Kidney stones symptoms
Urolithiasis (kidney stone) disease - a disease associated with the formation of stones in the urinary system.This is one of the most common urological disease, its incidence in Russia on average is 34.2%.Moreover, now the incidence continues to rise, and if earlier it was believed that only adults suffer now detected more cases among children.According to the Institute of Urology of Ministry of Health of the Russian Federation, among the younger pediatric age group the prevalence of urolithiasis reaches 19.9 per 100 000 population, and in the teen - 81.7 patients per 100 000 population.
calculi in urolithiasis can be not only in the kidney, but also in the ureter or bladder.However, under this section (and the book as a whole) will be considered only kidney stones, called nephrolithiasis (nephritis - kidney, lit. - stone).Stones in their chemical composition can be different -. Uric acid, phosphate, oxalate, cystine, etc. In particular forms of urolithiasis allocated staghorn kidney stones, kidney st
urolithiasis disease is considered multifactorial nature of its development play an important role, and environmental conditions, and characteristics of internal processes of the body.The leading role among them belongs to metabolic disorders - the so-called diathesis, which may be uric acid, purine, phosphate, calcium, oxalate.Disorders of calcium and phosphorus metabolism, purine bases and uric acid, oxalate (oxalic acid salts) can occur for various reasons, often they are innate.
kidney stones are formed when some substances (eg calcium oxalate) are concentrated in the urine and connected to solid, solid formation.Stones containing calcium are from about 70 to 80 percent of all kidney stones (mainly oxalate and calcium phosphate).Other stones consist of uric acid or magnesium compounds and ammonium phosphate.
While urine production both kidneys regulate fluid and electrolyte balance in the body and filter wastes from the blood.Urine is collected in the part of the kidney, called the renal pelvis.Then the urine passes from the kidneys into the bladder through a narrow tube called the ureter. Kidney stones can form in the renal pelvis, and then pass through the ureter to the bladder, before they can be eliminated from the body in urine.Some stones are so small that they do not cause any symptoms and painlessly out by themselves;large stones can not come out of the kidney and can be detected only if the X-rays do stomach for other reasons.
Sometimes the stone can enter into the ureter and cause unstable severe pain (known as renal colic), which continues until the stone reaches the bladder;This process can take anywhere from several hours to several days.Pain during a seizure is usually felt on one side only, however, the stones can be formed in the second kidney, causing pain and other side.The symptoms disappear as soon as the stone passes.Seizures usually recur, and treatment is aimed at to alleviate the symptoms, grinding or removing the existing stones and prevent their formation.
For all types of stones:
• urinary tract infections caused by certain bacteria that break down urea, the chemical can create an environment conducive to the formation of kidney stones.Urine ammonium content increases, it becomes alkaline, and this can lead to the formation of magnesium-ammonium-phosphate stones.
stones of uric acid:
• Overly acidic urine is the most common cause of the formation of uric acid stones.
high content of uric acid in the urine, sometimes associated with symptoms of gout can also lead to the formation of this kind of stones.
Among the external factors that contribute to the development of kidney stones, it should be noted especially the climate, drinking water and food, and therefore the disease is primary distribution in certain areas of the world (countries with hot, dry climate, mountain and northern areas).On the territory of Russia is the Volga area, the Urals, the Far North.
Purine bases include the nucleic acids, i.e. genes, and are contained in each cell of the human body.The final stage of metabolism of purines own organism, as well as purines arriving with food, is uric acid.Violations of the exchange of purine bases and uric acid takes place primarily in gout.In addition, an important role is played by dietary intake of increased amounts of purines (excessive consumption of meat products, beans, coffee) as well as diseases that are accompanied by a significant decay own protein.
Disorders of calcium and phosphorus metabolism are characteristic of a number of endocrine diseases, overdose of vitamin D, Part and duration of administration of calcium salts and strongly saline water, diseases of the musculoskeletal system, extensive fractures.As a result, the possibility of allocating lost partially soluble calcium phosphate, and calcium and phosphorus to pass the alkaline compound is poorly soluble.pH of urine in this case corresponds to the figure of 7.0 (neutral).Disorders
oxalic acid metabolism occur in excess of its admission intake (spinach, rhubarb, beets, parsley, coffee, cocoa), or increased formation of salts of oxalic acid in the body, such as in severe stress.The solubility of oxalate at pH urine lost about 5.5, and at elevated allocation ionized calcium.
