What You Should Know About Kidney Lithiasis

Written by: Dra. Rosa Regué Aldosa
Published: | Updated: 23/05/2018
Edited by: Patricia Pujante Crespo
Renal lithiasis is one of the most frequent urologic pathologies among the general population. It is the formation of a solid concretion in the kidney from components present in the urine.
 
It is not exactly known why they are formed although it is believed that it can be a multifactorial process and there are several causes:
Metabolic factors : by supersaturation some substances in urine such as calcium (hypercalciuria), oxalate (hyperoxaluria) or ac. Uric (hyperuricosuria, for deficits such as citrate (hypocitraturia) or magnesium.
Anatomical factors : congenital malformations such as horseshoe kidney, stenosis, etc.
Genetic Factors : Cystinuria. Renal Spongiosis, etc.
Urinary infections by germs favoring the formation of stones.
Associated Diseases : hyperparathyroidism, malabsorption, enf. Of Chron, etc.
Ingestion of drugs : Indinavir.
Environmental and dietary factors .
 
Renal lithiasis manifests with nephrotic colic and pain in the area of ​​the kidneys
 

What symptoms can alert the patient to the presence of kidney stones?

Most of the time kidney stones can go undetected without producing symptoms, when they produce the most characteristic clinical picture is nephritic colic. This is an episode of colicky pain, which starts abruptly in the renal area or is irradiated by the urinary tract to the bladder or genitals. It may or may not accompany digestive symptoms such as nausea and vomiting.
Nephritic colic can be associated with obstruction and / or urinary tract infection.
 
 

Treatments of renal lithiasis

Most often the episode of colicky pain is resolved with symptomatic treatment ie relieving pain with analgesics and waiting for spontaneous expulsion of the calculation that will be favored by the size of the calculation, increased water intake and drug administration Dilators of the urinary tract (alpha blockers).
 
In case the patient does not spontaneously expel the stone or does not improve the symptomatology will be necessary to offer an alternative treatment.
 
Currently, the majority of patients with stones <2 cm. May benefit from extracorporeal shock wave lithotripsy taking into account their limitations. It is the least invasive technique with a high percentage of success.
 
Depending on the location and size of the calculus, other more invasive techniques such as ureterorenoscopy (intracorporeal lithotripsy) can be performed , that is, entering the duct to break the calculation and helping the patient to be able to expel it more easily. The fragmentation is done in this case most of the time with pneumatic energy or laser energy (lasertripsia) .
 
The recommendation is as follows:
- Extracorporeal Lithotripsy : The least invasive technique is indicated for kidney stones <2cmm. And ureteral stones <1cm not impacted.
 
- Ureterorenoscopy / Lasertripsy : More invasive technique, indicated for calculations that are closer to the urinary bladder, impacted calculations and failures of lithotripsy.
 
There is some type of renal calculus that, because of its size or location, does not allow any of the previous treatments and for which more complex treatments such as open or laparoscopic surgery , percutaneous nephrolithotomy and newer techniques such as intracorporeal renal surgery are required. A flexible ureterorenoscopio that allows the renal access through the urinary tract.
 
There are some warning signs that any patient with nephritic colic should take into account. If the pain is very intense and does not improve with conventional analgesia or is accompanied by a fever, you should go to the emergency department since there may be an infection or obstruction of the urinary tract ( obstructive pyelonephritis ). In this case the treatment will not be so simple, antibiotic treatment should be instituted and the unobstruction of the urinary tract should be considered by means of an internal referral through the ureter ( ureteral catheter ) or external derivation ( percutaneous nephrostomy ) in order to avoid complications greater.
 

Importance of control of kidney stones

Even if the calculations are asymptomatic, it is recommended to perform periodic checks .
 
Depending on the type of renal calculus can be raised before the appearance of problems some type of medical treatment taking into account that some patients can benefit from it. For example, uric acid calculations can sometimes be dissolved by urinary alkalinizers and a diet low in protein and at the same time can prevent further calculations. Patients suffering from cystinuria (genetic disorder) also require lifetime urinary alkalis and some other type of drug to prevent the formation of stones.
 
 

Risk Groups

 
Patients who need to be monitored more strictly are those who belong to the risk groups:
 
Patients with recurrent oxaloccalcical lithiasis , "stone-laying stones".
Lithium of uric acid and cystine .
Congenital malformations , intestinal resections and inflammatory bowel diseases
Hyperparathyroidism, which may require medical or surgical treatment of the parathyroid gland.
 
On the other hand, patients with benign prostatic hyperplasia may find it difficult to expel ureteral stones or develop bladder lithiasis. In his case, the most appropriate treatment is to intervene the prostate surgically.
 
In summary, it could be said that renal lithiasis remains today despite being one of the most studied a great unknown and trying to get prevention is still a great challenge.

 

*Translated with Google translator. We apologize for any imperfection

By Dra. Rosa Regué Aldosa
Urology

Dr. Regué Aldosa is a surgeon specialized in Urology who develops her activity at the Urology Institute Serrate & Ribal. He has also been trained in General Surgery and Oncology and has participated actively in numerous national and international congresses.

*Translated with Google translator. We apologize for any imperfection

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