Kidney stones (urolithiasis) are a very common disease. The age of existence of urolithiasis can be judged from the data obtained from the study of a mummy (Ancient Egypt 3500-4000 BC), in which kidney stones were discovered. Urolithiasis occurs in almost all countries of the world. In many regions, urolithiasis is epidemic in nature, which confirms the importance of exogenous factors in its occurrence. Urolithiasis is common in Kazakhstan, the republics of Central Asia, the North Caucasus, the Volga region, the Urals, the Far North, as well as in Austria, the Netherlands, Yugoslavia, Greece, Turkey, Syria, Brazil, and the eastern regions of the United States. Among all surgical kidney diseases, urolithiasis accounts for 30-45%.
In recent years, there has been a slight predominance of women among patients with urolithiasis, especially pronounced in patients with coral kidney stones. Kidney stones occur at any age, but in children and the elderly, kidney and ureter stones are less common, and bladder stones are more common. Stones are localized somewhat more often in the right kidney than in the left; bilateral kidney stones in children are observed in 2.2-20.2% of cases, in adults - in 15-20% of cases. Kidney stones are reported in children of all age groups, including newborns, but more often at the age of 3-11 years. In children, urolithiasis is 2-3 times more common in boys.
Kidney and ureteral stones. Kidney stones causes
The causes of kidney stones (nephrolithiasis) in different patients, including children, are different, i.e. this disease is polyetiological.
According to modern views, an important place among the causes of nephrolithiasis is occupied by congenital pathological changes in the kidneys and urinary tract, which can be divided into three main groups:
1) enzymopathies (tubulopathy) - lesions of the proximal and distal tubules;
2) anatomical malformations urinary tract;
3) hereditary nephrosis- and nephritis-like syndromes.
Enzymopathies (tubulopathies) are disorders of metabolic processes in the body or the functions of the renal tubules as a result of insufficiency or absence of any enzyme, which causes blockage metabolic process. Genetically determined tubulopathies are called metabolic errors. The most common in the middle zone are the following tubulopathies that contribute to stone formation: oxaluria, cystinuria, aminoaciduria, galactosemia, fructosemia, and more rarely, lactosemia and rickets-like diseases. A common disorder is uraturia, the mechanism of which has not yet been sufficiently studied.
With tubulopathies, substances accumulate in the kidney that go towards building stones. It is known that, with rare exceptions, kidney and urinary tract stones in humans consist of calcium oxalate, calcium phosphate, uric acid, magnesium ammonium phosphate, cystine.
It should be noted that oxaluria, uraturia, cystinuria, generalized aminoaciduria, changes in carbohydrate metabolism can be not only congenital, but also acquired; occur after illnesses of the kidneys and liver (cholecystitis, hepatitis, pyelonephritis, glomerulonephritis, etc.) due to a violation of their function. In these cases, a combination of congenital and acquired tubulopathies may be observed. For example, pyelonephritis, which developed due to congenital oxaluria, can lead to the appearance of acquired uraturia. As a result, stones of unequal composition are formed in the same kidney at different periods or in different kidneys of the same patient.
Oxaluria occurs in approximately half of patients with nephrolithiasis and is usually accompanied by pyelonephritis.
The hereditary nature of the disease is evidenced by its presence in relatives of patients. Interestingly, only kidney stones in oxaluria consist of calcium oxalate, whereas most of- phosphate or mixed, consisting of oxalate and phosphate. It is known that the formation of phosphate stones is associated with the development of hyperfunction of the parathyroid glands, mainly secondary hyperparathyroidism, due to impaired phosphate reabsorption due to the deposition of oxalate crystals in the renal tissue or the development of an inflammatory process in it.
With oxalate stones, urine pH ranges from 5.1 to 5.9. A higher incidence of oxalate stones has been established in populations living in areas where there is a low magnesium content in water and food products. The degree of oxaluria is directly proportional to the activity of the inflammatory process in the kidney.
Uraturia occurs in a quarter of patients kidney stones and often among their relatives, mainly in the male line. The disease occurs when the synthesis of purine nucleotides is disrupted. Uric acid is the end product of purine metabolism. It is released through the process of glomerular filtration and tubular secretion. Its reabsorption also occurs in the tubules. Normal excretion of uric acid does not exceed 800 mg/day. Uraturia can occur in two ways: as a result of impaired purine synthesis, leading to increased formation of uric acid (in this case, uraturia is accompanied by an increase in uric acid in the blood), and due to decreased reabsorption of uric acid in the renal tubules.
Increased formation of uric acid occurs in all cases when the breakdown of nucleotides increases, including pyelonephritis. There is a direct dependence of the degree of uraturia on the activity of the inflammatory process; 97% of uric acid stones consist of uric acid and only 3% of its salts - urates.
Generalized aminoaciduria occurs in most patients with urolithiasis and in approximately half of their relatives. It is characterized by increased excretion of amino acids in the urine (2.5-5.7 g/day with a norm of 1-2 g). Aminoaciduria is the most sensitive indicator of proximal tubular dysfunction. . Generalized aminoaciduria is observed with various diseases: cystinosis of newborns, de Toni-Debreu-Fanconi syndrome, galactosemia, multiple myeloma, vitamin B deficiency, etc.
In most patients with coral kidney stones, aminoaciduria is accompanied by an increase in the level of amino acids in the blood serum. This type of aminoaciduria is called filling aminoaciduria and is classified as the hepatic type of aminoaciduria.
In addition to generalized aminoaciduria, there are also specific renal aminoaciduria - cystinuria, glycinuria, etc.
Cystinuria is a genetically determined disorder of reabsorption in the kidneys of four amino acids: cystine, lysine, arginine, ornithine. Normally, 95% of the cystine filtered by the glomeruli is practically not reabsorbed in the renal tubules. In patients with cystinuria, cystine is practically not reabsorbed, which leads to a decrease in its concentration in the blood serum by 50%. Two types of cystinuria coexist: complete - impaired reabsorption of all four amino acids and incomplete - impaired reabsorption of only three amino acids, most often cystine, ornithine and arginine.
A cystine stone is formed in 1 in 600 cases of cystinuria. However, in recent years, information has appeared about a higher incidence of cystine stones in those ethnic groups of the population where consanguineous marriages are common. All patients with cystinuria are diagnosed with pyelonephritis.
Of the inborn errors of metabolism associated with impaired carbohydrate metabolism, the most common are galactosemia and fructosemia, which are found in 12-13% of patients with nephrolithiasis.
Galactosemia occurs due to incomplete conversion of galactose to glucose as a result of deficiency of the enzyme galactose-1-phosphate uridyl transferase in the liver and red blood cells.
As a result of the entry of a large amount of galactose into the glomerular filtrate, galactosuria develops, which is accompanied by a loss of amino acids. Excessive levels of galactose in the blood have a toxic effect on the liver, kidneys, and cornea of the eye.
Fructosemia consists of patients intolerant to fructose due to deficiency of the enzyme fructose-1-phosphate aldolase in the liver, kidneys, and intestinal mucosa.
The resulting fructosuria is accompanied by proteinuria and aminoaciduria. Fructose and its metabolic products, which have toxic properties, accumulate in the blood.
Among the changes in calcium-phosphorus metabolism (rickets-like diseases), the main one is de Toni-Debreu-Fanconi syndrome - a hereditary tubulopathy, which is a combined disorder of the reabsorption of amino acids, glucose or phosphates. Clinically, this syndrome manifests itself as rickets or osteomalacia. IN in some cases The reabsorption of water, sodium, potassium, urates, and protein may be impaired. The syndrome is also called “swan neck syndrome” because when morphological study kidney tissue reveals a long and thin proximal tubule.
Kidney stones development mechanism
Numerous factors contributing to the formation of kidney stones against the background of tubulopathy can be divided into exogenous and endogenous, and the latter into general (characteristic of the entire body) and local (directly related to changes in the kidney).
Exogenous pathogenetic factors include climatic and geochemical conditions, nutritional habits, etc.
The wider distribution of nephrolithiasis in certain geographical areas confirms the importance of climatic conditions in its origin. An undoubted role is played by temperature and humidity, the nature of the soil, the composition of drinking water and its saturation with mineral salts, flora and fauna. It has been established that in residents of hot countries, as a result of increased sweating and dehydration, the concentration of urine increases, which can contribute to stone formation.
Geographical conditions determine the nutritional pattern of the population, which in turn affects the composition of urine and its pH.
Plant and dairy foods contribute to the alkalization of urine, meat - to its oxidation. Drinking water oversaturated with lime salts reduces the acidity of urine and causes an excess of calcium salts in the body.
The prevalence of kidney stones among the population of the Arctic is explained by polyhypovitaminosis, lack of ultraviolet rays and the predominance of meat and fish in the diet.
Consequently, exogenous factors play an important role in the formation of endemic foci of urolithiasis, but the state of the human body - endogenous pathogenetic factors - also plays an undoubted role in the occurrence of nephrolithiasis.
A special place among the endogenous factors contributing to the development of nephrolithiasis is occupied by hyperfunction of the parathyroid glands (hyperparathyroidism), which causes a disturbance in phosphorus-calcium metabolism.
Hyperparathyroidism is an acquired disease. It is known that phosphate excretion is under the control of the parathyroid glands. Parathyroid hormone (parathyroid hormone) plays a dual role in calcium metabolism. On the one hand, it increases the release of phosphorus and reduces its reabsorption in the tubules, on the other hand, it increases the release of calcium salts from bone tissue. Phosphate excretion increases in proportion to the increase in the level of parathyroid hormone in the blood. The loss of phosphates leads to the mobilization of phosphorus compounds from the bones. Since the latter are both calcium salts, calcium is released and its concentration in the blood and urine increases. Phosphaturia appears.
There are primary and secondary hyperparathyroidism.
Primary hyperparathyroidism (parathyroid adenoma) is characterized by high levels of calcium in the blood and urine, phosphaturia, increased alkaline phosphatase activity, polyuria, and a decrease in the concentration process in the kidney. The incidence of primary hyperparathyroidism in patients with nephrolithiasis is low (1-2%). Secondary, or compensatory, hyperparathyroidism is a consequence of the inflammatory process in the kidneys. However, it is also observed in aseptic nephrolithiasis, as well as in tubulopathies not accompanied by pyelonephritis. These kidney lesions cause disruption of the reabsorption of phosphates and calcium in the renal tubules, which in turn leads to a compensatory increase in the function of the parathyroid gland, the hormone of which causes the leaching of phosphates and calcium from the bones. Secondary hyperparathyroidism is characterized by hypocalcemia. The frequency of secondary hyperparathyroidism is high and is about 40% in patients with nephrolithiasis, and about 70% in patients with coral kidney stones. Secondary hyperparathyroidism accompanies tubulopathy in relatives of 6% of patients.
Elevated calcium levels in the blood serum also occur with bone trauma, osteomyelitis, osteoporosis, and peripheral neuritis, and therefore these diseases are often complicated by kidney stones.
Endogenous factors contributing to the occurrence of urolithiasis also include disorders of the normal function of the gastrointestinal tract (chronic gastritis, colitis, peptic ulcer). This is explained by the influence of hyperacid gastritis on the acid-base state of the body, as well as a decrease in the excretion from the small intestine and the binding of calcium salts in it. Violation of the barrier functions of the liver is also of great importance. Some importance in the pathogenesis of stone formation in children is given to gastrointestinal diseases, especially dysentery and toxic dyspepsia, accompanied by prolonged dehydration of the child’s body. Uric acid infarction of newborns, in which uric acid salts (which do not have time to be excreted by the kidneys) are deposited in the renal papillae, can often serve as the beginning of the formation of stones.
Finally, local endogenous factors play an important pathogenetic role in nephrolithiasis - changes in the normal state of the kidney and urinary tract, primarily factors leading to stagnation of urine, impaired secretion and reabsorption of its constituent elements, and the development of urinary infection.
Congenital kidney anomalies (doubling and dystopia of the kidney, horseshoe kidney, neurogenic bladder in spina bifida, primary and secondary vesicoureteral reflex in children, etc.), valves and narrowing of the ureters, pregnancy, etc. contribute to the deterioration of urodynamics. causing disruption of the outflow of urine from the kidney (hydronephrosis, ureteral strictures, nephrotuberculosis, etc.) are often complicated by the formation of stones in it.
Stone formation is also facilitated by a slowdown in renal blood flow, which causes anoxia and necrosis of the renal epithelium. This is caused by kidney injury, shock, and bleeding.
An important role in the development of kidney stones is assigned to the inflammatory process in the kidney. It contributes to various changes in the functions of the renal parenchyma and the condition of the mucous membrane collecting system, a violation of the surface tension between it and urine, as a result of which the phenomenon of adsorption develops. In this regard, pyelonephritis, often layered on congenital and acquired tubulopathies (enzymopathies), plays a very important role in stone formation. This is confirmed by studies that have established the presence of bacteria in the core of urinary stones removed from humans.