However, there is another very important factor in the development of urolithiasis - local.That is a factor contributing to the disease directly in the kidneys and urinary tract, namely the stagnation of urine at different levels of the outflow tract and the presence there of infection.In this connection a special role acquire the presence of vesicoureteral reflux-junction, and inflammatory disease - pyelonephritis, cystitis, urethritis.
stone formation process takes place gradually.First, a so-called stone core, which can be a blood clot, the accumulation of bacteria, white blood cells, the cells lining the renal collecting system.Then, under appropriate conditions, salt precipitation occurs on the organic matrix.It should be noted that the main prerequisite for this are changes in acid-base equilibrium urine.Normally, there is a mechanism in the body colloidal protection, which prevents precipitation of salts and supports in the form of a concentrated solution of a soluble - urine.However, by changing the pH of the urine protective factor loses most of its activity.
chemical composition of the stones can be homogeneous or mixed.Women most common phosphates (slightly soluble calcium salts of phosphoric acid).The men - oxalates, more rarely - urate (uric acid) and carbonates.Among the stones can also be a protein, cholesterol, cystine stones and sulfa.The latter are formed by prolonged treatment of sulfa drugs row.
stones of various nature have a different structure and density, differing even externally.Phosphates are typically smooth or rough stones white.Urata - smooth or grainy thick yellow stones.Oxalate - very dense stones with a rough surface, gray-black color, easily injuring the mucous membrane of the urinary tract.Cholesterol stones are very rare, they are dark, soft and light.Cystine stones (found in 1-3% of cases) have a dense texture, usually colorless or whitish-yellow and have a smooth surface.
In one kidney may be either a single stone or more (from 20% to 50% of cases).Typically, the disease affects only one of the kidneys, but 15-20% of kidney stones are found on both sides.Stones in the cups are less common than the pelvis stone.
stones also vary considerably in size - from very small ( "sand") to chicken egg size and weight - from 2.1 g to 2 kg.The pelvis is usually arranged oval stones.Staghorn occupy the entire renal pelvis, going to the ends of sprouts a cup in the shape they resemble the mold pyelocaliceal system with bulges at the ends of shoots.Cone or oblong shaped stones are formed in the ureters, but their location is not always a place of their formation.In the ureter, the bladder or the urethra stones often come from the kidney.
Education stones leads to various disorders of the urinary system.If the stone is a serious obstacle to the outflow of urine, hydronephrosis develops with subsequent atrophy of the renal tissue.The stagnation of urine promotes (aggravation) infection may be purulent fusion of the kidney tissue, purulent calculous pyelonephritis.In some cases, the kidney stops functioning completely.
Urolithiasis in individual patients can occur without obvious symptoms.In such cases, kidney stones are radiological finding during examination for another reason.Sometimes the disease appears dull, poorly-expressed pain in the lumbar region - usually it happens when the stones are large.But more often with urolithiasis occur typical bouts of renal colic, the characteristic that most colic is marked with stones of small size.
attacks may provoke prolonged walking, riding on a rough road, shaking, weight lifting, but colic often occurs without any apparent reason.The frequency of attacks may vary from several months to over a few years.
typical attack of renal colic is characterized by sudden onset of sharp pain in the lumbar region.Pain of significant intensity, cutting nature, quickly intensified to an intolerable degree.Patients with excited moaning, tossing in bed, trying to find a position that facilitates their suffering.In some cases, an attack of renal colic is prolonged with short remissions for several days.Pain begins in the lumbar region, but then quickly spread on his stomach in the course of the ureters, in the groin, men often gives pain in the scrotum, in the glans penis, women - in the area of the labia majora, inner thighs.
often significantly higher intensity of pain in the abdominal region and genitals than in the lumbar region.Typically, an attack of colic is accompanied by an increased urge to urinate, pain and sharp pain when urinating.This is especially true when passing "sand" or small stone.
In renal colic often have symptoms such as delayed stool and gas, bloating, nausea and vomiting, dizziness when changing body position.Sharp pain can cause a significant drop in blood pressure.Long attack, on the contrary, it causes increased blood pressure.
