Nephrolithesis


Nephrolithesis

Description, Causes and Risk Factors:

nephrolithesis

Alternative Names: Kidney stones, renal stones, urolithiasis, urinary stones, and renal calculi.

The kidneys produce the urine that dissolves wastes and excretes them through the urinary tract. Nephrolithesis is a condition when the urine becomes so saturated with a certain mineral that no more of it can dissolve into the urine. The un-dissolved portion of the mineral forms crystals that then clump together and grow into hard stones. Nephrolithesis usually develop in the kidneys; however they can form anywhere in the urinary tract. This condition is medically known as urolithiasis or nephrolithiasis. The condition of having renal calculi is known as nephrolithiasis while having stone anywhere in the urinary tract is known as Urolithiasis. It occurs more frequently in men and does show a familial predisposition.

Major types of stones involve:

    Calcium stones in 60-80%, most primarily calcium oxalate less often, calcium phosphate.

  • Struvite (magnesium ammonium phosphate) in 10-15%.

  • Uric acid (if pure, then radiolucent) in 5-10%.

  • Cystine in 1%.

When kidney stones are quite tiny, they may pass unnoticed with the urine. Often however, they grow too large to pass easily through the urinary tract, and some stones develop rough or sharp edges. When these stones pass through the urinary tract, it can be quite painful. In some cases, kidney stones cannot pass on their own, and treatment with specialized medical equipment or surgery may be necessary.

About 80% of kidney stones formed by adults in the U.S. are of calcium oxalate stones.

The following are food sources of oxalates:

    Fruits: blackberries, blueberries, raspberries, strawberries, currants, kiwifruit, concord (purple) grapes, figs, tangerines, and plums.

  • Vegetables: Spinach, Swiss chard, beet greens, collards, rhubarb, sorrel, okra, parsley, leeks and quinoa are among the most oxalate-dense vegetables. Celery, green beans, rutabagas, and summer squash would be considered moderately dense in oxalates.

  • Nuts and seeds: Almonds, cashews, peanuts, and poppy seeds.

  • Legumes: Soybeans, tofu and other soy products.

Symptoms:

Symptoms:

    Usually when stones pass from renal pelvis into theureter: Pain, nausea, vomiting, dysuria, urgency.

  • Pain typically waxes and wanes in severity, usuallylasting 20 - 60 minutes.

  • 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.

Diagnosis:

Treatment to prevent recurrence of stones is based upon knowledge of the pathogenesis of the metabolic environment that favors formation, aggregation, and growth of the crystal mass. The metabolic abnormality is reflected in the composition of the stone and is identified by selected blood and urine tests. Thus, every effort should be made to recover the stone for composition analysis.

Laboratory Tests:

    Blood examination - Increased WBC count, blood urea, NPN,and creatinine, increased calcium level (hyperparathyroidism anddisseminated malignancy).

  • Urine analysis - Physical examination(smoky urine due tohematuria), microscopic study shows RBC, pus cells and casts,culture and sensitivity test (UTI), and renal function tests to beperformed to rule out renal failure.

Other tests:

    Chemistry panel may help to identify calcium and bicarbonates.

  • PTH, if elevated serum calcium.

  • UA, including pH and urine cx.

Abdominal plain film:

    Will identify radiopaque stones (Ca, struvite, cystine).

  • Will miss radiolucent stones, small stones, stones overlying bony structures.

  • Will not detect obstruction, but can monitor stone progressionand guide shock wave lithotripsy

Treatment:

The goal of treatment is to relieve symptoms and prevent further symptoms. Treatment varies depending on the type of stone and how severe the symptoms are. People with severe symptoms might need to be hospitalized.

When the stone passes, the urine should be strained and the stone saved and tested to determine the type. Drink at least 6 - 8 glasses of water per day to produce a large amount of urine. Some people might need to get fluids through a vein (intravenous). For severe pain, you may need to take narcotic pain killers or nonsteroidal anti-inflammatory drugs.

Surgery is usually needed if:

    The stone is too large to pass on its own.

  • The stone is growing.

  • The stone is blocking urine flow and causing an infection or kidney damage.

Extracorporeal shock-wave lithotripsy is used to remove stones slightly smaller than a half an inch that are located near the kidney. This method uses ultrasonic waves or shock waves to break up stones. Then, the stones leave the body in the urine.

Tunnel Surgery: The doctor makes a small cut on your back. A special instrument passes through a narrow tunnel to the stone and removes it. This method is called percutaneous nephrolithotomy.

An ureteroscope looks like a long wire. The doctor puts it into the patient's urethra through the bladder and up the ureter, and directs it to the stone. This is done using a camera that lets the doctor see the stone. A tiny cage catches the stone and pulls it out, or the doctor may be able to destroy it with a laser.

People with nephrolithiasis should consume plenty of clean, pure water, especially those known to form kidney stones. Taking the best fiber supplement without consuming sufficient water to flush the system is of no benefit.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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