A number of microorganisms (staphylococcus, Proteus, Pseudomonas aeruginosa) have the ability to break down urea in urine, which leads to its alkalization and precipitation of salts - phosphates. Infection contributes to the formation of stones, especially in cases of stagnation of urine caused in children by tight swaddling in a non-physiological position, customs of carrying behind the back, prolonged immobilization in case of severe burns, injuries, etc. Thus, urinary infection is undoubtedly one of the important factors of stone formation, its role is especially great in the formation of phosphate stones, while in the formation of urate and oxalate kidney stones, general metabolic disorders in the body are of great importance.
According to modern views, in women with nephrolithiasis, local pathogenetic factors are of relatively greater importance - disturbances in urodynamics and the development of infection in connection with pregnancy and gynecological diseases (“organ lithiasis”), while in men nephrolithiasis more often develops due to general metabolic disorders (“lithiasis”). organism").
At the last stages of the pathogenesis of stone formation in the kidney, the nature of the ratio of mineral crystals and protective colloids in the urine is important. This mechanism can be explained in the light of the colloid-crystalloid theory, according to which urine contains protective colloids that prevent the crystallization of salts. When the function of the renal tubules is impaired, a large amount of polysaccharides and mucoproteins appear in the urine, which disrupt the colloid balance. The accumulation of crystalloids in a supersaturated solution of urine and their precipitation with subsequent crystallization lead to the formation of stones.
The process of stone formation (stone morphogenesis) is explained by the matrix theory. According to this theory, during stone formation, a protein skeleton is initially formed, on which salts are deposited for the second time. Careful studies of the structure of kidney stones have shown that their core is always an organic substance, which can serve either as a material for the formation of the entire stone (with protein, cystine stones), or (in most cases) only as a matrix on which various salts are deposited.
Thus, the process of formation of stones in the kidneys and urinary tract is complex and multi-stage. Against the background of enzymopathies (tubulopathies), metabolic disorders, which play the role of etiological factors, the action of various exo- and endogenous, general and local pathogenetic factors unfolds.
Based on their chemical composition, they are divided into oxalates, phosphates, urates, and carbonates. Less common are cystine, xanthine, protein, and cholesterol stones. Stones, as a rule, are layered, the number of stone-forming minerals is no more than three, other minerals can be found in the form of impurities. The stone is a mixture of minerals and organic matter.
Oxalate stones are formed from calcium salts of oxalic acid. These stones are dense, black-gray in color, with a spiky surface. They easily injure the mucous membrane, causing the blood pigment to color them dark brown or black.
Phosphate stones contain calcium salts of phosphoric acid. Their surface is smooth or slightly rough, their shape is varied, and their consistency is soft. They are white or light gray in color, are formed in alkaline urine, grow quickly, and are easily crushed.
Urate stones are composed of uric acid or its salts. The stones are yellow-brick in color, with a smooth surface and a hard consistency.
Carbonate stones are formed from calcium salts of carbonic acid. They are white, have a smooth surface, soft, and vary in shape.
Cystine stones are composed of the sulfur compound of the amino acid cystine. They are yellowish-white in color, round in shape, soft in consistency, with a smooth surface.
Protein stones are formed mainly from fibrin mixed with salts and bacteria. They are small in size, flat, soft, and white.
Cholesterol stones are made of cholesterol and are very rare in the kidney. They are black, soft, and crumble easily.
Kidney stones can be single or multiple.
Their size is very diverse - from 0.1 to 10-15 cm or more, weight from fractions of a gram to 2.5 kg or more. Often the stone forms the pelvicalyceal system as a cast with thickenings at the ends of the processes located in the cups. Such stones are called coral-shaped.
Causes of ureteral stones
By origin, stones in the ureter are almost always displaced kidney stones. They are varied in shape and size. Single stones are more common, but there are two, three or more stones in one ureter. The stone is often retained in places of physiological narrowing of the ureter; at the site of exit from the pelvis, at the intersection with the iliac vessels, in the paravesical (juxtavesical) and intramural sections.
Pathological anatomy. Morphological changes in the kidney with nephrolithiasis depend on the location of the stone, its size and shape, and the anatomical features of the kidney.
In many ways, morphological changes in the kidney are caused by the inflammatory process in it. Often, stones occur against the background of existing pyelonephritis, which is subsequently aggravated by a violation of the outflow of urine caused by the stone.
However, even with “aseptic” stones, morphological changes in the renal parenchyma are quite characteristic. The absence of infection in the urine during bacteriological examination does not mean the absence of inflammatory changes in the kidney, which in these cases are interstitial nephritis; expansion of urinary tubules and glomeruli, phenomena of peri- and endarteritis, proliferation of interstitial connective tissue, especially around the tubules. Atrophy of the renal tissue gradually occurs.
Modern histochemical and electron microscopic studies show that in the kidney tissue during nephrolithiasis, there is an excessive accumulation of glycoproteins, mucopolysaccharides, including hyaluronic acid, in the interstitial tissue of the kidney and in the basement membranes of the glomerular capillaries.
Sclerosis and tissue atrophy, starting in the pelvis, spread to the interstitial tissue of the kidney, which leads to the gradual death of the functional elements of the renal parenchyma and its simultaneous fatty replacement.
An important component of the morphological changes in the kidney during “aseptic” nephrolithiasis are the consequences of impaired urine outflow caused by the stone.
Stones located in the calyxes cause minor morphological changes, since they are inactive and disrupt the outflow of urine only from a small area of the kidney. The greatest changes are caused by stones in the renal pelvis or ureter.
These stones, disrupting the outflow of urine, cause an increase in intrapelvic pressure, which in turn causes an increase in pressure in the calyces. The increase in pressure in the collecting system spreads to the tubular system of the kidney, resulting in increased intrarenal pressure. The tubules expand, their epithelium loses its function.
As a result of impaired blood circulation in the kidney, glomerular filtration decreases. Pelvic-renal reflux, which occurs when intrapelvic pressure increases, contributes to the permeation of the interstitial tissue of the kidney with urine. The interstitial tissue gradually turns into scar connective tissue, replacing the renal parenchyma. During hydronephrotic transformation, the kidney continues to produce urine for a long time, but its concentration is sharply reduced. The presence of an obstruction to the outflow of urine gradually leads to further stretching of the pelvis, thinning of its wall and progressive atrophy of the renal parenchyma, i.e. hydronephrotic transformation.
Chronic calculous pyelonephritis
With “infected” stones, i.e. calculous pyelonephritis, the inflammatory process spreads from the medulla to the renal cortex. Focal inflammatory infiltrates and suppuration in the interstitial tissue of the kidney lead to subsequent scarring, resulting in atrophy of the tubules and then the glomeruli.
Chronic calculous pyelonephritis can cause purulent melting of tissue (pyonephrosis). The inflammatory process successively involves the papillae (necrotizing papillitis), and then the deeper parts of the renal pyramids. Abscesses arise and merge in the parenchyma, the capsule thickens and fuses with the surrounding adipose tissue.
The renal parenchyma is sometimes completely destroyed, involving the perinephric tissue in the inflammatory process.
Morphological changes in the pelvis and ureter with “aseptic” stones that disrupt the outflow of urine are reduced to loosening of the mucous membrane, hemorrhages in the submucosal layer, hypertrophy of the muscle wall. Over time, atrophy of the muscle fibers of the pelvis and ureter and their nerve elements develops, their lymph and blood circulation is disrupted, and their tone sharply decreases. The pelvis expands, the ureter turns into an enlarged atonic connective tissue tube, sometimes up to 2-4 cm in diameter (hydroureteronephrosis).
In the presence of infection, inflammation develops in the wall of the pelvis and ureter. Gradually, the surrounding fiber is involved in the process; Peripyelitis, periureteritis, pedunculitis develop, the ureter becomes sclerotic and becomes immobile. In place of the stone in the ureter, a stricture, bedsore, and even perforation of its wall can form.
Kidney stones symptoms
The most characteristic symptom of kidney stones is pain in the lumbar region, especially paroxysmal pain (renal colic). Hematuria, pyuria, dysuria, spontaneous passage of stones and (rarely) obstructive anuria are also observed.
In children, especially young children, none of the above symptoms are typical for kidney stones. Often the disease is asymptomatic for a long period of time. The younger the child, the less pronounced these symptoms are. In older children, the clinical picture is typical for adult patients.
Pain from kidney stones can be constant or intermittent, dull or sharp. The localization and irradiation of pain depend on the location of the stone. Large pelvic stones and coral kidney stones are inactive and cause dull pain in the lumbar region. Absence of pain from kidney stones is rare. Renal stone disease is characterized by the association of pain with movement, shaking, etc. Pain in the lumbar region often radiates along the ureter, to the iliac region. As the stone moves down the ureter, the irradiation of pain successively changes; it begins to spread lower to the groin, thigh, testicle and head of the penis in men and the labia in women.
Renal colic
The most characteristic symptom of kidney and ureteral stones is an attack of acute pain - renal colic.
The cause of renal colic is the sudden cessation of urine flow caused by blockage of the upper urinary tract by a stone. Violation of the outflow of urine leads to overflow of the pelvis with urine, an increase in intrapelvic pressure, which in turn causes irritation of the receptors of the sensory nerves of the hilum and the fibrous membrane of the kidney. The pain increases due to impaired microcirculation in the kidney and developing hypoxia of the renal tissue and the nerve endings of the plexuses innervating the kidney.
An attack of renal colic caused by a stone occurs suddenly, more often during or after physical exertion, walking, shaking, or drinking copious amounts of fluid. Appear in the lumbar region and hypochondrium sharp pains, often spreading to the entire corresponding half of the abdomen.
Patients constantly change position, often moan and even scream. This characteristic behavior of the patient often makes it possible to establish a diagnosis “at a distance.” The pain sometimes continues for several hours or even days, periodically subsiding. Acute pain is followed by nausea, vomiting, and sometimes frequent painful urination. Some patients experience reflex intestinal paresis, stool retention, and muscle tension in the anterior abdominal wall.
Disorders of the gastrointestinal tract in renal colic are explained by irritation of the posterior parietal peritoneum adjacent to the anterior surface of the fatty capsule of the kidney, and connections between the nerve plexuses of the kidney and organs abdominal cavity.
With renal colic, oliguria may be observed, associated both with a decrease in kidney function, blocked by a stone, and with increased fluid loss due to vomiting. Renal colic is also accompanied by weakness, dry mouth, headache, chills and other general symptoms.
During an objective general clinical examination of a patient with renal colic, pronounced pain in the area of the corresponding hypochondrium, tension in the muscles of the anterior abdominal wall in this area, and a sharply positive Pasternatsky sign are noted. Palpation of the kidney area and tapping of the lumbar region to identify Pasternatsky's symptom should be done with renal colic with extreme caution so as not to cause a persistent increase in pain.
With a stone in the ureter, palpation sometimes reveals the greatest pain not in the kidney area, but in the underlying parts of the abdomen, in the projection of the part of the ureter where the stone is located.
An attack of renal colic may be accompanied by an increase in body temperature and an increase in blood leukocytosis, which is caused by pyelovenous and pyelotubular reflux.
Renal colic caused by a small stone usually ends with its spontaneous passage. If the stone does not pass, renal colic may recur. In children, renal colic is less common than in adults, which is due to the presence in them of a high percentage of small stones, which easily descend into the bladder through relatively wide ureters. The pain is characterized by its moderate intensity and short duration. Often these pains are localized in the navel area and are accompanied by nausea, vomiting, and high body temperature. Young children cannot clearly indicate the pain point.
The passage of stones can be considered a pathognomonic sign of nephroureterolithiasis; it is almost always accompanied by renal colic. The ability of a stone to pass spontaneously largely depends on its size and location, on the state of tone and urodynamics of the upper urinary tract.
With a decrease in tone and dynamics, emptying the pelvis and ureter, the passage of stones is difficult or becomes impossible, and stone retention in the urinary tract leads to further disruption of urodynamics.
Hematuria is observed very often in urolithiasis. It can be microscopic, when 20-30 red blood cells are found in the urine sediment (erythrocyturia), and macroscopic. Macroscopic hematuria caused by a kidney stone or a stone in the ureter is always total. It is a consequence of rupture of thin-walled veins of the fornical plexuses, caused by the rapid restoration of urine outflow after a sudden increase in intrapelvic pressure. With large stones, hematuria occurs after prolonged walking or physical activity, as a result of injury to the fornical veins or their rupture due to sudden intrarenal venous hypertension. In children, macro- and microhematuria is detected in 80-90% of cases. Macrohematuria is preceded by a short attack of pain.
In the majority (60-70%) of patients with kidney and ureteral stones, the course of the disease is complicated by associated infection, which aggravates the disease and worsens the prognosis. The infection, the causative agent of which is most often Escherichia coli, staphylococcus, Proteus vulgaris, manifests itself in the form of acute or chronic pyelonephritis, urethritis, pyonephrosis, therefore pyuria is a common symptom of kidney stones.
Pyuria in children is not constant symptom kidney stone disease, therefore, when ascertaining it, it is first necessary to suspect a developmental anomaly urinary tract complicated by urolithiasis.
