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NephrolithiasisNephrolithiasis – General InformationNephrolithiasis is the process of forming a kidney stone, a stone in the kidney or lower in the urinary tract. The kidneys stones are a common cause of the blood in the urine, flank, groin and pain in the abdomen. The process of forming these kidneys stones is related to decrease urine volume or increased excretion of stone forming components like calcium, oxalate, xanthine (is a substance found in caffeine and encountered in coffee, tea and cola), cystine (is the most insoluble amino acid), urate (is a salt that derives from the uric acid) and phosphate (a form of phosphoric acid). The kidney stones usually form in the urine collecting area of the kidney, named pelvis, and may be from tiny to staghorn stones the size of the renal pelvis. There are five major categories of kidney stones, such as:
From the five types of kidney stones, calcium stones are definitely the most commonly appearing form of Nephrolithiasis. Calcium oxalate stones are more common than the calcium phosphate stones, but the mixed form, meaning calcium phosphate and oxalate is the most common variety. Struvite stones that are usually seen in the setting of urinary tract infections are the second type of kidney stones. Uric acid stones, cystine stones and oxalate stones are a minor part of the total stones formed, but their importance relies in the fact that they need to be recognized and that it is feasible to prevent their development. Nephrolithiasis – SymptomsThe patients who have Nephrolithiasis (calcium kidney stones and uric acid stones) usually present flank pain that radiates to the anterior abdomen or to the genitalia. This pain is severe and comes in waves. In this case there exists usually a hematuria, be it microscopic or gross. Calcium oxalate crystals may be seen in the urine by microscope, but this is not a form of diagnosis since the calcium oxalate be found in the urine in non stone forming patients. There also exist patients with renal stones who are asymptomatic or that have painless hematuria. Struvite stones may cause the typical symptoms of a renal colic, but they are usually discovered in the course of investigating a patient who had recurrent urinary infections or that has asymptomatic bacteriuria. It is well known that these stones can grow to big sizes and this is why they are usually located in the renal pelvis and infundibula of the kidneys. In the case of the cystine kidney stones the patients have the symptoms of Nephrolithiasis at a younger age than those who have calcium kidney stones. These stones are radiopague, meaning that they have the appearance of a ground-glass, and amber. Other symptoms that patients may have are listed below:
Nephrolithiasis – TreatmentThe treatment goals of Nephrolithiasis include the relief of the symptoms and prevention of apparition of further symptoms. The treatment is based on the kind of the type of stones and the extent of the symptoms and complications that may appear. If the symptoms are severe hospitalization may be necessary.When the stone passes, the stones should be kept for analysis to determine their type and the urine should be strained. The patients should drink lots of fluids in order to produce high urinary output. Patients with Nephrolithiasis should drink at least six to eight glasses of water a day, but intravenous fluids may be necessary. Analgesics (which are pain relievers may be needed in order to control the renal colic, which is the pain associated with the passage of the stones and the severe types of pain can be treated with narcotic analgesics). Depending on the kind and severity of Nephrolithiasis medication is given in order to help the breakdown and excretion of the material that causes the forming of stones and in order to decrease the stone formation. These medications can include: diuretics, phosphate solutions, allopurinol (that is used for uric acid stones), antibiotics (that are used for struvite stones), and medications that alkalinize the urine like sodium bicarbonate and sodium citrate. Bicarbonate is a baking soda and it helps in the neutralization of the acid. Patients that have to follow this treatment will have to drink this solution every day for a period of time, which will be established by their doctors. Shock waves and ultrasonic waves are the regular therapy used for Nephrolithiasis, in order for the kidney stones to be eliminated in the urine (extracorporeal shock-wave lithotripsy) or in order for them to be removed with an endoscope. The endoscope is inserted into the kidney through a small incision (percutaneous nephrolithotomy). There are a few factors that influence the passage of the kidney stones, and these are:
Other drugs used in the treatment of Nephrolithiasis are:
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