
D.H.M.S. B.H.M.S.
Research officer
Sewa Mandir
Mobile: 9829978284
E-Mail: sewamandir@usa.net, drgsbhatnagar@gmail.com
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