Dysuria depends on the location of the stone: the lower the stone in the ureter, the more pronounced it is. The urge to urinate becomes almost continuous when the stone is in the intramural portion of the ureter, which is caused by irritation of the interoceptors in the bladder wall.
When examining a patient with unilateral nephroureterolithiasis, asymmetry of the lumbar region may be noted due to scoliosis and atrophy of the muscles of the lumbar region on the opposite side. It is rarely possible to palpate the affected kidney with nephrolithiasis, but pain on palpation of the kidney area and Pasternatsky's symptom are often observed. A ureteral stone is characterized by pain in the areas of its projection - in the iliac or inguinal region. In rare cases, it is possible to palpate a large stone in the perivesical ureter in women through the anterior vaginal wall.
Kidney stones complications
The most common complication of nephroureterolithiasis is an inflammatory process in the kidney, which can occur in acute or chronic form. Favorable conditions for the development of this complication in renal stone disease are created due to disruption of the outflow of urine by kidney stones and especially the ureter, increased intrapelvic and intracalyceal pressure, renal pelvic reflux and renal hemodynamic disorders.
Acute pyelonephritis occurs in approximately half of patients with nephroureterolithiasis. Its clinical picture corresponds to acute secondary pyelonephritis. If occlusion of the urinary tract by a stone is not eliminated and antibacterial therapy is ineffective under these conditions, then serous acute pyelonephritis turns into purulent, and then into pustular (apostematous) or into a renal carbuncle. Extensive apostematous pyelonephritis or multiple kidney carbuncles can lead to complete death of the kidney parenchyma and the need for its removal. Thus, the timely restoration of urine outflow from the kidney in one way or another is of paramount importance for a favorable outcome of organ-preserving treatment.
Chronic calculous pyelonephritis is a typical example of chronic secondary pyelonephritis. If a stone that disrupts urodynamics is not removed from the kidney in a timely manner, then antibacterial therapy is not able to eliminate the infection and stop the progression of the inflammatory process in the renal parenchyma. Kidney shrinkage (nephrosclerosis) gradually develops and its function decreases.
The result of chronic calculous pyelonephritis can also be calculous pyonephrosis - purulent melting of the kidney parenchyma, turning it into a sac containing stones, pus, tissue decay products and serving as a source of severe intoxication of the body. Kidney function during pyonephrosis is almost completely and irreversibly lost, and therefore the only possible treatment is nephrectomy.
With stones that occlude the ureteropelvic segment or ureter, calculous hydronephrosis often develops as a complication - a typical example of secondary hydronephrosis.
Chronic pyelonephritis, pyonephrosis, and hydronephrosis due to nephroureterolithiasis, in turn, can lead to another complication - nephrogenic arterial hypertension.
The most serious complication of nephroureterolithiasis is acute and chronic renal failure. It develops when both kidneys or a single kidney (congenital or remaining after nephrectomy) are affected.
Acute renal failure develops as a result of sudden blockage of both ureters or the ureter of a single kidney with a stone. The first signs of this complication are acute pain in the area of both kidneys or a single kidney, anuria or severe oliguria, then dry mouth, nausea and vomiting, diarrhea and other symptoms of acute renal failure appear. If proper treatment is not undertaken in a timely manner (removal of stones, drainage of the kidney), the patient’s condition steadily worsens, and the symptom complex of uremia develops (confused consciousness, itchy skin, uncontrollable vomiting, gastroenterocolitis, polyserositis, etc.) and death occurs.
Chronic renal failure due to nephroureterolithiasis develops with a partial and gradually occurring disruption of the outflow of urine from both kidneys or from a single kidney, which is most often observed with coral or multiple kidney stones. The disturbance of urodynamics caused by stones leads to the progression of chronic pyelonephritis, wrinkling of the renal parenchyma, and a gradual but steady decrease in its function.
This, in turn, causes changes in homeostasis characteristic of chronic renal failure: hyperazotemia, disturbances in electrolyte balance and acid-base status. Only possible means preventing development terminal stage chronic-renal failure in nephroureterolithiasis is timely organ-preserving surgical treatment.
Kidney stones diagnosis
Diagnosis of nephroureterolithiasis is based primarily on the patient’s complaints. Of these, the most important are attacks of renal colic, especially repeated ones, with dull pain in the lumbar region in the periods between attacks, the passage of stones, hematuria, especially occurring after physical activity. Blood in the urine after renal colic is a pathognomonic symptom of nephrolithiasis. In children, especially younger ones, it is not possible to obtain objective anamnestic information. The doctor learns the latter from their parents. Unfortunately, this information is often subjective and not always clear. And the pain that arises in a child is most often interpreted as pain localized in the abdomen. Sometimes parents point out the fact that red urine is released after the end of the pain syndrome.
General clinical examination methods can identify signs of damage to the kidney and urinary tract (positive Pasternatsky's sign, pain on palpation in the kidney area or along the ureter, palpable kidney). Objective clinical symptoms nephroureterolithiasis is not always pathognomonic.
A blood test in patients with urolithiasis during remission reveals few changes, and during renal colic or an attack of pyelonephritis it reveals leukocytosis, a shift in the leukocyte formula to the left, toxic granularity of neutrophils, an increase in ESR, a urine test reveals a small amount of protein (0.03-0.3 g /l), single cylinders, fresh red blood cells and salts. Leukocyturia appears when nephrolithiasis is complicated by pyelonephritis.
Chromocystoscopy is of great importance in the diagnosis of kidney stones. It allows you to see a stone if it is “born” from the ureter into the bladder, or signs of its close location near the mouth (swelling, hyperemia and looseness of the mouth of the ureter). Often, against the background of a normal mucous membrane of the bladder, salt deposits, hemorrhages are noticeable, and with prolonged calculous pyelonephritis, inflammatory changes in the circumference of the ureteral orifice of the affected kidney. Cloudy urine is often discharged from the mouth of the ureter, and with pyonephrosis - thick pus, like paste from a tube. Chromocystoscopy allows, to a certain extent, to assess renal function, as well as to distinguish between partial and complete occlusion of the ureter, which is especially important in the differential recognition of renal colic. With the latter, as a rule, within 10-12 minutes there is no discharge of urine stained with indigo carmine from the mouth of the ureter of the affected kidney. The absence of indigo carmine release between attacks of pain may indicate significant destructive or atrophic changes in the kidney parenchyma, sharply impairing its function (hydronephrosis, pyonephrosis, purulent pyelonephritis). With coral kidney stones that impair its function, in most cases there is a late and weak release of indigo carmine. Ultrasound examination of the kidneys and bladder occupies a certain place in the diagnosis of urolithiasis. This method Unlike X-ray, it is characterized primarily by its harmlessness, which is especially important for a growing child’s body. Using echo scanning, the acoustic signs of stones in the calyces and pelvis of the kidney, ureter and bladder are determined.
An indirect symptom in favor of the presence of an upper urinary tract stone is the statement of dilatation of the pyelocaliceal system.
X-ray examination takes a leading place in identifying kidney and ureteral stones.
The most common method is survey urography.” With its help, you can determine the size and shape of the stone, as well as approximately its location.
A survey urogram should cover the entire area of the kidneys and urinary tract on both sides. Not all stones cast a shadow in a survey photo. The chemical composition of stones, their size and location are extremely diverse. Oxalates and phosphates contain elements with high atomic mass and produce intense shadows. In 10% of cases, stones are not visible on a plain X-ray (urate, cystine and xanthine stones), since their density in relation to X-rays approaches the density of soft tissue (X-ray negative stones). With an abnormality of the urinary tract, the shadow of a stone on a survey image can be detected outside the usual location of the kidneys and ureters.
It should be borne in mind that a shadow suspicious for a kidney or ureteral calculus may belong to a foreign body, a calcified lymph node, a gall bladder stone, etc. In the projection of the pelvis, rounded shadows are often visible - phleboliths, similar to a stone. Their distinctive feature is correctly round, clear contours and lightening in the center.
Based on survey urography, a diagnosis of coral-shaped kidney stones is made, which are a cast of the pyelocaliceal system and give a dense shadow in the area of the projection of the kidneys, with the exception of X-ray negative stones.
After a survey of the urinary tract, excretory urography should be performed. Based on its data, it is possible to determine whether the shadow visible on the survey image refers to the urinary tract. Excretory urography allows you to identify the anatomical and functional state of the kidneys, establish the type of pelvis (intrarenal or extrarenal) and the localization of the stone (in the pelvis, calyx or ureter). In cases where a stone disrupts the outflow of urine, excretory urograms reveal changes in the pyelocaliceal system (hydrocalicosis, pyeloectasia). Typically, the images show a shadow of the stone against the background of a radiopaque substance. If a stone occludes the ureter, then a radiopaque substance is located above the stone in the dilated ureter, as if “pointing” to the stone. With an X-ray negative stone, a filling defect corresponding to the calculus is visible against the background of a radiopaque substance. As a rule, excretory urography gives a complete picture of the functional capacity of the kidney, however, after an attack of renal colic, the kidney is in a state of blockage and temporarily does not function. When studying the functional capacity of such a kidney, great help is provided isotope methods research. They make it possible to establish that in most cases a blocked, “silent” kidney retains its functional capacity and that there are no irreversible changes in the tubular apparatus.
Retrograde pyelography with a liquid radiopaque substance or oxygen (pneumopyelography) is performed only in cases where there are doubts about the diagnosis or the shadow of the stone is not visible - usually with an X-ray negative stone. On a retrograde pyelogram with a liquid radiopaque substance, such gum appears as a filling defect. However, round filling defects on a retrograde pyelogram should be interpreted very carefully, since during retrograde pyelography, air bubbles may enter the urinary tract along with the radiopaque substance. Often, after retrograde pyelography, the calculus is impregnated with a radiopaque substance and becomes clearly visible on the survey image.
With retrograde pyelography using gaseous substances (oxygen or carbon dioxide), an X-ray negative stone in the pelvis or calyx is revealed against the background of gas in the form of a clear shadow.
An important method for diagnosing kidney stones is tomography, which allows one to differentiate a kidney stone from gall bladder stones and other shadows not related to the urinary system.
When choosing the type of treatment, great importance is attached to radioisotope research methods, which make it possible to establish the degree of preservation of kidney function (both tubular and glomerular apparatus).
Differential diagnosis.
Recognizing renal colic is usually not difficult. However, in 25% of patients it occurs atypically (pain spreads throughout the abdomen, radiating to the epigastric region, scapula, shoulder, etc.). In such cases, it is necessary to know the main symptoms of a number of acute surgical diseases of the abdominal organs in order to correctly differentiate them from renal colic.
In acute appendicitis, the disease develops gradually, beginning with an increase in body temperature and pain in the epigastric, and then in the ileal region, nausea and vomiting. A distinctive feature is the patient’s calm behavior and position on the right side or on the back. Movement increases pain. The pulse is increased, Rovsing and Shchetkin-Blumberg symptoms are expressed.
Acute cholecystitis causes severe pain in the right hypochondrium, which occurs suddenly and radiates to the right supraclavicular fossa (phrenicus symptom), right scapula, and back. Pain, as a rule, occurs after an error in nutrition.
A perforated ulcer of the stomach or duodenum is manifested by severe, “dagger-like” pain in the epigastric region, which occurs suddenly at the moment of perforation. The entry of stomach and intestinal contents into the abdominal cavity leads to peritonitis. The patient lies motionless abdominal wall board-like tension. Percussion of the abdomen reveals tympanitis in the area of renal dullness.
An X-ray examination of the abdominal cavity reveals sickle-shaped gas under the dome of the diaphragm.
Acute obstruction of the small intestine begins suddenly with severe cramping pain in the abdomen, retention of stool and gas, bloating, and vomiting. The possibility of reflex intestinal paresis in renal colic complicates differential diagnosis, which requires special methods studies: chromocystoscopy, excretory urography. Colon obstruction develops more gradually, abdominal pain is much weaker, which facilitates differential diagnosis.
Acute pancreatitis is manifested by severe pain in the epigastric region, radiating to the back, shoulder, hypochondrium and quickly becoming shingles. Peritoneal phenomena and vomiting are observed. The general condition is serious, but the body temperature is normal. The content of diastase in the blood and urine is increased.
An ectopic pregnancy is characterized by constant pain in the lower abdomen, a position on the back with bent legs, symptoms of peritoneal irritation, and a pattern of internal bleeding.
In addition to renal colic, it is necessary to differentiate the shadows of kidney and ureteral stones on radiographs of the urinary system from shadows of other origin. The latter may be due to calcified lymph nodes intestinal mesentery and retroperitoneal space, fecal stones, drug tablets in the intestine, petrificates in the kidney parenchyma of tuberculous origin.
Unlike the shadows of kidney and ureter stones, the shadows of petrific stones have a non-homogeneous structure, uneven contours and irregular shape, and bile duct stones have a scalloped shape, low intensity and crowded location. Clarity in the differential diagnosis is brought by X-ray contrast examination in two projections or more (in the supine, abdominal, semilateral position), in which shadows suspicious for stones either completely coincide with the image of the urinary tract, or appear outside them.
