Update: February 2019
- History reference
- Classification of kidney stones
- Causes of urolithiasis
- Clinic – symptoms of the disease
- Renal colic treatment
- Patient Frequently Asked Questions
Urolithiasis (ICD) or urolithiasis is one of the most
common urological problems affecting 1–3%
able-bodied population, 70% of cases – people aged 20-50
years old. Most often, urinary stones (uroliths) are formed in the kidneys, less often –
in the ureters and bladder. As a rule, the disease
happens unilateral, at the same time (both left and right) kidneys
affects about a third of cases. Among patients there is
slight predominance (by about 6–10%) of males. AT
This article will talk about kidney stones, symptoms and treatment.
Urolithiasis exists as long as it exists.
humanity. Archaeologists discover urinary stones in burials
prehistoric people, and in the sarcophagus of Egyptian mummies, and in
tombs of the Middle Ages. �“Stone Masters,” who extracted uroliths,
existed in ancient Egypt, “stone-cutting” was practiced in
ancient China and India. This procedure was performed without
anesthesia, therefore, demanded from the artisan
were considered doctors) remarkable dexterity.
Many famous minds from medicine have spent a lot of energy
developing treatments for kidney stones. Hippocrates in IV
century bc er described renal colic and methods of getting rid of
her, and also remembered stone-cutting in his famous oath.
Several treatises on this disease belong to the pen of Avicenna,
who devoted much time to the development of diagnosis and treatment
Classification of kidney stones
The size of the stones:
- small: up to 10 mm
- medium: 10 – 20 mm
- large: more than 20 mm
According to radiological characteristics:
The image of stones on X-rays is largely
depends on their mineral composition. Since computer
tomography most accurately demonstrates radiographic
the density and structure of stones, according to her urinary stones
can be divided into the following groups.
- X-ray contrast: oxalates and calcium phosphates.
- Poor x-ray contrast: magnesium and ammonium phosphates,
- X-ray negative: uric acid and urates, xanthine,
Causes of urolithiasis
A unified and generally accepted theory of calculus formation has not yet
exists, therefore it is necessary to speak not about the causes of urolithiasis
diseases, and on factors contributing to the appearance of urinary stones.
Factors exist formal and causal:
Formal – reflect the process of direct stone formation
in the urinary tract.
- Reaction (pH) of urine: human urine is usually acidic, therefore for
most stones need to increase its pH to alkaline, however
Some of them can also be formed in acidic urine (urates).
- The glut of urine salts that can precipitate.
- The presence in the urine of a certain number of organized protein
substances (decayed cells, bacteria, fibrin, etc.) that
subsequently become the cores of precipitation, gradually transforming into
Causal – various violations triggering their mechanisms
- Urinary infections. It is known that 30% of patients with pyelonephritis
(kidney infection) the disease is complicated
stone formation. Infections cause large numbers of
precipitation nuclei around which may appear
- Stasis urine. May result from a huge amount
causes: injury, spinal cord injury, urinary tract obstruction
tumors, congenital anomalies, foreign bodies, etc.
- Food factor. Monotonous eating or abuse
any product leads to a glut of urine salts.
For example, an excess of meat in the diet can lead to urate
stones, and the abuse of milk – to the formation of calcium
- Genetic or endocrine abnormalities (osteoporosis, gout and
others.) – lead to a glut of urine salts.
- Lack of fluid in the body – leads to an excess of salt in the urine.
ATозникает по ряду причин: жаркий климат, особенности диеты и
- Medications. The risk of stone formation may increase
some drugs used in the treatment of osteoporosis,
туберкулеза и others
Clinic – symptoms of the disease
In itself, the presence of uroliths in the urinary system does not
manifests itself. Symptoms of the disease occur when
concretions begin to disrupt urine flow. AT этом случае появляется
pain is the main symptom of the disease.
Pain when urolith is localized in the kidney is of two types:
- Acute attack of intense pain – renal colic. ATозникает
with a sudden blockage of the ureter with a stone. Localized in the right
or the left side (on the side of the lesion of the left or right kidney), may
accompanied by symptoms such as nausea and vomiting.
- With incomplete obstruction of the urinary tract pain is not very strong,
with that it is constant, aching, or cramping.
