Disease and treatment

Kidney stone :- Cause, symptoms and treatment

Etiology

  1. Infection– Infection results in production of urea, leading to stasis of urine.Bacteria e.coli, pseudomonas , Klensielleae are mostly responsible for reccurent urinary infection.
  2. Hot climate:- In hot climate , due to excessive sweating, there is increased concentration of solvent and decreased fluid level of kidney, precipitating the stone.
  3. Dietary Factor:-
    1. diet rich in calcium as milk
    2. Diet rich in oxalate- tomato,brinjal
    3. Diet rich in urea as fish , eggs , meat
    4. Lack of vitamin “A” diet results in destruction of renal epithelium
  4. Metabolic causes:-
    1. Gout:- Which increases level of uric acid and produces uric acid stones which are radiolucent & incidences are 10%.
    2. Hyper Para Thyroidism:- Which results in increased calcium level.
  5. De-calcification:- Due to immobilization as paralysis , orthopedic disorders large amount of calcium is de-calcified from bones & excreted from urine which ultimately increases calcium level of urine leading to formation of stone.
  6. Decreased citric acid level :- Normal is 300 to 900 mg/day. citric acid maintains pH of urine & it is under control of hormones. As citric acid levels is decreased it disturbs pH of urine & forms a stone by precipitating urinary calcium.
  7. Congenital disorders:- Renal fusion Horseshoe kidney ,due to obstruction it leads to infection and forms kidney stone.
  8. Drugs:- Mg tri-silicate, Aluminium Hydroxide & Calcium Gluconate taken by patient for long duration.
  9. Randaall’s plaques:- Due to bacterial growth , small erosion/ ulcer in which particles of urine compositions like calcium , phosphate, oxalate get deposited & form stone.

Symptoms:-

  • Renal pain– particularly, there is pain in renal angle. It is constant, sometimes refers to costo-vertebral region. Tenderness is present when stone is in pelvic ureter junction.
  • Hematuria- The blood in urine is fresh but quantity is less.
  • Fever with chills
  • Burning micturition
  • Pyuria (Pus with urine)
  • Frequency of micturition
  • Guarding of muscles of anterior & posterior renal angle during severe episode of a renal stone. (In right side as mimic to appendicitis & crihn,s disease while in left side as disease of sigmoid colon)

Complications

  • Hydronephrosis
  • Pyonephrosis
  • Stag Horn Calculi
  • Renal failure

Investigations

  • Urine Routine (crystal,RBC, Pus cells)
  • Blood urea & creatinine to rule out renal failure
  • X-ray plain KUB
  • USG
  • IVP (Intravenous pyelography)
  • Urine for culture & sensitivity

Treatment

  • Hydrotherapy :- Small stones less than 6mm in size passes out spontaneously with forceful urine excreted by consuming excessive water. Such treatment is known as hydrotherapy.

Intra-venous fluid (2-3 ltrs.) is infused in a short period of time and patient is advised to retain urine as possible as , after that 20 mg. Frusemide (lasix) is intravenously injected. Due to forceful urination , stone which is less than 6 mm passes easily trough urethra.

  • ESWL (Extra corporal shock wave lithotripsy) :- It was introduced in 1950 & successfully tried on human by Darwin in 1985 in USA. It is an extra corporeal shock wave Lithotripsy under short general anesthesia.Followed by cystoscopy, ureter stent(probe) which is ‘J’ shaped is placed on the site of stone & electric shock wave is generated which crushes the stone into small fragments. Most of stones will come out with stent / pass with urine.

Advantage

  • No incision, no pain
  • safe method
  • Minimum hospitalization & post-operative complication.

Disadvantage

  • Not available in all centres due to its cost effect
  • This treatment is only effective to the less than 2.5cm size of stone.

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