It is especially often necessary to differentiate the shadows of stones in the pelvic ureter and phleboliths (vein stones), which are calcifications of the pelvic veins and appear as rounded shadows in the image (cross section). They are distinguished from stones in the ureter by their geometrically correct rounded shape, completely smooth contours, clearing in the center and multiplicity. However, it is possible to completely exclude the relationship of the phlebolith shadow to the ureter only with the help of its contrast (by excretory urography or the introduction of a radiopaque ureteral catheter) and images in two projections. If in both projections the suspicious shadow coincides with the contours of the ureter, then this indicates the presence of a stone in the ureter, otherwise - phlebolith.
Kidney stones treatment
Treatment methods for patients with nephroureterolithiasis are varied. Their choice depends on the size and location of the stone, its clinical manifestations and composition. Of no small importance are the age and condition of the patient, the anatomical and functional state of the kidney and urinary tract.
Treatment of patients with kidney stones can be conservative and surgical. As a rule, patients are subjected to complex treatment.
Due to the fact that many questions of the etiology and pathogenesis of kidney stones have not yet been resolved, surgical removal of a kidney stone does not mean a cure for the patient.
Conservative treatment is aimed at eliminating pain and inflammation, preventing relapses and complications of the disease. There are many drugs that promote spontaneous stone passage. In recent years, medications have been introduced into practice to help dissolve stones.
Conservative treatment is indicated mainly in cases where the calculus does not cause a disturbance in the outflow of urine, hydronephrotic transformation or shrinkage of the kidney as a result of the inflammatory process, for example, with small stones in the renal calyces. Conservative therapy is also carried out if there are contraindications to surgical treatment of nephroureterolithiasis.
Conservative therapy consists of restorative measures, dietary nutrition, medications and sanatorium-resort treatment. A rational diet helps restore normal metabolism^ and maintain homeostasis. It is prescribed depending on the type of salt metabolism disorder.
In case of uraturia and the formation of urate stones, it is necessary to limit the intake of foods that contribute to the formation of uric acid (brains, kidneys, liver, meat broths, etc.). For phosphaturia and phosphate stones; urine is alkaline. Such patients need a diet that includes less lime in the diet, which promotes urine oxidation.
Prescribe predominantly meat foods, excluding milk, vegetables, and fruits. In addition to meat, it is recommended to eat fish, lard, flour dishes, and vegetable fats. For oxalate stones, limit the introduction of oxalic acid into the body, exclude lettuce, spinach, sorrel, reduce the consumption of potatoes, carrots, milk, and also in the postoperative period in order to eliminate complications and prevent urolithiasis.
Sanatorium-resort treatment is of no small importance in the complex treatment of patients with urolithiasis. However, to the appointment mineral waters should be treated with caution, as excessive consumption can worsen the course of the disease. Mineral waters increase diuresis, allow you to change the pH of urine, its electrolyte composition and acid-base state - Spa treatment It is advisable to recommend after stone passage or surgical removal with satisfactory renal function and sufficient dynamics of emptying of the pelvis and ureter.
For uric acid diathesis, patients are recommended to resort to alkaline mineral waters (Essentuki No. 4 and 17, Smirnovskaya, Slavyanovskaya, Borzhom). Patients with oxaluria are prescribed low-mineralized waters (Essentuki No. 20, Naftusya, Sairme). For phosphaturia, it is advisable to use mineral waters that promote the oxidation of urine (dolomite narzan, naftusya, arzni).
Drug treatment of patients with kidney stones is aimed at activating urodynamics for small stones in the pelvis or ureter in order to achieve their spontaneous passage, to fight infection and dissolve stones. In the presence of stones that tend to pass on their own, drugs from the terpene group (cystenate, artemizole, enatin, Avisan, etc.) are used, which have bacteriostatic, antispasmodic and sedative effects.
In recent years, various drugs that help dissolve stones have been increasingly used. When treating patients with urate stones with these drugs, a decrease and, in some cases, complete dissolution of the stones was noted.
A special place in the treatment of nephroureterolithiasis is occupied by measures to relieve renal colic. It is advisable to start them with thermal procedures (heating pad, hot bath) in combination with injections of painkillers and antispasmodics (5 ml of baralgin intramuscularly or intravenously, 0.1% solution of atropine 1 ml with 1 ml of 1-2% solution of omnopon or promedol subcutaneously, 0.2% solution of platyphylline 1 ml subcutaneously or 0.005 g, spasmolitin 0.1-0.2 g or papaverine 0.02 g 3-4 times a day orally). If there is a stone in the lower part of the ureter, it is often possible to replicate an attack of renal colic by administering 40-60 ml of a 0.5% novocaine solution
in the area of the spermatic cord in men or the round uterine ligament in women (Lorin-Epstein block).
An intrapelvic novocaine blockade according to Shkolnikov can give a similar effect. A thin long needle is injected 2 cm inward and above the spina iliacae anterior superior perpendicular to the skin until its tip reaches the medial surface of the ilium. Then the needle is withdrawn a little and, retracting its outer end to the lateral side, slowly move the needle tip further along the bone until it hits the bone. The needle is removed again by 0.5 cm and a similar manipulation is performed, and so on several times, until the needle is in the retrocecal region behind the iliac muscle at a depth of 8-10 cm. The solution should be injected not behind the muscle, but in front of it, so the needle is removed 0.5 cm and again injected 1.5-2 cm, but not into the bone, but into soft tissue. The needle is fixed and 40-60 ml of 0.5% novocaine solution is injected through it.
An important role in the treatment of patients with nephroureterolithiasis belongs to medications that are used to combat urinary infections. They are prescribed taking into account the results of urine culture and the sensitivity of its microflora to antibiotics and other antibacterial drugs.
Surgical treatment is the leading method of removing stones from the urinary tract. Removing the stone does not relieve the patient from urolithiasis, but at the same time prevents the destruction of the renal parenchyma. In this regard, certain indications have been developed for surgical treatment. Surgery is necessary if the stone causes pain that deprives the patient of his ability to work, or if the outflow of urine is impaired, leading to a decrease in kidney function and hydronephrotic transformation; during attacks of acute pyelonephritis or progressive chronic pyelonephritis; with hematuria.
Kidney surgeries in patients with nephrolithiasis can be organ-sapping (nephrectomy) and organ-preserving (pyelolithotomy, nephrolithotomy, kidney resection). Before the operation, the presence of a second kidney and its functional capacity should be determined. On the day of surgery, it is necessary to take a control survey image in two to three projections, since stones often change their location. It is most advisable to take a control photograph immediately before surgery on the operating table after placing the patient in the position for kidney surgery (lateral position on a bolster with the head and foot ends of the table lowered).
The main stages of preoperative preparation are active treatment of pyelonephritis, and in the presence of renal failure - detoxification therapy.
Advances in the field of surgery and anesthesiology have made it possible to widely use organ-conserving operations. Stones can be removed through an incision in the pelvis (pyelolithotomy), the wall of the calyx (calicolithotomy) and the renal parenchyma (nephrolithotomy). Operative approaches to the kidney in children are the same as in adult patients.
Pyelolithotomy has become the most widespread. Depending on which wall of the pelvis is dissected, pyelolithotomy can be anterior, lower, posterior and upper.
Most often, posterior pyelolithotomy is performed, since the main renal vessels pass along the anterior surface of the pelvis.
The size and location of kidney stones are extremely varied. Each stone requires an individual approach, and not all stones can be removed by pyelolithotomy and calicolithotomy. Stones located deep in the renal calyces and in the intrarenal pelvis can in some cases be removed by nephrolithotomy. In the presence of large coral-shaped stones with multiple processes in the calyces and thinned parenchyma, a “sectional” incision of the kidney is made. In children, preference is given to the so-called anatrophic incision, i.e., an incision made in the less pronounced vascular zone of the parenchyma, which allows the complete removal of multiple and coral stones.
Stones in the ureter treatment
Treatment of patients with stones in the ureter can be conservative, instrumental and surgical.
Conservative treatment is indicated for the presence of stones in the ureter that do not cause severe pain, do not significantly impair the outflow of urine, do not lead to hydroureteronephrosis and tend to pass spontaneously.
In 75-80% of cases, stones from the ureter pass away on their own after conservative measures. Treatment is aimed at strengthening the motility of the ureter and eliminating its spastic contractions. They recommend water loads, an active regimen, ingestion of antispasmodics, and for renal colic - the measures described above.
For instrumental treatment - removal of stones from the ureter, many instruments have been proposed - extractors, of which the most popular are the Zeiss loop and the Dormia basket.
A Zeiss loop is a ureteral catheter, in the lumen of which a nylon thread is passed, exiting the end of the catheter and re-entering its lumen through a hole made at a distance of 2-3 cm from the end of the catheter. When the thread is pulled, the tip of the catheter bends and forms a loop. Instrumental methods for removing stones from the ureter in children are performed when they are small in size - 0.5-0.6 cm in diameter, most often over the age of 7 years.
The Dormia extractor is a ureteral catheter, in the lumen of which there is a metal rod ending in a retractable basket, which expands when removed from the catheter, and contracts when inserted back.
Before the manipulation, a survey photograph is taken to determine the location of the stone. After administering antispasmodics to the patient, a catheterization cystoscope is inserted into the bladder. The extractor is carried above the stone, grabbed and carefully lowered.
Since 1980, in clinical practice, both in children and adults, a method of treating patients with urolithiasis has been used, which allows the destruction of stones in the urinary tract without any instrumental intervention at all - external lithotripsy. Short bursts of energy generated outside the body in the form of shock waves are focused on the stone. The pressure in the focal zone reaches 160 mPa (1600 bar), which leads to the destruction of the stone. Currently created devices for external lithotripsy use three basic principles for generating shock waves:
1) electrohydraulic, in which a short-term interelectrode discharge leads to the evaporation of a certain volume of water and a local increase in pressure. Since the electric discharger is placed in the first focus of a bronze ellipsoidal mirror, the propagating shock waves are collected in the zone of the second focus of the ellipse, which is combined with the stone;
2) electromagnetic - an alternating current is passed through the coil, which causes an alternating magnetic field to appear around it. Under the influence of this field, the membrane begins to vibrate and generate a shock wave, which the lens focuses on the stone;
3) piezoelectric - part of the sphere is covered with a large number of piezoceramic crystals (4-5 thousand). All crystals are simultaneously supplied with high voltage alternating current, which causes a synchronous change in their shape. The pressure fluctuations that occur near each crystal are summed up at the focus of the sphere on the stone.
Targeting a high-pressure zone (focus) on a calculus is carried out using an electron-optical converter of an X-ray machine or using ultrasonic scanning. Since the shock wave penetrates the soft tissues while not yet focused, the specific energy density is low and its entry into the patient’s body is slightly painful. On modern devices, remote lithotripsy is performed after intravenous or intramuscular administration of narcotic anesthetics, after local anesthesia, and often without any anesthesia at all.
Once a stone in the kidney or ureter is crushed, the problem of removing the fragments arises. If the size of the fragments is small enough and their number is small, then their removal occurs without complications. To speed up the passage of fragments, patients are recommended to drink plenty of fluids, active movements, and are prescribed stimulation of the upper urinary tract (drug-induced sound vibration therapy), etc. In cases where stone fragments do not pass out on their own and lead to occlusion of the ureter, it is necessary to resort to catheterization of the ureter, endoscopic ureterolithoextraction, percutaneous puncture nephrostomy.
For large stones, as well as staghorn stones, when it is known that there will be a lot of stone fragments, the kidney is drained ventively by percutaneous puncture nephrostomy or by installing an intravenous catheter “stent”. After completing the course of crushing and eliminating fragments, the drainage is removed. In the presence of large stones or staghorn stones, the combined use of endoscopic percutaneous puncture nephrolithotripsy and subsequent extracorporeal lithotripsy of unremoved fragments is possible and justified.
It has now become obvious that surgical methods of treating patients with urolithiasis should be used extremely limitedly - in cases where, in addition to stone removal, surgical correction of urodynamic disorders of the upper urinary tract is necessary and feasible, in acute destructive pyelonephritis, for nephrectomy.
The possibilities for non-operative removal of stones in case of urolithiasis are higher, and the number of their complications is lower, the earlier such treatment is undertaken. It is necessary to identify small stones in the kidney and destroy them using the method of external lithotripsy. An increase in the size of stones, as well as their migration into the ureter, in many cases make it necessary to use endoscopic manipulations, and this increases the risk of complications. In this regard, clinical examination of the population and ultrasound examination of the kidneys during its implementation are of particular importance. Prevention and metaphylaxis (prevention of relapse) of urolithiasis is based on the treatment of metabolic disorders leading to stone formation, timely treatment chronic pyelonephritis and restoration of impaired urine passage.
Diet therapy comes down to limiting the total amount of food consumed, fats, table salt. It is advisable to completely exclude broths, chocolate, coffee, cocoa, fried and spicy foods. With normal glomerular filtration, it is recommended to take at least 1.5 liters of fluid per day.
