Thứ Hai, 13 tháng 1, 2014

Nephrolithiasis

Nephrolithiasis Nephrolithiasis also called as renal lithiasis is the kidney stones wherein hard deposits of stone like particles are found in the kidneys. They are actually not stones but are unused minerals and salts formed in the urine, which unite to form small stones. When urine concentration gets higher than normal it allows certain chemicals and salts to crystallize thus forming nephrolithiasis.


Kidney stones are generally harmless except causing pain when they pass through your kidney. In most of the cases, drinking plenty of water and taking pain-killers are enough for treating nephrolithiasis. However, in some cases, surgery has to be done for removing stones from the kidney.


Symptoms :


Often, nephrolithiasis will not cause any symptoms. It will cause moderate to severe pain if the stones move around within the kidneys or gets into the ureter tube. There can be severe pain at your back region below the ribs. The pain will be felt progressive spreading from lower abdomen till the groin. The intensity of pain will increase gradually and pain will spread like waves or ripples. Pain will be felt while urinating and urine will be dark red or brown in color with foul smell.


For some people there can be nausea, vomiting, fever and chills and the person will feel like urinating often. There can be bloody discharge in urine and difficulty in passing urine.


Causes :


There is no one single cause for nephrolithiasis since several factors play important role for causing kidney stones. If the urine contains lots of calcium and uric acid which combine to form crystals then it causes stone formation. Normal urine should be more diluted form than containing solid substances. If more and more crystals are formed it will combine together to form stone.


When there is more of calcium oxalate in the urine it can cause nephrolithiasis. Oxalate occurs in natural foods, fruits and vegetables. Metabolic disorders, liver problem, and diet that contain high level of vitamin D can increase the formation of calcium oxalate. Increased level of calcium oxalate will lead to formation of calcium phosphate. Certain types of infection can cause struvite stones which will grow rapidly in size forming large stones. Urinary tract infection can cause this type of stone.


Individuals who drink less water will get uric acid stones. Further eating high protein diet and genetic factors will also contribute to the formation of uric acid stones. Crystine stones are found in people who have genetic problems with kidney stone formation.


Who are at risk?


People who are obese, people who don’t drink enough water, people who lose more of fluids, people who consume protein rich diet and people who have family history of kidney illness have increased chance for getting nephrolithiasis. Age is another factor to get kidney stones. Individuals who have undergone gastric bypass surgery or those having inflammatory bowel disorder are susceptible for stone formation due to poor absorption of calcium.


Tests :


Your doctor will request for blood culture and urine test for checking the levels of uric acid. Further he would order for imaging tests like CT scan or X-ray for monitoring the urinary tract. Further he may collect the urine through strainer for checking it on the lab for the presence of kidney stones.


Treatment :


Very often kidney stones can be treated by taking medications and by drinking plenty of water. Small sized kidney stones can manage to pass through the ureter by having lots of fluids. You need to drink at least 2-3 liters of water daily for flushing out the stones through urinary system. For managing pain, you can take ibuprofen or acetaminophen pills like Tylenol which will reduce pain and discomfort. Alpha blocker drugs are given for relaxing the muscles and tissues of the ureter so that kidney stones can easily pass through it quickly without causing much pain. For large sized kidney stones conservative methods are not enough since they cannot pass through the tract. It can cause bleeding or even kidney damage and repeated urinary tract infections.


Shock wave lithotripsy is the method used for creating strong vibrations inside the urinary tract for breaking the stones into small pieces so that it can pass through urine. This process will take around one hour and the person is kept under sedation during the procedure. SWL may cause bloody urine and pain on the back and abdomen since the stone breaks up to find its path through the urinary tract.


Surgery can also be done for removing large sized stones of nephrolithiasis. This process is called percutaneous nephrolithotomy in wich kidney stones are removed through special instruments by making a tiny incision on the back. You will have to stay in the hospital for two days or even more until your condition becomes stable. This procedure is used for removing stones that are not responsive for SWL therapy.


Alternatively, a tiny tube with light and camera is sent through urethra into the bladder for removing small stones. The tools will either trap the stones which are brought out or break them into pieces for passing through the urine. This technique will not take more than few hours and it can be done with local anesthesia. If kidney stones develop due to abnormal levels of thyroid (hyperthyroidism) then extra growth from the gland is removed through surgery.


Prevention :


You can easily prevent formation of nephrolithiasis by making small changes in your daily routine. Drink enough water daily unless you have any other medial issues. Doctors will initially ask you to measure the volume of urine output per day to ascertain that you are drinking plenty of water. For people who live in hot climatic zones it is necessary to drink even more water to prevent kidney stones. Ensure the color of the urine is light and clear which indicates that you are drinking enough water.


Take less quantity of foods that are rich in calcium oxalate. For instance you need to restrict the intake of sweet potatoes, beans, soy, spinach, nuts, coffee, tea and chocolates which have high levels of oxalate. Reduce the total volume of salt intake and restrict eating animal proteins. You can continue to take calcium rich foods since it will not lead to the formation of kidney stones. But avoid taking calcium supplements.


Certain medications can be useful for preventing accumulation of minerals and uric acid in kidneys. Thiazide diuretic is prescribed for managing calcium stone formation. Uric acid stones can be prevented by taking allopurinol or aloprim which will keep the uric acid level in control. Struvite stones can be managed by taking antibiotics. Cystine stones can be removed by specific medications meant for it.


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