The movement of calculus along the urinary tract causes injury to them.
walls, causing blood to appear in the urine.
The intensity of bleeding is different. From single red blood cells,
detectable only under a microscope, to significant impurity
blood visible to the naked eye (gross hematuria).
Do not forget that a violation of the passage of urine can be
the cause of the infectious process in the kidney. By the way, availability
stones almost always leads to chronic bacterial
inflammation in this case is added to the pain syndrome
general infectious symptoms:
- headache, etc.
The ICD clinic is independent of gender, therefore the symptoms of kidney stones
in men and women are no different.
The main diagnostic method is stone visualization. Simply put,
calculus must be seen with medical equipment.
УЗИ – проводится в качестве первичной
procedures, as this method is safe and inexpensive. With
calculus more than 5 mm ultrasound efficiency
is about 98%.
Обзорный снимок почек – рентгенологическое
research, inexpensive and not difficult, but ineffective, allows
identify only x-ray positive stones.
Экскреторная урография (ЭУ). In fact, on
X-ray of the kidney is not visible. To consider them
contrasting procedure used: intravenous to patient
A special substance is introduced — X-ray contrast, which is not
skips x-rays. This drug is filtered in the urine and
the kidneys are visible on x-rays.
EC is a very informative procedure, as it allows to identify
the presence of a block in the urinary tract and also provides some
kidney function data. This procedure is not technically very simple.
Yes, and the contrast itself has a lot of terrible side effects: allergies,
острая почечная недостаточность и others
Компьютерная томография (КТ) – считается
the most effective method for visualization of urinary calculi
system, as not only allows you to determine the localization of the stone in
left (right) kidney, but also to reveal its X-ray density, and
also structure. ATыполнять КТ сложно и дорого, поэтому экскреторная
urography still has not lost its importance in the diagnosis
Algorithm of medical imaging of calculi in the urinary system
- With наличии подозрений на МКБ выполняется УЗИ мочевых
- With обнаружении конкремента, либо признаках блока мочевых путей
CT scan of the abdominal cavity is performed, and if CT is not possible,
power is being done.
The combination of ultrasound and CT has an efficiency close to 100%.
- Urinary tract infections: acute and chronic pyelonephritis,
suppuration of the retroperitoneal space (adipose tissue in which
находятся почки), уросепсис и others
- Hydronephrosis. Prolonged partial obstruction of the ureter with a stone
leads to chronic overstretching of the renal pelvis, which in its
queue causes atrophy of the kidney tissue. AT результате почка,
in fact, dies, turning into a bag of urine (see hydronephrosis
- Chronic renal failure. ATызванное камнями
an increase in urine pressure in the urinary tract, combined with chronic
infection, causes destruction of the filtering apparatus of the kidneys and
hardening of its tissues. AT итоге почки перестают справляться со
its functions, up to the complete cessation
Renal colic treatment
It is believed that the pain in renal colic is the strongest of all
possible, so the fight against pain – the main task in relieving
данного осложнения ICD.
With почечной колике наилучшее сочетание эффективности и
safety demonstrate nonsteroidal anti-inflammatory
средства (НПATС) – Диклофенак, Кеторол, Индометацин, Ибупрофен и
others, которые назначаются на период от 3 до 7 дней (см. список
pain shots). Narcotic analgesics have no advantage in
сравнении с НПATС не имеют и назначаются тогда, когда использование
Diclofenac and its “relatives” are impossible, for example, because
AT качестве дополнения к НПATС могут применяться спазмолитики:
папаверин, но-шпа и others (см. лекарства для лечения kidney).
If it is not possible to eliminate the block of the kidney with medication, it is performed
surgical decompression of the urinary tract, which happens to be two
- Retrograde stenting. With помощи специального
equipment, a special catheter is inserted through the ureter into the kidney
– stent. This stent is located at one end in the renal pelvis,
and the second is lowered into the bladder, ensuring the flow of urine.
- Percutaneous nephrostomy. Under ultrasound control
held puncture of the renal pelvis through the skin of the back. Through the puncture
A catheter is inserted into the pelvis, which expels urine from it.