Treatment of hyperuricemia must be carried out by suppressing the formation of uric acid in the body through enzymatic inhibitors (milurite, allopurinol). Reducing the level of uric acid in the blood can be achieved by using uricuretics (butadione). In all cases, it is advisable to maintain urine pH at the level of 6.2-6.8 using citrate mixtures (magurlit, blemoren, etc.) and sodium bicarbonate (baking soda).
The main method used to reduce oxaluria is oral administration of magnesium oxide or magnesium and pyridoxine salts, which reduce the formation of oxalic acid and increase the solubility of calcium oxalate. When treating hypercalciuria, it is often sufficient to limit the intake of calcium into the body by eliminating dairy products.
Among medications, hypothiazide is recommended at a dose of 0.015-0.025 g 2 times a day. When treating with hypothiazide, it is necessary to increase the potassium content in the diet. Prescribe 200 g of dried fruits (dried apricots, raisins) or potassium chloride 2 g per day. Treatment must be carried out under strict control of the electrolyte composition of the blood. Reduction of hypercalcemia in primary hyperparathyroidism is achieved by using thyrocalcitonin.
Forecast. With conservative treatment of nephrolithiasis, the prognosis is usually unfavorable. The kidney stone gradually increases in size, creating conditions for disruption of the outflow of urine, the occurrence and progression of pyelonephritis. With timely surgical treatment, the prognosis is favorable, but relapse of stone formation always poses a certain threat, since nephrolithiasis is a disease not only of the kidney, but of the entire body, and removal of a stone does not mean elimination of the disease. In children, relapse of stone formation is recorded in 3-10% of cases; in adults it reaches 11 - 28.5%.
To prevent recurrent stone formation, it is recommended to carry out the complex treatment described above (anti-inflammatory, dietary, etc.). In cases where, with a good passage of urine, it is possible to eliminate metabolic disorders, the inflammatory process in the kidney, and maintain the urine pH at the required level, a relapse does not occur for many years. Active pyelonephritis, supported by resistant microorganisms (Proteus, Pseudomonas aeruginosa), impaired outflow of urine, hypothermia, gastrointestinal, gynecological and some other diseases quickly lead to relapse of stone formation in the operated kidney. Patients require long-term follow-up.
Bilateral kidney stones. The pathology occurs in 15-20% of patients with nephrolithiasis and differs from unilateral lesions in a faster and more severe clinical course, as they are more often and earlier complicated by renal failure.
Indications for surgical treatment for bilateral kidney stones are the same as for unilateral nephrolithiasis. The operation can be performed in one or two stages. In recent years, surgical intervention has been increasingly used, since stone removal gives more favorable results than conservative treatment. The question of the advisability of immediate stone removal is always decided individually. It can be performed in children and young people, with the general good condition of the patient, satisfactory renal function and easily accessible location of the stones. In case of anuria caused by a violation of the outflow of urine from both kidneys, it is advisable to begin the operation on the kidney, the blockage of which occurred later and which, therefore, is more preserved.
In a two-stage operation, it is advisable to first remove stones from the kidney that worries the patient more, in which the outflow of urine is more impaired, and pyelonephritis progresses. With a single stone in the pelvis on one side and multiple stones on the other, and with satisfactory function of both kidneys, it is better to start the operation with pyelolithotomy for a single stone. Simultaneous removal of bilateral staghorn and multiple kidney stones is technically very difficult, so it is rarely performed. In such patients, surgical treatment is often carried out in two stages, the interval between which should not exceed 2-3 months. Nephrectomy for bilateral kidney stones is performed in extremely rare cases, according to vital indications, for example, in case of profuse, life-threatening bleeding from the kidney.
Single kidney stones. The disease poses a danger to the patient's life. Severe complication is anuria, which, with a single kidney, is usually of an excretory nature.
Diagnosis is made based on medical history and X-ray results. In most patients, it is possible to find out that stones have passed in the past and that the contralateral kidney has been removed due to urolithiasis. Anuria is usually preceded by renal colic. When examining patients, they are limited to only a survey image, in which a shadow of a calculus can be detected in the projection of the kidney or ureter.
Excretory urography is not performed, since the radiopaque substance is not excreted by the kidney. Treatment should begin with catheterization of the kidney in order to install the ureteral catheter above the stone. This allows you to restore the outflow of urine, improve the general condition of the patient and, after further examination, decide on further treatment tactics. If catheterization of the ureter fails, emergency surgery is indicated - pyelolithotomy, ureterolithotomy, kidney drainage. If the patient arrives in a state of uremia and conservative measures do not lead to the desired results, it is advisable to use hemodialysis as a preoperative preparation. In most patients with a stone in a single kidney, surgical removal is necessary.
Bladder stones
This is a relatively common disease that occurs in males in childhood and old age. Stones either migrate into the bladder from the kidney, or are formed in it itself. The formation of stones in the bladder or the retention and growth of stones descended from the kidney is facilitated by factors that cause difficulty in the outflow of urine. These include adenoma and cancer prostate gland, stricture urethra, diverticulum, tumor, trauma and foreign bodies bladder, neurogenic bladder dysfunction. In children, the development of bladder stones is often caused by phimosis, balanoposthitis, narrowing of the external opening or the urethral valve. Often the cause of the development of bladder stones in children is foreign bodies in the bladder, its diverticulum, etc. Bladder stones have different shapes, sizes and weights, and can be single or multiple. The chemical composition, consistency and color are the same as kidney stones.
Bladder stones symptoms
Pain in the bladder at rest is mild, but it intensifies with urination and movement. The pain radiates to the head of the penis, perineum, testicle. Urination becomes more frequent when moving, walking, or jolting, but remains normal at rest, so bladder stones are characterized by an increased urge to urinate during the day, but not at night. The addition of infection leads to the development of cystitis, which causes severe dysuria. During urination, a symptom of interruption (“backing up”) of the stream is often observed, which is restored when the body position changes. There may also be a complete disruption of the outflow of urine as a result of wedging of a stone into the urethra. Some patients can only urinate while lying down. Urinary incontinence occurs when a stone enters the neck of the bladder, which makes it impossible to close the internal sphincter. With urgency, patients complain of urinary incontinence. Hematuria or erythrocyturia occurs as a result of injury to the mucous membrane of the bladder and the inflammatory process. Stone entrapment at the bladder neck sometimes leads to terminal hematuria. Stone damage to dilated venous vessels in the area of the bladder neck in prostate adenoma causes profuse total hematuria. With concomitant cystitis, in addition to erythrocytes, a large number of leukocytes are found in the urine. Cystitis in the presence of a stone in the bladder can be complicated by pyelonephritis.
Diagnosis. Diagnosing bladder stones is not particularly difficult. Its main methods are cystoscopy and x-ray examination. Cystoscopy allows you to determine the capacity of the bladder, the condition of its mucous membrane, the number of stones, their size and type. It is impossible to perform cystoscopy in a patient with a small bladder capacity due to severe cystitis or with a stricture of the urethra. In these cases, the leading method for diagnosing bladder stones is X-ray examination. The plain radiograph clearly shows the shadows of stones located in the pelvis, in the projection of the bladder.
Differential diagnosis.
Important differential diagnostic signs of a bladder stone are an intermittent stream of urine, a symptom of urine “blocking”, increased hematuria, and dysuric pain in the bladder area when moving.
X-ray and endoscopic examination methods provide final clarity to the diagnosis.
Bladder stones treatment
There are two main methods of treating patients with bladder stones: stone crushing (lithotripsy) and stone cutting (lithotomy). Stone crushing is the method of choice; it is performed with special instruments - a lithotripter or a lithotripter cystoscope. Stone crushing is carried out after injecting the patient with 1 ml of 1% morphine or 2% omnopon or under shallow anesthesia. The patient lies on his back in the cystoscopy position. The bladder is filled with 250 ml of sterile furatsilin solution. The stone crusher is inserted into the bladder in a closed form. The expansion of its jaws is carried out according to the size of the stone, which, under the influence of gravity, rolls into the recess of the lithotripter. The screw lever is lowered downwards, the stone is fixed and crushed. After stone crushing, the bladder is washed, evacuating stone fragments, and a permanent catheter is left in place.
Contraindications to stone crushing are strictures of the urethra, acute cystitis, paracystitis, small bladder capacity, fixed stones, prostate adenoma. If the patient’s condition allows, then for prostate adenoma it is advisable to combine cystolithotomy with adenomectomy.
In cases where stone crushing is contraindicated, as well as in young children, stone sectioning is performed - a high suprapubic section of the bladder.
Relapses of stone formation are rare if the cause that interferes with bladder emptying is eliminated. Prevention of the formation of bladder stones is based on the treatment of inflammatory processes and the elimination of factors that disrupt the outflow of urine. Testing of drugs aimed at dissolving stones continues.
Forecast. For bladder stones, the prognosis depends mainly on the nature of the disease that disrupts the outflow of urine from the bladder and the underlying stone formation (urethral stricture, prostate tumors, etc.). If this disease is eliminated, the prognosis is favorable; otherwise, recurrence of stone formation in the bladder is most likely.
Urethral stones
Primary urethral stones form behind strictures, fistulas, and in urethral diverticula (mainly in men). Secondary stones descend from the upper urinary tract and become lodged in the urethra. The shape and number of stones vary. More often, the shape of the stones corresponds to the part of the channel in which they are located.
Symptoms and clinical course. Urethral stone causes pain when urinating, difficulty urinating, weakening of the urine stream and changes in its shape. When a stone completely obstructs the lumen of the urethra, acute urinary retention occurs. The prolonged course of the disease causes urethritis, paraurethritis, prostatitis, the formation of bedsores and urethral fistulas.
Diagnosis. Diagnosis of urethral stones does not cause difficulties, since stones are often identified by palpation not only in the hanging part of the canal, but also in its posterior sections (during rectal examination). A urethral stone can also be identified using a metal bougie, which encounters an obstacle in the urethra, causing a sensation of friction against the stone. A more accurate idea of the location and size of the stone can be obtained from a plain radiograph or urethrogram.
Differential diagnosis. The clinical picture in the presence of a stone in the urethra may be similar to signs of other diseases that interfere with the outflow of urine from the bladder (urethral stricture, prostate adenoma). X-ray and instrumental examination of the urethra can make the correct diagnosis.
Urethral stones treatment
Stones in the anterior urethra are removed with special urethral forceps. The stone can be removed from the scaphoid fossa with tweezers; if the external opening of the urethra is narrow, it is dissected (meatotomy). If it is not possible to remove a stone from the posterior part of the urethra, you can try to push the stone from it into the bladder and then crush the stone.
If instrumental manipulations are unsuccessful, stones located in the hanging or bulbous part of the urethra are removed by urethrotomy. Surgical removal of stones from the posterior urethra is best done from the bladder.
Forecast. Provided that the stone is urgently removed from the urethra in one way or another, the prognosis is favorable.
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Consultation on treatment using traditional oriental medicine methods (acupressure, manual therapy, acupuncture, herbal medicine, Taoist psychotherapy and other non-drug treatment methods) is carried out in the Central district of St. Petersburg (7-10 minutes walk from the Vladimirskaya/Dostoevskaya metro station), With 9.00 to 21.00, no lunches and weekends.
It has long been known that best effect in the treatment of diseases is achieved through the combined use of “Western” and “Eastern” approaches. Treatment time is significantly reduced, the likelihood of disease relapse is reduced. Since the “eastern” approach, in addition to techniques aimed at treating the underlying disease, pays great attention to the “cleansing” of blood, lymph, blood vessels, digestive tracts, thoughts, etc. - often this is even a necessary condition.
The consultation is free and does not oblige you to anything. on her all data from your laboratory and instrumental methods research over the last 3-5 years. By spending just 30-40 minutes of your time you will learn about alternative treatment methods, learn How can you increase the effectiveness of already prescribed therapy?, and, most importantly, about how you can fight the disease yourself. You may be surprised how logically everything will be structured, and understanding the essence and reasons - the first step to successfully solving the problem!
Therapeutic diet No. 6 is prescribed for diagnoses: urolithiasis with the formation of stones from uric acid salts, gout. Diets No. 7 are followed for acute pyelonephritis and chronic nephritis without renal failure.
The basic principle of nutrition for these diseases is the exclusion of spicy seasonings, fried foods and legumes from the menu, limiting foods with a high content of plant proteins: all types of cereals, flour and baked goods. The amount of salt is up to 3-6 g per day.
It is recommended to drink at least 2 liters of water per day in order to ensure intensive cleansing of the kidneys and the entire body from toxins. Preferred are weak green tea, rosehip decoction, lingonberry and cranberry mousses and fruit drinks, infusions of medicinal herbs used to cleanse the kidneys.
Urolithiasis - causes.
Stones in the kidneys, bladder and ureters can form if you are predisposed to this disease: if your diet is dominated by spicy and sour foods, with diseases of the skeletal system: osteoporosis or osteomyelitis, with a deficiency in the body essential vitamins and minerals, for chronic diseases of the gastrointestinal tract: gastritis, peptic ulcer, enterocolitis. Water containing a large amount of impurities and untreated can also cause the formation of stones.
