Thursday, May 10, 2012

Kidney stones (calculosis renis)

Introduction
Kidney stones (calculosis renis) are one of the most painful disorders that affect people, and also one of the most common disorders of the urinary tract. Men are more frequently affected than women. Most kidney stones out of the body without the intervention of a doctor. Cases in which symptoms are present continuously or appear other complications can be treated by various techniques, most of which does not include more surgical intervention. Progress in research also brought us a better understanding of the many factors that promote stone formation.


What is it?
Kidney stones are formed from crystals that precipitate from urine and accumulate on the inner surfaces of the kidney. Urolithiasis is a technical medical term used to describe stones that appear in the urinary tract. Doctors also use terms that describe the accommodation calculus in the urinary tract. For example, a ureteral stone (or ureterolitijaza) is a kidney stone which is in the urinary tract and kidney stones (nephrolithiasis). To simplify things, throughout this paper we will use the term "kidney stones".

Description of disease
Scientists have even found evidence of kidney stones in the Egyptian mummy which it is estimated that more than 7,000 years.
The urinary system consists of kidneys, ureter, bladder and urethra. The kidneys are two organs form bean seeds located below the ribs toward the middle of the back. The kidneys remove excess water and waste products from the blood, turning them into urine. They also maintain a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and helps produce red blood cells. A thin tube called the urethra carries urine from the kidneys to the bladder, a triangle-shaped cavity in the lower abdomen. As with balloons, elastic walls of the bladder is stretched wider to urine deposited. They cleave together when urine is emptied through the urethra outside the body.
Normally, urine contains chemicals that prevent or inhibit the creation of the crystal. However, it appears that these inhibitors do not work for all people, and some people are created stones. If the crystals remain tiny enough, will travel through the urinary tract and come out of the body in urine and that people do not even notice. Kidney stones may contain various combinations of chemical substances. The most common type of stone contains calcium in combination or with oxalate or phosphate. These chemical substances are part of the normal diet of man and constitute important parts of the body such as bones and muscles.
Less common types of stones caused by infection in the urinary tract. This type of scale is called infectious stones. It is even less common uric acid stones and cystine stones are rare.

Who gets?
Although stones occur more frequently in males, the number of women who suffer from kidney stones is increased in the last 10 years, so the ratio changes. Kidney stones strike most people between the ages of 20 to 40 years. When once a person's were more than one scale, the more likely they will still appear.
A person in whose family there were cases of kidney stones are more likely to get them herself. Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders such as hyperparathyroidism are also linked with the formation of stones. In addition, kidney stones develop in more than 70 percent of patients with a hereditary disease called renal tubular acidosis.
Cystinuria and hyperoxaluria are two other rare inherited disorders that often cause kidney stones. In Cystinuria, the kidneys produce too much amino acid cystine. Cystine is insoluble in the urine and can accumulate and create stones. In hyperoxaluria, the body produces too much oxalate salt. When there is more oxalate than can be dissolved in the urine, the crystals precipitate and form stones.
Do absorptive hypercalciuria occurs when the body absorbs too much calcium from food and release excess calcium into the urine. Because of this high level of calcium in the urine crystals of calcium oxalate or calcium phosphate are formed in the urinary tract.
Other causes of kidney stones are hiperurikozurija (a metabolic disorder of uric acid), the role, too much vitamin D, and blockage of the urinary tract. Some diuretics (water pills to expel from the body) or calcium based antacids may increase the risk of kidney stones by increasing the amount of calcium in the urine. Calcium oxalate stones may also be created among people with chronic inflammatory bowel disease or have had intestinal bypass operation, or ostomy. As noted above, infectious kidney stones can develop in people who have had a urinary tract infection.

Symptoms
Usually, the first symptom of kidney stone is a very strong pain. The pain often begins suddenly when the stone starts to move in the urinary tract, causing irritation or blockage. Usually, a person feels a sharp, cramping pain in the back and side in the kidneys or lower abdomen. Sometimes this pain with nausea and vomiting occurs. Later, pain may spread to the groin.
If the scale is too large to pass easily, pain continues as the muscles in tight urinary trying to squeeze the tube down the stones in the urinary bladder. How stone grows or moves, blood may appear in the urine.How to scale down the urethra close to the bladder, a person may feel a frequent need to urinate or a burning feeling when urinating. If these symptoms are accompanied fever or chills, infection may be present. In this case, you should immediately contact a doctor.

Which tests can I do?
Sometimes "silent" stones (which do not cause symptoms) found on the radiograph made out during a general health examination. These stones would likely pass unnoticed. More often, kidney stones are found on the X-ray or ultrasound images of the person who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the size and location of stones.Blood and urine tests help to detect possible abnormal substance that can speed up the stone formation.Your doctor may decide to record a special urinary tract X-ray examination called intravenous urography. Together, the results of these tests help in determining appropriate treatment.

