Renal calculus. How to solve?

223040872_garota_bebendo_chaWhat is it?

O kidney stone (kidney stones) is the disease that is caused by crystals that are eliminated in the urine. Thus, it can occur as a result of diet and internal metabolism. When excess crystals occur in the urine, supersaturation occurs. In this way, the crystals are added to form the renal calculus.

There are many types of calculations, with different colors and formats.

It is usually caused by systemic metabolic changes. Therefore, it is not a renal disease, although there are calculations related to kidney tubule disease and rare genetic diseases, such as cystinuria and primary oxalaturia.

It occurs from 2-3 times more in men than women, with peak incidence between 4a e 6a decades of life. It is the most frequent disease in hot and dry climate regions. Mostly, it occurs in the summer and in workers exposed to warm environment. They are called occupational disease. In addition, it is associated with increased BMI, type II diabetes and metabolic syndrome.

Signals and symptons

The calculation inside the urinary collector system rarely causes pain. THE renal colic is one of the worst pains reported and indicates the passage of the calculus through the ureter. May occur hematuria micro or macroscopic, nausea and vomiting.

Generally the calculation smaller than 5 mm causes pain stronger than the larger ones. Nephrotic colic occurs due to pressure caused by the passage of urine through the obstructed ureter. Thus, during the descent from the calculus to the bladder there is ureteral distension. In addition, it causes hydronephrosis (the dilation of the kidney) and, consequently, colic pain.

The most painful moment occurs when the calculus attempts to overcome the bladder musculature and the submucosal pathway of the ureter into the bladder. This is the place of greatest resistance to the passage of the calculation. At this stage dysuria (difficulty urinating) and voiding urgency. Fever and chills may occur if there is a urinary tract infection. Thus, once in the bladder, usually the elimination of the calculus by the urethra is painless.


Risk factors

There is an association with family history, with dehydration, with high temperatures (higher incidence in summer, high risk in patients working in hot environments), ethnicity (higher incidence in white patients), obesity (the higher the BMI, or Body mass index, the greater the risk).

In addition, due to anatomical alterations of the urinary tract (obstruction), renal tubular acidosis, hyperparathyroidism, inappropriate eating habits, sedentary lifestyle, urinary tract infection, metabolic disorders, diabetes.

Moreover, medications (probenecid, losartan, salicylates, protease inhibitors, vitamin C, carbonic anhydrase inhibitors, calcium supplementation), chemotherapy, altered urinary pH, reduced volume (dehydration). Other hyperoxaluria, hypocitraturia, hypomagnesuria, hyperuricosuria, cystunuria, prolonged immobilization, intestinal resection, chronic inflammatory bowel disease (diarrhea), postoperative of bariatric surgery by fast weight loss.

Kidney stone diagnosis

In the acute phase, the ultrasound can report on the situation of the kidneys and presence of calculations in the urinary collecting system. In this way, it can show the degree of ureteropielocalicial dilation (hydronephrosis) and location of the calculi in the proximal and distal ureter and in the bladder. The gold standard of diagnosis is computed tomography without contrast. It reports on the size, number, location and density of kidney stones. Therapeutic behavior may be clinical or surgical.

Treatment of kidney stone

Some types of kidney stones can be treated, that is, dissolved, with adequate diet and medication. They can be removed spontaneously or surgically removed.

Knowing the type of the calculation one can plan the clinical treatment, especially for calculations smaller than 5mm, of uric acid or cystine. Larger calculations may be impacted and cause pronounced hydronephrosis, with or without pain, with destruction of the renal parenchyma.

These kidney stones should be removed by ureteroscopy or percutaneous renal surgery. However, sometimes the best course of action is simply to drain the urinary system because it is impossible to remove the urinary tract infection. It is a medical emergency because the patient is at risk of spreading the infection (septicemia).

Prevention of kidney stone

  • Increase fluids until light urine is given at all times of the day. One should drink at least 2 liters per day. Thus, recurrence occurs in 12% in hyperhydrated vs. 27% in those who drank water normally.
  • Decrease animal proteins to reduce the excretion of calcium, oxalate and uric acid.
  • Take juice from citrus fruits that neutralize the acidic load coming from animal proteins, especially lemonade. Lemon is the richest fruit in citrate. Moreover, it has 5 times more than orange and reduces oxalate excretion,
  • do physical activity (ideal is 3 times per week per 1: 15h),
  • avoid metabolic syndrome: central obesity (waist circumference greater than 100 cm);
  • hypertension (blood pressure equal to or greater than 130 / 85 mmHg);
  • altered glycemia (greater than or equal to 100 mg / dL); triglycerides greater than or equal to 150 mg / dL;
  • low HDL cholesterol or lower HDL cholesterol than 40 mg / dL) and
  • eating low-sodium diets (low sodium, calcium, pH and urinary citrate increase) and high fiber content.
  • Restrict oxalates (chocolate, sweet potato, spinach, soft drinks, multigrain cereals, peanut butter, green beans, tea, celery).
  • Depending on the type of calculation, your doctor may direct diet and medications to acidify or alkalize the urine.

However, if you would like to know more about this and other diseases of the genitourinary tract, access our content area for patients to understand and gain knowledge. Culture always makes a difference. You will be surprised! In it you can choose the subject you are interested to know. Select what you are looking for.

Reference

https://www.auanet.org/guidelines/kidney-stones-medical-mangement-guideline

https://www.auanet.org/guidelines/kidney-stones-surgical-management-guideline

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