Everything in the body is interconnected, therefore chronic diseases genitourinary system: pyelonephritis, cystitis, prostate adenoma and prostatitis, also lead to impaired kidney function and the development of urolithiasis and gout.
Gout - symptoms and causes.
The main reasons for the development of the disease are genetic predisposition and non-compliance with the basics of a healthy and balanced diet. The intensive development of the disease can be provoked by alcohol consumption and smoking, a menu consisting of fried and fatty foods, preference instead of healthy food and regular meals, fast food, Coca-Cola and other sweet carbonated drinks.
Other causes may include: excess weight, uncontrolled use of medications: diuretics and aspirin, cardiac ischemia, hypertension, skin diseases: psoriasis, eczema.
With gout, small joints of the extremities are affected: legs and hands, as well as elbows and knees - all those areas of the body where greatest number nerve endings. This occurs due to the deposition of uric acid salts, which form tiny crystals.
Symptoms of the disease are sharp pain in the joint, redness and swelling. Attacks of the disease can recur only 1-2 times a year, beginning with symptoms of tingling in the joint and local fever.
If the first symptoms are ignored and treatment is not started in a timely manner, the disease progresses: attacks become more frequent and become more painful, joint deformation begins, their mobility decreases, and bone fragility increases.
If the diet and drinking regime are not followed, uric acid salts begin to accumulate in the body, affecting other joints, worsening the functioning of the kidneys, heart and brain, leading to general intoxication of the body and the appearance of renal failure.
At the first symptoms of gout, it is necessary to take a biochemical blood and urine test, analyze the synovial (intra-articular) fluid, do an ultrasound of the kidneys and an x-ray of the joints
Pyelonephritis – main symptoms.
Pyelonephritis is the most common inflammatory kidney disease caused by pathogenic microorganisms. Women are susceptible to this process more often than men - this is due to the structural features of the genitourinary system and may be one of the manifestations of complications of untreated cystitis. But the source of infection can also be diseases of the respiratory system, gastrointestinal tract, caries, weakened immunity, influenza and other viral diseases.
Symptoms of pyelonephritis: pain in the lower abdomen and lumbar region, fever and chills, profuse sweating, thirst, violation of regular urination. There is general weakness, and sometimes, with intense intoxication of the body, due to disruption of normal kidney function, nausea or even vomiting may occur. The body thus tries to cleanse itself of accumulated toxins.
It is better not to self-medicate - the sooner a final and correct diagnosis is established, the more successful the treatment will be. Therefore, with such symptoms, increase the amount of liquid you drink - warm teas and herbal infusions, drink 2 tablets of no-shpa and one of furadonin, and call an ambulance.
With insufficient treatment, the disease can progress and become chronic form.
What are the dangers of kidney disease?
Of course, when all organs are healthy, our health is safe. But the kidneys are the main cleansing organ of the body and disruption of their normal function can lead to intoxication of the body, swelling under the eyes and legs, arthritis and renal hypertension, diseases of the cardiovascular system, provoke a heart attack or stroke.
Therapeutic diets No. 6 and No. 7 according to Pevzner largely combine the general principles of nutrition.
In your menu you can include:
– bread, preferably bran, as well as salt-free, cookies – lean. You can prepare pancakes or pancakes from yeast dough without salt 1-2 times a week.
– vegetarian borscht, vegetable soups with added cereals, okroshka and beetroot soup, milk soups.
– dairy and lactic acid products: low-fat milk and sour cream, cottage cheese, mild cheese and kefir, yogurt.
– a boiled egg per day.
– buckwheat, oatmeal, rice, millet, pearl barley – in moderate quantities, as a side dish or in the form of porridge, once a day.
– the limited amount of cereals and meat products on the menu can be compensated for by dishes made from vegetables: raw, boiled, stewed. You can prepare salads, vinaigrettes, vegetable caviar. But exclude pickles and marinated ones.
– fresh fruits and sweet berries, dried fruits.
– sweets: honey, candies without chocolate, marshmallows, marmalade.
– from fats: butter and vegetable oils.
Prohibited products:
– hot seasonings and spices – they irritate both the walls of the stomach and the kidneys.
– strong mushroom, meat and fish broths.
– alcohol, alcohol medicinal tinctures.
– strong tea and coffee, cocoa, carbonated drinks, chocolate.
– from vegetables and herbs: radishes, radishes, onions and garlic, cauliflower, sorrel, spinach, celery, hot peppers.
– liver, kidneys, tongue, smoked meats, sausages, canned food, caviar, sharp and salty cheeses,
– all fried and fatty foods, cakes and pastries should also be excluded from your diet.
Meals, as with all diets, are fractional and regular - 5-6 times a day.
Infusions of medicinal herbs for kidney diseases.
Horsetail infusion.
Steam 2 tbsp. l. dry herbs with 0.5 liter of boiling water, wrap and leave for an hour and a half. Strain and take half a glass warm after meals or between meals, 4 times a day.
Infusion of juniper berries against swelling.
A tablespoon of dry or a teaspoon of fresh, steamed juniper berries 0.5 liters. boiling water, leave for 30-40 minutes, strain and drink 0.5 cups 3-4 times a day, regardless of meals.
Herbs for acute pyelonephritis.
Prepare an anti-inflammatory mixture, which includes: rose hips, chamomile, knotweed - 2 tbsp. l., crushed marshmallow root - 1 tbsp. l.
Steam a tablespoon of the collection with boiling water for half an hour, strain and take half a glass half an hour after eating, warm.
Anti-inflammatory and diuretic – currants.
2-3 tbsp. l. dry currant leaves or 3-4 fresh leaves, pour 2 cups of boiling water, strain after 20-30 minutes. When you have fresh currants, mash a tablespoon of berries with a fork and add to the warm infusion.
You can add rose hips.
This infusion also helps remove sand and dissolve stones, and contains vitamin C.
Take half a glass instead of tea or between meals.
Carrot seeds - to remove sand and stones from the kidneys.
Steam 3 tbsp. l. seeds 0.5 liters of boiling water, leave overnight. Strain and take half a glass 30 minutes before meals, 3-4 times a day, always warm.
Anti-inflammatory collection.
Calendula flowers, herb and St. John's wort flowers, strawberry and currant leaves, horsetail are taken equally. For example, 5 tablespoons.
Steam 2 tablespoons of the collection with a liter of boiling water. Leave for 30-40 minutes, strain. Drink half a glass throughout the day, regardless of meals.
Parsley infusion - against swelling.
Parsley, greens and root are strong diuretics. Cut the parsley root into rings and pour boiling water over it along with the herbs overnight. In the morning, strain and take a third of a glass throughout the day.
In order to reduce puffiness under the eyes, you can soak cosmetic discs in this infusion and cool them for 10 minutes in the freezer. Then apply to the eyelids for 10-15 minutes. If you regularly wipe your face with parsley infusion, the skin condition will noticeably improve: slight whitening and nutrition with vitamins and microelements occurs.
A potato mask will help get rid of bags under the eyes. Grate raw potatoes on a fine grater, wrap this mixture in a bandage folded in half, and apply to your eyelids for 10 minutes. You can squeeze out the juice. Since it dries out the skin under the eyes, apply a nourishing cream after this mask. It is better not to use hydrating eyelid creams temporarily until swelling decreases. And after 15 minutes, be sure to blot the nutritious layer with a napkin: an excess layer can interfere with normal moisture exchange.
Take all infusions of medicinal herbs in courses: 10 days, then take a break for 5-6 days, and repeat.
Mineral water as medicine - how to take it correctly
In medicine, pyelonephritis is an inflammatory process that occurs in the calyces and pelvis of the kidneys. This disease often develops from an acute form into a chronic form, which is accompanied by frequent exacerbations. To ensure that such periods occur as rarely as possible, and long-term remission of chronic pyelonephritis occurs, doctors strongly recommend strictly following a specific diet.
Table of contents: Basic principles of nutrition for pyelonephritis What you can’t eat with pyelonephritis What you can eat with pyelonephritis Diet for pyelonephritis in pregnant women What happens if you don’t follow the diet for pyelonephritisBasic principles of nutrition for pyelonephritis
Pyelonephritis: symptoms, treatment, features of the disease in pregnant women and childrenWhy follow a diet at all when there is inflammation of the pyelocaliceal region of the kidneys, what problems does it solve? proper nutrition? Doctors have compiled a number of goals that can be achieved through nutritional correction:
- creating optimal conditions for the functioning of the urinary system, in particular the kidneys;
- reducing the load on organs affected by the inflammatory process;
- reduction and stabilization of blood pressure (against the background of pyelonephritis, its levels are usually elevated);
- reduction of frontal and peripheral edema;
- improving the process of removing toxins, waste, salts and nitrogenous compounds from the body.
- limiting protein foods;
- maintaining the amount of incoming fats and carbohydrates within the physiological norm;
- Dietary food should be fortified.
For pyelonephritis, you need to drink a certain amount of liquid - up to 3 liters per day, and this amount includes first courses, tea, and compotes with fruit drinks.
People diagnosed with pyelonephritis should not only know which foods they can and should eat, but which ones they should avoid. The fact is that it is very important to follow certain rules:
- Dishes on a diet for pyelonephritis can be baked, stewed, boiled and even fried - with the disease in question, only the urinary system is affected, the gastrointestinal tract functions normally. By the way, food does not need to be chopped - even large pieces of food do not increase the load on the kidneys. True, you will need to consult a nutritionist, because when diagnosing organ diseases digestive system the rule of eating dishes of any preparation does not apply.
- You need to eat at least 4 times a day; 5 meals a day will be better for the body. With this regime, the body will constantly have the necessary supply of vitamins and micro-/macroelements, and the kidneys will have time to process the body’s waste products in a normal rhythm.
- It is imperative to limit your salt intake; doctors generally prohibit salting food, and only ready-made dishes can be slightly adjusted to taste. You just need to remember that people with diagnosed pyelonephritis can consume a maximum of 6 grams of table salt per day. This limitation is due to the fact that it is the accumulation of salt in the body (and during the inflammatory process, the kidneys stop completely removing excess sodium ions from the body) that provokes the appearance of peripheral and frontal edema, increases arterial pressure, can cause the formation of stones in the kidneys and ureters.
- The patient needs to give up alcoholic beverages and not just limit their consumption during exacerbations, but forget about them even during long-term remission. The fact is that alcohol simply puts a crazy strain on the kidneys; they begin to work slowly and do not have time to remove toxins from the body. The result of such an attitude towards doctors’ recommendations will be swelling and exacerbation of the inflammatory process.
- The diet for pyelonephritis does not imply any specific temperature regime for food. But, we repeat, this rule applies only if the patient does not have any disturbances in the functioning of the digestive system.
- As part of the diet, patients must consume foods that have an alkalizing effect - vegetables, fruits, milk. This is due to the fact that an acidic environment is considered the most favorable for the development of pathogenic microorganisms, and it is they who provoke the inflammatory process in the renal collecting region.
What not to eat if you have pyelonephritis
Patients with the disease in question need to limit the amount or completely eliminate the consumption of those foods that irritate the kidneys. These include:
What can you eat if you have pyelonephritis?
In fact, for the disease in question, you can eat most of the usual foods. For example, doctors recommend that you include vegetables and fruits, milk and various drinks in your diet. List of foods and dishes allowed for consumption as part of the diet for pyelonephritis:
- any products made from yeast-free dough, but without added salt;
- bread, preferably yesterday's bread and cooked without adding salt;
- soups with milk and vegetable broths;
- “secondary” meat and fish broths from low-fat products;
- any poultry and lean meats, just keep in mind that it is better to boil them before frying and stewing;
- weak black tea, green tea;
- fruit drinks and rosehip decoction;
- jelly from vegetables and fruits;
- zucchini, pumpkin, potatoes;
- any greens, carrots and beets;
- any salads from vegetables - both raw and boiled;
- pasta;
- absolutely all cereals;
- oils – vegetable and unsalted butter;
- any sauces - tomato, sour cream, milk;
- citric acid, vanillin and cinnamon;
- various spices and seasonings (be careful with spicy additives!);
- boiled eggs or steamed omelet;
- milk and all lactic acid products.
Diet for pyelonephritis in pregnant women
If the disease in question is diagnosed in women during pregnancy, then nutritionists develop a slightly different diet for them. It is strongly recommended to include the following products and dishes in the menu of a pregnant woman diagnosed with pyelonephritis:
- boiled chicken without skin;
- whole milk and low-fat cream;
- fermented baked milk and kefir, sour cream and yoghurts with minimum percentage fat content;
- dietary bread without salt;
- unsweetened baked goods;
- steamed omelettes, boiled eggs, but no more than 2 times a week;
- boiled or baked fish (remove skin);
- weak black tea with added milk, fruit drinks, fruit and vegetable jelly;
- zucchini, eggplant, cucumbers, carrots, fresh tomatoes;
- apples, pears, grapes;
- some spices - it is allowed to add cloves, parsley, dill, bay leaf and cinnamon to dishes;
- porridge cooked without adding salt.