If renal colic occurs against the backdrop of pyelonephritis, typically increased body temperature to high numbers.After the attack in the urine indicated the presence of red blood cells, white blood cells.Sometimes a temporary blockade of the kidneys in the urine changes are absent.The general analysis of blood usually develops increased erythrocyte sedimentation rate and white blood cells.
In the interictal period, patients may experience complaints of dull pain in the lower back, as well as changes in urinary sediment (erythrocytes, leukocytes, salt in large numbers) and the discharge of "sand" or small stones.Often in the interictal period any subjective feelings are absent.Almost always determined Pasternatskogo positive symptom - pain during effleurage in the lumbar region.
presence of red blood cells in urine is especially true in the presence of calcium oxalate stones, because of their uneven surface of the most heavily injure the mucous membranes of the renal pelvis and ureter.Usually, these effects are amplified after a walk and exercise.Long remaining red blood cells and white blood cells in the urine is particularly characteristic of the acceding chronic pyelonephritis, further development is accompanied by the formation of new stones.
Urolithiasis is prolonged, with a tendency to frequent exacerbations.As a result of the prolonged presence of kidney stones is increasing, irreversible changes that lead to the development of hydronephrosis, with concomitant infection - purulent complications.
When nephrolithiasis in conjunction with chronic pyelonephritis noted persistent increase in blood pressure.
In 13-15% of patients with renal stone disease is asymptomatic, the phenomenon of pyelonephritis are not expressed, there are no functional changes.Just in such cases the stones are random finding during examination for other reasons.
Survey reveals most kidney stones pictures.However, urate or protein soft stones are not detected by X-ray methods.To identify them using computer and magnetic resonance tomography, excretory urography.Excretory urography is shown to clarify the function of the kidney after survey shots.It allows you to most accurately determine the localization of the stones (calyx, pelvis, ureter) and to identify the presence and nature of complications.
forecast expressed in the absence of violations of kidney tissue structure and its functions favorable if staghorn or multiple stones, especially a solitary kidney, - serious.Timely removal of stones with the appropriate anti-treatment aimed at ending chronic inflammation and normalization of metabolic disorders, making prognozbolee optimistic.Otherwise urolithiasis continues to develop, giving rise to severe complications.These include purulent calculous pyelonephritis, hydronephrosis kidney.Acute complications of renal colic attack is excretory anuria.
Festering calculous pyelonephritis (calculous - stone associated with the presence of a stone) develops in the presence of pyogenic bacteria in the urine and often complicates the course of nephrolithiasis.A characteristic feature of this complication is the property of any violations of the outflow of urine lead to the appearance of fever with severe inflammatory manifestations in the blood - high ESR and a large number of white blood cells, which requires the urgent hospitalization of the patient to the hospital.In the absence of timely assistance in such cases may develop septic condition.
hydronephrosis develops gradually as a result of violations of the outflow of urine, which lead to the expansion of pelvis first, then the cups, then collecting tubules and tubules of the nephron.This results in marked changes of renal tissues with subsequent atrophy.Stagnation of urine contributes to the development of urinary tract infections, at the same time developing an infected hydronephrosis.Increased pressure inside the pelvis, and then in the whole of the collective system leads to a decrease in the functional activity of the tubules of the nephron.Interstitial kidney tissue soaked with urine, to work on it can not, and as a result of kidney tissue is replaced by connective (scar) tissue.Loss of kidney function is irreversible, they are not restored even after the elimination of obstacles to the flow of urine.
reveal hydronephrosis on the background of urolithiasis without special methods of examination difficult.In the initial stages the main feature are the attacks of renal colic, which are typical for nephrolithiasis.In the future, may join dull pain preferentially localized in the lumbar region.This is due to the replacement of tissues pelvis and cups on the connective tissue, where they lose the ability to shrink, to mention far come process.
characteristic for the presence of hydronephrosis in the general analysis of urine red blood cells, but in small quantities.During the excretory urography marked slowdown in the accumulation of a radiopaque material in advanced pelvis and cups.In severe violation of renal function may accumulate contrast only for 1-2 hours, or all of the affected kidney is not able to release it.