Treatment
Fortunately, most stones can be treated without surgery. Most kidney stones can pass through the urinary system with plenty of water (2 to 3 liters per day) which helps to scale down. In most cases, a person can remain at home during this process, taking pain medication as needed. The doctor usually asks the patient to retain thrown stones (ce) for examination.
Your doctor may prescribe certain medications to prevent the formation of calcium stones and uric acid stones. These drugs control the amount of acid or alkali in the urine, which is a key factor in stone formation. Alupurinol medicine may also be useful in some cases of hypercalciuria and hiperurikozurije.Another way in which the doctor can try to control hypercalciuria, and thus prevent the creation of calcium stones, the transcription of certain diuretics, such as hidroklorotijazid. These drugs reduce the amount of calcium released by the kidneys into the urine.
When infectious stones that are completely removed, the first preventive measure is to maintain the urine free of bacteria that can cause infection. The patient's urine will be tested regularly to confirm that bacteria are not present.
To prevent the formation of calcium stones in hiperparatiroidnih patients, the surgeon can remove all the parathyroid glands (located in the neck). It is usually also the treatment of hyperparathyroidism. In most cases, only one of the glands increased. Removing the glands solve the patient problems with kidney stones.
Some form of surgical operation may be needed to remove a kidney stone if the stone:
- Do not go out after a reasonable period of time and causes constant pain
- Is too large to come out I
- Impedes the flow of urine
- Causing permanent urinary tract infection
- Damages the kidney tissue or causes constant bleeding
- Increases (as seen from the following X-ray)
Until recently, surgery to remove tartar was very painful and required a long recovery time (4 to 6 weeks). Today, the treatment of these stones greatly facilitated. There are many options that do not require major surgery.
Extracorporeal shock wave lithotripsy (popular "breaking stones") is most commonly used procedure for treating kidney stones. Using the shock waves that are produced outside the body and travel through the skin and body tissues until they hit the dense stones. Stones are converted into the sand and easily pass through the urinary tract in the urine.
In some cases, the "break" can be performed outpatient.
Recovery time is short, and most people can return to normal activities after a few days. Complications can occur with
this procedure. Most patients have blood in the urine for several days after the procedure. Easy bruising and pain in the back or abdomen caused by the shock waves are also common. To reduce the likelihood of complications, doctors usually tell patients to avoid taking aspirin or other medications that affect blood clotting for several weeks before the procedure.
It is sometimes recommended for descaling procedure called percutaneous nefrolitotomija. This procedure is often used when the scale is quite large or in a place that does not allow effective use of shock waves.

Complications
Kidney stones are painful but usually throw without cause permanent damage. They have a tendency to recurrence, especially if the cause is found and treated. The complications include:
-Recurrence of stones
Urinary-tract
-Obstruction of the urethra
-Acute unilateral obstructive uropathy (a disorder that involves rapid inhibition in the flow of urine from the ureter of one kidney, which results in retention of urine and kidney damage)
-Kidney damage, scars
- Reduction or loss of function of the affected kidney

Prevention
In patients in whom there is more than one kidney stone are likely to create more of them. That is why prevention is important. In order to prevent stone formation, one must determine the cause. The urologist will determine the laboratory tests, including blood and urine tests. It will also examine the patient history, the work done and eating habits. If the scale is removed, or if the stones come out and the patient it is preserved, scale can be analyzed in the laboratory to determine its composition.
The patient may be asked to collect urine 24 hours after the stones come out or is removed. The sample is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate and creatinine (by-product of protein metabolism). The doctor will use this data to determine the cause of the formation. Sometimes it takes another collection of urine for 24 hours to determine whether the prescribed treatment effectively.
The simple and most important lifestyle changes to prevent the creation of stones is to drink more fluids (preferably water). A person in whose re-created stones should try to drink so much fluid during the day to produce at least 2 two liters of urine every 24 hours.
Patients who have too much calcium or oxalate in the urine may need to eat fewer foods containing calcium and oxalate. However, not everyone will benefit from the low-calcium diet. Some patients who have high levels of oxalate in the urine may benefit from additional calcium in the diet. Patients may be said to avoid food with added vitamin D and certain types of antacids based on calcium. Patients who have very acidic urine may need to eat less meat, fish and poultry. These foods increase the amount of acid in the urine. To prevent the formation of cystine stones, patients should drink each day is enough water to reduce the amount of cystine in the urine, which enters. It is difficult because it can take more than four liters of water every 24 hours, of which one third must be consumed during the night.
People prone to calcium oxalate stones, your doctor may ask you to reduce the intake of certain foods from the following list.:
Apples, asparagus, beer, beets, nuts (various, eg. Cranberries, strawberries), black pepper, broccoli, cheese, chocolate, cocoa, coffee, cola drinks, collard greens, figs, grapes, ice cream, milk, oranges, parsley, peanut butter, pineapple, spinach, chard, rhubarb, tea, beets, vitamin C, yogurt
Patients do not stop to eat or take to avoid this kind of food without prior consultation with the doctor. In most cases, these foods can be eaten in limited quantities.

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