If a woman diagnosed with pyelonephritis is pregnant, then she needs to exclude spicy, sour, pickled and salty foods, legumes, mustard, cocoa, pastries, sorrel, radishes and spinach from her diet.
Note: During pregnancy, almost all medications are prohibited for use, so the inflammatory process in the pyelocaliceal section of the kidneys must be “restrained” by diet.
What happens if you don’t follow a diet for pyelonephritis?
Many patients with chronic pyelonephritis, unfortunately, ignore the recommendations of a nutritionist and constantly violate the prescribed diet. No, during periods of exacerbation of the inflammatory process, even the most carefree patients remember the need to exclude provoking foods from the menu, but as soon as the disease enters the remission stage and all pronounced symptoms disappear, they allow themselves to relax. It is unlikely that they realize the seriousness of pyelonephritis, because even with a simple violation of the diet, the following complications can arise:
- the inflammatory process begins not only to progress, but also to spread to the tissues surrounding the kidney - this condition is called paranephritis;
- with a probability of up to 87%, stones will begin to form in the patient’s kidneys - pyelonephritis and urolithiasis in tandem pose a threat to human life;
- if, with chronic pyelonephritis, periods of exacerbation of the pathology are recorded too often, then doctors begin to place a high level of risk of developing a carbuncle or abscess in the kidneys - literally purulent melting of the kidney occurs;
- the kidneys work not just with disturbances, but in an unacceptable mode, which as a result can lead to renal failure - a condition requiring immediate medical attention, possibly surgical intervention and removal of the affected organ;
- with a constant violation of the diet, toxins accumulate in the body, which can “result” in bacteriotoxic shock - only specialists can remove the patient from it.
Treatment of pyelonephritis that occurs in a chronic form is always long-term; doctors say that a complete recovery is impossible, but the probability of long-term remission of the pathology is very high. In order for the inflammatory process in the pyelocaliceal section of the kidneys to stop its development, it is necessary not only to follow all the prescriptions of the attending physician, to undergo courses of physiotherapy and sanatorium-resort treatment - it is very important to follow the diet and diet.
Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.
In the treatment of pyelonephritis, in addition to medications, properly adjusted nutrition is of great importance.
Diet for the inflammatory process in the kidneys (pyelonephritis) is a mandatory component of treatment, it alleviates the patient’s condition and leads to a speedy recovery.
It should be noted that different forms of pyelonephritis require different nutrition. The diet for chronic inflammatory process in the kidneys will differ from the diet for the acute form of the disease. The diets of adults and children suffering from pyelonephritis will also differ.
What is pyelonephritis
Pyelonephritis is the most common kidney disease, which is characterized by the presence of an inflammatory process in the renal pelvis, calyces or parenchyma.
Reason pyelonephritis is an infection of kidney tissue with Escherichia coli, staphylococci or other bacterial microflora.
Most often, the inflammatory process is secondary in nature - the infection penetrates the kidneys through the bloodstream from other organs. Less commonly, the infection comes from the urinary tract and is a consequence of cystitis and urethritis.
Pyelonephritis happens sharp or chronic. In the acute form, inflammation is accompanied by fever, headache, vomiting and other symptoms of intoxication of the body. Acute pyelonephritis can be accompanied by suppuration and changes in the shape of the kidney: the disease requires mandatory treatment in a hospital.
Sometimes surgery is required to treat pyelonephritis.
Chronic pyelonephritis can only bother a person with periodic aching pain and high blood pressure However, from time to time, sluggish pyelonephritis enters the acute stage.
Before prescribing diet and treatment, special attention should be paid to
signs of kidney disease
To make a correct diagnosis.
Half-fallen is very effective means in the fight against kidney diseases. Read more about the beneficial properties of this herbal medicine here.
General objectives of the diet for kidney pyelonephritis
Nutrition for any form of pyelonephritis is intended to fulfill the following therapeutic tasks:
- Increase urine flow;
- Increase the amount of alkalizing foods in the diet;
- Reduce the amount of fats and proteins consumed;
- Reduce the amount of salt consumed;
- Increase the amount of fluid consumed daily.
Fasting for any kidney disease is not an appropriate method of therapy. If you have pyelonephritis, you should eat regularly - at least four times a day.
Diet for acute pyelonephritis
Acute pyelonephritis requires fairly strict nutritional rules, the purpose of which is to reduce pain. Correcting the pH of urine helps achieve a therapeutic effect.
In acute pyelonephritis, a diet is prescribed that causes urine to become alkaline. The volume of fluid consumed is of great importance - to avoid intoxication it must be increased.
At the initial stage of the disease, when the patient has a fever and pain, it is recommended to drink more than two liters of fluid per day. These can be compotes, natural juices and herbal decoctions.
For the treatment of kidney diseases, our readers successfully use Galina Savina's method.
The liquid provides constant rinsing of the urinary tract and gradual normalization of the acid-base level of urine. However, if there are disturbances in the outflow of urine, the amount of fluid should be limited, and the patient should be warned about this by the attending physician.
If, in addition to pyelonephritis, the patient has persistent hypertension (increased blood pressure), then the amount of salt should be reduced to 2 g per day.
For particularly complex forms of pyelonephritis, doctors advise completely eliminating salt from the menu.
Your daily diet must include fruits and vegetables that have a diuretic effect - watermelons, melons, cucumbers, zucchini.
However, if uremia (urinary bleeding) develops against the background of pyelonephritis, foods of plant origin should be limited, while increasing the consumption of foods containing glucose.
Eliminate completely The following products are required from the menu:
- Meat and fish broths;
- Beans, beans;
- Smoked meats;
- Mushrooms;
- Marinades and pickles;
- Canned food;
- Herbs and spices;
- Carbonated drinks;
- Alcohol.
In addition to fruits and vegetables, it is allowed to consume milk and fermented milk products, eggs. At the recovery stage, you can gradually add lean meat to the menu - beef, veal, fish.
The first dishes for acute pyelonephritis should be consumed only vegetarian. Flour products (dietary bread without salt) and cereal porridge in moderate quantities are also allowed. Butter is allowed to be consumed in moderation (30 g per day).
For the prevention of diseases and treatment of the kidneys and urinary system, our readers advise
Monastery tea of Father George
It consists of 16 of the most beneficial medicinal herbs, which are extremely effective in cleansing the kidneys, in the treatment of kidney diseases, urinary tract diseases, and in cleansing the body as a whole.
Doctors' opinion..."
Meals should be fractional. When preparing dishes, only gentle methods are used - food can be boiled, steamed or simmered over low heat.
Diet for chronic pyelonephritis
In chronic pyelonephritis, the principles of nutrition are similar to the diet in the acute form of the disease. The same products should be excluded. The list of permitted dishes and products includes:
- Fish, poultry and lean meat (preferably minced or boiled);
- Milk soups;
- Vegetarian soups (vegetable and fruit);
- Gray or white bread - preferably day-old and salt-free;
- Eggs (no more than one per day);
- Pasta;
- Cereal porridge;
- Berries, fruits, especially rich in iron - strawberries, pomegranate, apples;
- Melons;
- Honey, jam;
- Sweets.
Dried herbs, lemon juice or cinnamon can be used as seasonings instead of salt. All products must be well chopped or boiled until soft: this is especially true for meat. Well-boiled meat contains practically no extractive substances that are harmful for pyelonephritis.
Features of the diet for pyelonephritis in children and pregnant women
First of all, extractive substances should be excluded from the diet of children with pyelonephritis: when released through the kidney tubules damaged by the disease, these compounds irritate them, preventing recovery.
Such substances are found in abundance in meat, mushroom and fish broths, fried foods, onions, garlic, spices, smoked meats, mustard, horseradish, spicy dishes and cocoa. Children should follow a dairy diet. The diet must include eggs, cheese and cottage cheese.
Pregnant women should definitely monitor their bowel function to avoid constipation - as they contribute to the exacerbation of the disease. Subject to all other above-mentioned nutritional rules, the diet of pregnant women should include products to relax the intestines - prunes, beets and various decoctions (from buckthorn or Alexandria leaf).
Sample diet menu No. 7 for pyelonephritis
An example of a rational menu for kidney inflammation:
- Breakfast- apple and carrot salad, semolina, weak tea;
- Lunch- a glass of fresh fruit juice;
- Dinner - vegetable soup, steamed meat with boiled rice, jelly;
- Dinner- curd baba, applesauce, tea;
- Before bedtime- a glass of kefir.
The diet (or table No. 7) for pyelonephritis should be agreed with the attending physician. To prevent inflammatory processes in the kidneys, you should promptly and fully treat any infectious diseases, and also eat only natural and healthy foods.
Video: How to treat pyelonephritis
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The most effective way to combat kidney disease will be not only drug treatment, but also a diet for pyelonephritis. An integrated approach to eliminating the symptoms of this disease is a prerequisite for a positive outcome.
A little general information The etiology of pyelonephritis, as a rule, is bacteriological in nature, as well as with cystitis. It is bacteria that cause the inflammatory process that occurs in the kidneys. Infection through the ascending route (from the urethra, bladder or genital organs to the kidneys) enters the human body and leads to impaired kidney function.
With pyelonephritis, damage occurs to the interstitial tissue of the kidneys and the pyelocaliceal system. As a result, the normal functioning of the kidneys in general, as well as the filtration and removal of substances from the body in particular, are disrupted. Patients accumulate “extra ions,” which causes swelling and urolithiasis.
External manifestations are a swollen face, frequent “trips” to the toilet.
Symptoms of the disease with pyelonephritis may be similar to those with cystitis.
Cystitis that is not treated in time can lead to infection spreading from the bladder area to the kidneys. With cystitis, the color of urine may change (darkening) and the presence of blood in it.
The described symptoms of cystitis and pyelonephritis are insufficient to make an accurate diagnosis. It is imperative to undergo tests that will help the doctor not only in determining the disease, but also in prescribing a set of treatment measures.
Acute stage
Pyelonephritis can be acute with a sudden sharp rise in body temperature.
This form is characterized by:
- headache;
- chills;
- nausea;
- heavy sweating;
- vomiting is possible.
The pain is severe and concentrated in the lumbar region.
Chronic
In chronic pyelonephritis, there is a periodic alternation between a state of remission and a stage when the disease worsens.
At chronic course disease is observed:
- general malaise, weakness;
- dull lumbar pain;
- low-grade fever;
- urinary disorders.
The acute period of the disease, with illiterate treatment or non-compliance with nutritional recommendations, very often passes into the chronic stage.
In chronic pyelonephritis, the manifestations are slightly smoothed out and are not always easy to recognize.
Regardless of the form in which pyelonephritis occurs, there are a number of principles, adherence to which is simply necessary to obtain a positive treatment result.
Firstly, you need to try to reduce the load on the kidneys as much as possible and thereby try to normalize their work.
Secondly, by changing your diet, try to shift the urine reaction to the alkaline side. This will help reduce the number of pathogens.
Thirdly, it is necessary to include in your daily menu foods with a minimum content of sodium, phosphorus, proteins and fats. Preference should be given to fortified products, because The body, weakened by the disease, needs strength to overcome the infection.
The table recommended for patients with pyelonephritis is No. 7, the main characteristic of which is a slight decrease in the amount of protein foods while maintaining normal carbohydrates and fats and increasing the consumption of foods with vitamins.
There are no restrictions on calorie content or methods of cooking. You can boil, bake, fry food (without fanaticism).
Cranberry juice is very useful because... it has several beneficial properties at once: it is a diuretic, gets rid of germs, relieves inflammation, and saturates the body with vitamins.
How to eat properly with pyelonephritis
For patients with pyelonephritis, the following can be advised:
- If swelling is not observed, then you need to consume a lot of fluids (to remove toxins and reduce the concentration of urine).
- Salted, pickled, canned food should be strictly prohibited.
- Limited dosage of dishes with seasonings, smoked meats, and spices. Horseradish, mustard, garlic
should not be present on the table or in food. - With extreme caution, include in your diet foods that increase the level of uric acid in the blood (fish, meat, seafood, legumes, mushrooms, sorrel, cauliflower, celery).
- Eliminate strong tea, coffee, and alcoholic drinks from your menu.
- To reduce the amount of glucose in the body, take strict control over the consumption of sweets, flour, and pasta.
- Buckwheat and oatmeal should become permanent components of the daily diet.
- Berries, vegetables, and fruits can be consumed in large quantities to replenish vitamin reserves, cobalt and iron.
Features of children's nutrition
Children suffering from pyelonephritis practically do not feel deprived in terms of nutrition. The diet for pyelonephritis in children is based on a large amount of dairy products, and they, as you know, are the main component of children’s food.
Phosphorus, calcium, and proteins contained in dairy products are necessary for a young, growing body. A child with pyelonephritis will receive everything he needs for growth and full development.
Another advantage of consuming dairy products is the normalization of the activity of intestinal microflora. This is very important when treating with medications, because... many of them lead to dysbiosis.
What to eat for pregnant women
The diet for pyelonephritis in pregnant women should be structured in such a way that neither the woman nor unborn child were not injured. Proper and nutritious nutrition is simply necessary for both.