Percutaneous nephrostomy is much more traumatic, but much easier.
therefore, stenting has not yet supplanted it. Decompression
considered as a temporary measure, followed by
surgical elimination of the stone.
This is the expulsion of a stone from the kidney by medical means. When
start treatment of urolithiasis, the question is not idle.
It is believed that urinary stones up to 6 mm, which do not give clear
symptoms do not grow and do not cause complications – do not require treatment
(see regular sex helps to remove kidney stones (before
6mm)). The expulsion of such a calculus is a double-edged sword. Can
remove it, and you can get sick even more. ATот заткнет этот камень
a kidney tight and a small problem will grow into a huge …
Litokinetic therapy считается оправданной, если требуется
remove from the kidney fragments of stone after the destruction of its surgical
Medical dissolution of uroliths in the kidneys or chemolysis
used to treat urate stones. For this you need
make urine weakly alkaline. With помощи специальных цитратных смесей
or sodium bicarbonate (soda) urine pH is understood to be 7.0 and above, and
held at this level for several weeks. The dose of the drug, including
including soda, is selected individually, and the effectiveness of treatment
controlled with special test strips.
Дистанционная ударноволновая литотрипсия (ДУATЛ)
The essence of the method is contactless destruction of a stone by force.
ultrasonic wave. Considered the safest and safest
method of getting rid of calculus, allows you to eliminate uroliths
up to 20mm in 90% of cases.
Противопоказания у ДУATЛ
- Low blood coagulability
- Active urinary tract infection
- Severe obesity
- Withзнаки обструкции мочевых путей ниже зоны дробления
Some features of the procedure:
- Ultrasonic wave affects not only the calculus, but also
on the skin, which can cause pain, in some places
сильные, поэтому ДУATЛ требует адекватного обезболивания.
- AT процессе ДУATЛ камень разрушается на мелкие осколки, которые
can cause renal colic.
- It is not always possible to destroy urolit from the first session, some
patients may need 2 or more procedures.
ATарианты хирургического лечения
ATыбор методики оперативного лечения МКБ зависит от размеров и
the position of the stone, the condition of the urinary tract, infection activity,
patient build, doctor’s experience and many other factors.
- The endourethral technique is injected into the renal pelvis.
endoscopic equipment through the urethra or through a puncture in the skin.
The apparatus is brought to the stone, which is removed or destroyed.
one of the ways: mechanically, by a contact ultrasonic wave,
- An open operation is the oldest, most reliable, but with
This is the most traumatic and therefore dangerous method. Stone mechanically
extracted by incision of the kidney or bladder.
Используется при невозможности применить ДУATЛ или эндоскопическую
technique: severe obesity, severe skeletal deformities,
коралловидный камень и others
The formation of stones in the urinary system is complex and
multifaceted, so preventive measures for each
the patient must be developed individually. However, there are
several common points that significantly reduce the risk
- Maintaining adequate diuresis – in simple terms, it is necessary
drink 2 or more liters of liquid daily.
- Maintaining normal urine acidity – normal urine pH
should be in the region of 6.0. People with a neutral or alkaline pH
need to eat more acidic foods (meat, fish, beans,
Coca-Cola, natural coffee).
- Diet – food should be complete and varied, not
It is worth fixing on certain products.
Patient Frequently Asked Questions
Can clean water prevent education?
Not quite right. Any water load over 2l per day is capable
reduce the risk of stone formation, and “slagging” the body
�“Dirty” water is more like a scarecrow of unclean filters sellers
for water treatment.
Каковы симптомы выхода песка, stones?
�“Sand in the kidneys” is a term coined by specialists.
ultrasound diagnostics, to describe a fine suspension,
present in concentrated urine. This suspension is very
thick and sometimes can clog the ureter, causing typical
renal colic, but unlike ICD, the release of “sand” flows more
What drugs are used in the treatment?
Drug therapy is used in the treatment of urolithiasis as
addition to surgical techniques. It is anti-inflammatory
agents, antispasmodics, antibiotics.
ATместо заключения. Considering that urolithiasis has serious
Symptoms and treatment is not a harmless thing, so
you should trust your kidneys to all kinds of “folk healers”. To help
you can only professionals.