RENAL CALCULI (kidney Stone)
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.
The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.
CLINICAL FEATURES OF RENAL CALCULI (kidney Stone)
- Pain in flank.
- Dull aching.
- Pain worse on: Movement, Changing position, Walking upstairs.
– Tenderness of renal angle.
– Onset: sudden.
– Sharp, excruciating.
– Radiates from loin to groin.
– Patient draws up his knees and rolls.
– Profuse sweating.
– Pulse: fast.
– Rigidity of lateral abdomiiial muscles.
– Percussion over kidney produces sharp stab of pain.
– Frequent unsatisfactory urination.
– Pain at end of micturition.
– Worse during exertion, jolting movements.
– Better by lying.
– Radiates to tip of penis.
– Interruption of urinary stream (stone blocking internal meatus).
. Better by change of posture.
– Tenderness over suprapubic region may be present.
Other symptoms can include:
- Abnormal urine color
- Blood in the urine
- Decrease or loss of function in the affected kidney
- Kidney damage, scarring
- Obstruction of the ureter (acute unilateral obstructive uropathy)
- Recurrence of stones
ETIOLOGY OF RENAL CALCULI (kidney Stone)
- Concentrated urine: Hot climate, Decreased fluid intake, Chronic diarrhoea.
- Urinary stasis: Urinary tract obstruction, Prolonged recumbency.
- Recurrent urinary tract infection.
- Polycystic kidney disease.
- Vitamin A deficiency.
- Foreign body.
- Hypercalcaemia: Hyperparathyroidism, Vitamin D toxicity, Excessive intake of calcium, e.g. milk, cheese, eggs.
- Hyperoxaluria: Excessive intake of oxalate, e.g. tomato, raddish, spinach, strawberry, tea, chocolate, cola drinks, Crohn’s disease.
- Hyperuricemia: Gout, Myeloproliferative disorders, Excessive intake of purine rich foods, e.g. red meat, fish.
- Age: peak incidence between 30-50 years.
- Sex: common in males.
- Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
- Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
- Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid stones.
- Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and other inherited metabolic conditions, including cystinuria and hyperoxaluria.
- People with inflammatory bowel disease are also more likely to develop kidney stones.
- Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.
- Those who have undergone intestinal bypass or ostomy surgery are also at increased risk for kidney stones.
- Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual’s risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.
- Impaction and obstruction.
- Urinary tract Infection.
- Stricture of ureter.
- Anuria (bilateral renal/ureteric calculi).
Risk for RENAL CALCULI (kidney Stones)?
Anyone may develop a kidney stone, but people with certain diseases and conditions (see below) or those who are taking certain medications are more susceptible to their development. Urinary tract stones are more common in men than in women. It is estimated that about 12% of men and 7% of women in the U.S. will develop stones in the urinary tract at some point in their lives. About 20 million people seek medical care each year because of kidney stones. Most urinary stones develop in people 20-49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life. People who have already had more than one kidney stone are prone to developing further stones.
In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. People who live in the southern or southwestern regions of the U.S. have a higher rate of kidney stone formation than those living in other areas. Over the last few decades, the percentage of people with kidney stones in the U.S. has been increasing; the reason for this is not well understood.
A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood (hyperuricemia).
A small number of pregnant women (about one out of every 1,500-3,000 pregnancies) develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus. Healthy pregnant women also have a mild increase in their urinary calcium excretion. However, it remains unclear whether the changes of pregnancy are directly responsible for kidney stone formation or if these women have another underlying factor that predisposes them to kidney stone formation.
INVESTIGATIONS OF RENAL CALCULI
– Macroscopic for blood, pus, sediments.
– Chemical for
. Presence of blood, albumin.
• 24 hour urinary calcium, phosphate, urate.
– Microscopic for RBC’s, pus cells.
X-Ray KUB: For radio-opaque calculi.
CT scan: For non-opaque calculi.
USG: Calculi >1 cm cast a specific shadow.
Excretory urography to
– Confirm that opacity is intra-renal.
– Determine exact location.
– Analyze renal function.
– Detect obstruction.
– Serum calcium.
– Serum uric acid.
- Abdominal CT scan
- Abdominal/kidney MRI
- Abdominal x-rays
- Intravenous pyelogram (IVP)
- Kidney ultrasound
- Retrograde pyelogram
How can we prevent kidney stones?
Rather than having to undergo treatment, it is best to avoid kidney stones in the first place when possible. It can be especially helpful to drink more water, since low fluid intake and dehydration are major risk factors for kidney stone formation.
Depending on the cause of the kidney stones and an individual’s medical history, dietary changes or medications are sometimes recommended to decrease the likelihood of developing further kidney stones. If one has passed a stone, it can be particularly helpful to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered.
People who have a tendency to form calcium oxalate kidney stones may be advised to limit their consumption of foods high in oxalate, such as spinach, rhubarb, Swiss chard, beets, wheat germ, and peanuts.
– Calculi < 5 mm are passed spontaneously.
– Good, if infection and obstruction are pre vented.
– Recurrences are common.
– Predominant sycotic disorder.
– To remove stone.
– To treat cause.
– To prevent Complications.
– To prevent recurrence.
GENERAL MANAGEMENT OF RENAL CALCULI
– Plenty of fluids (more than 4 litres/24 hours).
– Control and treatment of infection.
– Diet restriction according to type of stone:
If stone is of uric acid and urates, eliminate.
– Meat and meat products, shellfish and dais, whole grain cereals, oat meal, dried peas and beans, spinach.
If stone of oxalate, eliminate
– Green plantain, spinach, sweet potato, colocasia roots [arvi], beet, currants, figs, almonds, cashewnuts, grapes.
– Large stones may require surgical removal.
HOMOEOPATHIC TREATMENT OF RENAL CALCULI
– Berberis Vulgaris: Renal Stones.
– Hydrangea: Left Ureteric Calculus.
– Lycopodium: Lithic Cliathesis.
– Nux Vomica: Ineffectual Urging.
– Ocimum Canum: Uric Acid Diathesis.
– Pareira Brava: Vesical Calculus.
– Sarsaparilla: Right Ureteric Calculus.
– Solidago: Homoeopathic Cathetar.
– Uva Ursi: Vesical Calculus, Cystitis.
– Vesicaria: Cystitis with Irritable Bladder.
Following medicines showed improvement in haematuria, burning micturition and episodes of pain:
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RENAL CALCULI (kidney Stone)