A competent specialist will help you create a menu that will simultaneously treat a pregnant woman and provide everything necessary for the development of the fetus.
A pregnant woman needs to start changing her diet even with cystitis, such a common female disease.
Diet during exacerbation
Vegetables in all their forms (baked, stewed, in the form of juices, purees) should become the basis of food for patients facing exacerbation of pyelonephritis. Gradually, in small portions, fruits can be introduced into the diet.
If the patient’s position has stabilized somewhat, then eggs and milk can be added. It is better to give preference to fermented milk products, because... They are useful for increasing immunity and helping the body that has lost strength.
Patients should drink up to two liters of fluid per day if they do not have edema. Decoctions of herbs with a diuretic effect (for cystitis) and foods that help increase urine output (zucchini, watermelons, melons) are very useful. You can include natural juices, weak tea without sugar, compotes and fruit drinks from various fruits and berries in the menu.
What to eat for the chronic form
The diet for pyelonephritis in adults in the absence of exacerbation should not contain prohibited foods in abundance (see general recommendations).
The entire diet should be subordinated to one goal - to prevent exacerbation of the disease. It is good if the food is boiled or steamed.
Fractional nutrition in small portions will be an additional advantage during treatment for chronic pyelonephritis.
It is better not to start the process of treatment (including nutrition) of the acute stage of pyelonephritis, so that the disease does not become chronic. As a preventative measure (for cystitis, acute form of pyelonephritis), in addition to therapeutic nutrition, you can take into account the following tips:
1st week of illness - fruit drinks from berries, rosehip decoction;
2nd and 3rd weeks - herbal infusions (preference should be given to those herbs that have a diuretic effect);
Week 4 – drugs with antimicrobial action.
The recovery process will be most optimal if a person with pyelonephritis does not self-medicate, but consults a specialist in a timely manner. The doctor will prescribe those medications and therapeutic nutrition, which will reduce the risk of complications and speed up recovery.
Diet for pyelonephritis can be an additional important way in the fight against the disease.
Thank you for your attention! Best regards, Olga.
Diet for kidney stones and pyelonephritis
The disease, which is expressed by inflammatory processes affecting the underlying tissue of the kidneys, as well as lower back pain and malaise, is called chronic pyelonephritis. This disease is very serious, so its complications should not be allowed. If you suspect something is wrong with your health, immediately pick up the phone and make an appointment at the best medical center in Moscow - with us! Highly qualified doctors are always ready to listen to your complaints in order to understand how to act. The main procedures that you will have to undergo will be examinations using the best equipment and tests. Upon completion of all manipulations, doctors will be able to prescribe you competent treatment, which will be selected individually for you.
Reasons for the formation of the disease
The main prerequisites for the emergence ICD, chronic pyelonephritis becomes bacterial flora. Pyelonephritis can be judged by the presence of L-form microbes, which are localized in organs for a long time. They are difficult to distinguish due to the fact that they are located in the interstitial matter and are activated under certain conditions. The disease takes on a permanent form after an acute illness that was not treated by patients. The acute form of the disease occurs as a result of inflammation, smoking and alcohol abuse, severe obesity or immunodeficiency.
Main forms of the disease
The following forms of the disease are distinguished:
Latent – reveals itself with minor symptoms of fatigue, headache and fever. At this stage, patients feel pain in the lower back and swelling. In addition, moderate anemia and a slight increase in blood pressure appear.Anemic - there is a lack of air, the skin turns pale, pain in the heart appears.
Hypertensive – characterized by hypertension, which is indicated by frequent headaches, dizziness and shortness of breath.
Azotemic - makes itself felt only in case of renal failure.
Recurrent – there is a change of remission and exacerbations. A person develops chills and lumbar pain, as well as increased urination. When exacerbations begin, acute inflammation occurs. The main symptom is hypertension, which is expressed by dizziness, blurred vision, and heart pain. Sometimes anemia syndrome occurs and renal failure develops.
Symptoms of the disease
ICD, chronic pyelonephritis They don’t give themselves away. However, patients who have previously suffered from an acute form must definitely monitor their health so that the disease does not become chronic. Signs of the disease indicate:
Fever;Frequent and severe fatigue;
Feeling weak;
Headache;
Unpleasant feeling in lumbar region backs;
urinating too frequently;
Cloudy urine;
Urine has a very peculiar, specific smell. The patient often confuses these symptoms with a common cold. Therapy with anti-cold medications will only slightly alleviate a person’s condition, but the development of inflammation will continue.
Pyelonephritis. Diet
At any stage of the disease, dietary nutrition brings excellent results. The main principle is to avoid spicy foods, caffeine, spices, alcohol, meat and fish. The food of such patients should contain a large amount of vitamins and essential calories. Every day a person is required to consume vegetables, fresh fruits, and dairy products. Fish or meat is shown only in boiled form. In addition to food, an important condition is to drink up to two liters of fluid per day. During exacerbations of the disease, the volume of water is reduced to prevent improper outflow of urine. The diet should include fatty fish, which contains sufficient amounts of PUFAs.
Drug treatment
This type of therapy is applicable in the case of normal urine passage. Treatment uses antibacterial medications, which are prescribed after determining the sensitivity of microbes to the drug. The duration of the procedures is not stopped until the prerequisites for the occurrence of ICD leukocyturia are completely eliminated. In addition, an appointment is made vitamin complexes and herbal preparations.
The minimum course of antibiotic therapy is 14 days. In case of a malignant course, the frequency of exacerbations is more than 2 times per year, a prophylactic course of antibiotic therapy is recommended in half the dose 2 weeks after the main course.
Also highly active against microorganisms determined by bacterial culture of urine are cephalosporin antibiotics, mainly of the latest generations. They are convenient for long-term use due to the minimum of side effects.
Aminoglycoside antibiotics have a powerful antimicrobial effect and show high effectiveness in the treatment of chronic pyelonephritis.
But, due to their inherent nephro- and ototoxicity, their use requires caution; their use is justified in complicated forms of the disease.
Other groups of antimicrobial agents are also used according to indications. In addition to application antibacterial drugs, it is necessary to eliminate urodynamic disorders (treatment of urolithiasis, prostate adenoma, plastic elements, etc.). General strengthening agents are also used.
At pain syndrome antispasmodics are prescribed, and antihypertensive drugs are prescribed to correct arterial hypertension. They are used quite actively in the treatment of chronic pyelonephritis. folk remedies- " ". But for folk remedies to be beneficial, they must be used only in combination with drug therapy and in moderation.
Diet
During an exacerbation of chronic pyelonephritis, dietary nutrition is aimed at reducing the load on the kidneys.
To combat intoxication in the first 2 days, nutrition is limited to plant foods and a large volume of liquid.
In the next 1-2 weeks it is prescribed diet table number 7.
The food is predominantly vegetable and dairy; lean meats are gradually being included. Chemical sparing is provided (spicy, smoked, fatty foods are excluded), without mechanical sparing (special grinding of products is not required).
Food is steamed or boiled. Salt is completely eliminated or used in minimal quantities. Frequency of meals – up to 6 times a day in small portions.
Prevention
Measures to prevent the development of chronic pyelonephritis are aimed at curing the acute form of the disease, correcting urodynamic disorders, and eliminating persistent foci of inflammation in the body.
Methods of relapse prevention include adequate treatment of exacerbations using prophylactic courses of antibiotic therapy according to indications, compliance with nutritional recommendations, and the fight against parallel pathological conditions that can complicate the course of pyelonephritis.
Next entry Children's pyelonephritis: symptoms, methods of treatment and prevention of the diseaseA very common disease is inflammation of the kidneys due to stones formed in the urinary tract (urolithiasis) or in the kidneys themselves. Due to inflammatory changes, stones of various sizes and nature are formed in one or two kidneys at once. Doctors say that stones or sand in both kidneys are found in 1/3 of all cases of nephritis.
Kidney lithiasis is relevant for people of any age, however, in children, stones or sand in the kidneys and their inflammation are observed less frequently. Women are less predisposed to this pathology in comparison with men, but they often have stones that are much more complex in structure. The stone is formed due to sediment and crystallization of salts. It should be noted that inclusions can have different structures and also vary significantly in shape.
The size of stones in the kidneys and bladder ducts ranges from 2 mm (sand) to several cm. They can be round, flat, angular, or reminiscent of coral in shape. The latter formations are the most dangerous, as they are capable of completely filling the calyx and pelvic region of the kidneys, and this can cause serious consequences in the future. In addition, it should be emphasized that stones can be single or multiple.
Causes of lithiasis
There are many provoking factors influencing the formation of stones in the kidneys and ducts of the bladder, because the manifestations of urolithiasis are influenced by genetic predisposition, living conditions and lifestyle, as well as ignoring personal hygiene standards. In addition, another cause of pathology is chronic kidney inflammation. It is very likely that lithiasis will develop in residents of underdeveloped countries due to the lack of proper medical care and the low standard of living of citizens.
In economically stable countries, the following factors can be called provocateurs for inflammation of the kidneys and the subsequent formation of stones in them and in the ducts of the bladder:
- low activity;
- alcohol abuse;
- unbalanced diet (abundance of fried, spice-rich foods, excess meat).
Any stone does not appear in an instant. As a rule, it grows over months and even years. The high content of protein and salts in the urine is particularly conducive to the appearance of stones, which is always associated with malfunctions of the kidneys (inflammation).
Initially, formations of small sizes of a protein nature are formed. They serve as a frame for future stones. When the pebbles are tiny (sand), they usually leave the kidneys on their own with a stream of urine. If the calculus is fixed in the kidney, then further deposits will only attach to it.
All types of stones are a serious threat to human health and life, as they can provoke chronic pyelonephritis (inflammation), kidney failure or an abscess of one of the kidneys. 
Common causes of stones in the kidneys and bladder ducts:
- physical inactivity;
- diabetes;
- heredity;
- excess protein foods;
- lack of sunlight;
- pathologies of the digestive system;
- defects of the bladder tract (their abnormal structure);
- fractures leading to a failure of calcium metabolism in the body;
- disruptions of the endocrine system leading to calcium metabolism disorders;
- chronic infectious (pyelonephritis, cystitis);
- geographical factor: increased sweating increases the salt content in the urine.
Symptoms of the phenomenon
Formations in the kidneys (stones, sand), as a rule, provoke intense pain in the lumbar area or on one side of the lower back. The pain can radiate to the bladder area, as well as the organs of the reproductive system. It is very rare for a person to find out about the presence of stones by chance during an ultrasound. If we consider the signs of the phenomenon in more detail, they will boil down to the following:
- the appearance of blood in the urine (but this is a symptom of other ailments);
- pain in the lower back during prolonged walking or exercise;
- urinary tract dysfunction (urinary retention or frequent urge).
Urolithiasis is often accompanied by kidney inflammation. It is characterized by chills, high temperature and aching pain in the lumbar area. Further urine tests indicate the presence of white blood cells. It is important to know that pathology can provoke a cessation of urine outflow. So, if a patient has not had the desire to go to the toilet for 3 hours, then it is likely that a stone has blocked the renal duct. If such a pathology is suspected, consultation with a urologist or nephrologist is necessary. 
Therapy for lithiasis
If there is pain in the side or lower back, the doctor will prescribe certain examinations. As a rule, the leukocyte count is initially determined in order to detect the presence of infection and inflammation. It is necessary to undergo a general and biochemical blood and urine test, as well as culture for bacteria. Additionally, ultrasound and radiography will be required. In addition, additional tests are carried out to determine the nature of the formation.
A correct diagnosis allows you to accurately select the necessary therapy. Often in such cases they resort to conservative or surgical treatment. The choice of method will directly depend on the size and type of formation, as well as on the age and general condition of the patient. For particularly large formations, surgery is inevitable.
If the stone does not have sharp corners and can be easily crushed, then conservative therapy is preferred.
Such therapy includes stone-breaking drugs (Canephron, Urolesan, Fitolysin), antispasmodics and antibiotics. In order to eliminate pain during crushing and removal of formations, they resort to drug blockade, and also prescribe drugs that reduce tension in the muscles of the ducts.
Kidney stones up to 5 mm (sand) easily leave the body when urinating. Often used in treatment are herbs such as torment, horsetail, and Pol-Pala. They effectively eliminate inflammation, normalize blood supply to the kidneys and help eliminate sand and larger stones.
However, neglected pathological process threatens certain complications. For example, it can be inflammation. It is often provoked by chronic pyelonephritis or renal failure. Often the patient does not notice the symptoms of the disease when the ducts of one kidney are blocked, but the second successfully copes with its functions. In such a situation, an abscess is likely to form in the diseased kidney, and then surgical intervention to remove it is inevitable.
Therefore, if a person knows about his own predisposition to urolithiasis, regular monitoring of his condition by a specialist is necessary. As a preventative measure in the summer, it is recommended to eat more fruits (especially melons) and birch sap, and in winter - decoctions of rose hips, viburnum and dried fruits. A healthy lifestyle, a balanced diet and a proper drinking regime are excellent in resisting the disease.
