Urolithiasis (syn.: Urolithiasis) is a chronic disease characterized by metabolic disorders in the body, changes in the kidneys and urinary tract with the formation of urinary stones in them. The most common form of this disease is kidney stone disease, or nephrolithiasis, in which urinary stones form in the parenchyma of the kidneys, renal calyces, and pelvis. In this case, stones can move into the ureters and the bladder, less often they form in the bladder.
The reasons for the development of urolithiasis are a violation of water-salt metabolism and the functions of its endocrine glands (thyroid gland, parathyroid glands, pituitary gland), urinary stasis in the urinary tract in diseases accompanied by a violation of its outflow, kidney and urinary tract infection. The formation of urinary stones is facilitated by the prolonged use of foods containing a large amount of mineral salts, hard drinking water, etc.
Depending on the composition, urates are distinguished - urinary stones from uric acid salts, oxalates - from calcium oxalate, phosphates - from phosphate salts, etc. Small urinary stones can gradually increase in size. Large stones can follow the shape of the renal calyx and pelvis - coral stones.
The clinical picture depends mainly on the localization of the stone. Kidney stones may not manifest themselves in any way, and sometimes cause pain in the lumbar region and microhematuria. The pain is usually aching, aggravated by physical exertion and especially when shaking. A stone can interfere with the outflow of urine from the renal pelvis and cause renal colic - a sudden attack of constant intense bursting pain in the lumbar region or in the corresponding half of the abdomen, sometimes spreading to its lateral and lower sections. Renal colic is often accompanied by reflex intestinal paresis (nausea and vomiting , bloating, stool and gas retention) and dysuria (frequent painful urination and false urge). With renal colic, the patient is restless, rushing about, often changes the position of the body in bed. Pain is noted when striking in the lumbar region. After resolving the seizure, red blood cells are usually detected in urine tests; the appearance of protein, white blood cells, epithelial cells is possible. Treatment of renal colic should be carried out under the supervision of a physician. Prior to its examination, painkillers that distort the clinical picture cannot be used, since similar symptoms can be observed with some acute diseases of the abdominal organs; prescription of antispasmodics (no-shp, atropine) is possible.
Clinical manifestations with ureteral stones are almost the same as with kidney stones, but more often there are acute paroxysmal pains radiating to the inguinal region, genitals, inner thigh, and frequent urination often occurs.
The diagnosis is made on the basis of the clinical picture (severe pain syndrome with characteristic irradiation, restless behavior of the patient, dysuria), medical history, laboratory and instrumental studies - X-ray examination (survey and excretory urography), radionuclide renography, ultrasound examination of the kidneys and urinary tract.
Treatment consists of removing stones, eliminating the causes of their formation, and the associated inflammatory changes. In cases where kidney stone stones do not cause significant clinical manifestations, conservative treatment is preferred. An important role in the conservative treatment of urolithiasis is played by rational nutrition, prescribed depending on the nature of metabolic disorders. An idea of the chemical composition of the stone can be obtained on the basis of urinalysis, x-ray data and the study of already identified stones.
With oxalaturia and oxalate stones, the consumption of products containing an excess of oxalic and citric acid is limited (sorrel, lettuce, spinach, pepper, legumes, currants, citrus fruits, etc.). Patients are recommended foods rich in B and A vitamins, such as boiled meat, fish, vegetable oil, cereals, beets, cucumbers, watermelons, melons, non-acidic varieties of apples, pears, plums, and others. Patients with uraturia and urate stones are limited in food intake containing purine (cocoa, coffee, chocolate, meat), and recommend a milk-vegetable diet. With phosphaturia and phosphate stones, they limit the consumption of dairy products, eggs, etc., exclude products and drugs that alkalinize urine (lemons, alkalis, etc.), recommend products that promote its acidification (meat, fish, fats, vegetable oils and other). With urolithiasis, it is recommended to increase fluid intake to 2 - 2.5 liters per day. Drinking mineral waters with a diuretic effect, with antispasmodic and anti-inflammatory effects is shown: with urate and oxalate stones or urinary salts and acid urine reactions - Essentuki No. 4, Slavyanovskaya, Smirnovskaya, Berezovskaya, etc., which contribute to a decrease in urine acidity. For patients with phosphate stones and phosphaturia with an alkaline urine reaction, it is advisable to drink Arzni, Naftusu, etc.
Small stones (up to 0.5 cm in diameter) are expelled from the kidneys and ureters with the help of various medications, including antispasmodic drugs, physiotherapy, physiotherapy and water stress (heavy drinking in the absence of renal colic). Stones larger than 0.5 cm in diameter are crushed or removed surgically. Widely used remote extracorporeal lithotripsy, which allows crushing urinary stones due to sound and other types of energy directed exposure. In the late stages of the disease, with the loss of kidney function and severe purulent-inflammatory complications, a nephrectomy is performed.
The prognosis for timely and proper treatment is relatively favorable. After surgical treatment, patients are shown long-term anti-relapse treatment taking into account the chemical composition of stones, urine reaction, the presence of urinary infection, and renal function. With concomitant pyelonephritis, anti-inflammatory therapy is performed. Patients with urolithiasis should be registered at the dispensary, the main tasks of which are observation, anti-relapse treatment and timely hospitalization.