URBAN DISEASE (syn .: urolithiasis) is a chronic disease characterized by impaired metabolic processes 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 disease, or nephrolithiasis, in which urinary stones are formed in the parenchyma of the kidneys, kidney cups and the pelvis. At the same time stones can move to the ureters and the bladder, less often they are formed in the bladder.
The causes of the development of urolithiasis are impaired water-salt metabolism and the function of the endocrine glands that regulate it (thyroid, parathyroid glands, pituitary gland), urinary congestion in the urinary tract for diseases associated with impaired outflow, infection of the kidneys and urinary tract. The formation of urinary stones is promoted by long-term use of products containing large amounts 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 repeat the outlines of the kidney cups and pelvis - coral stones.
The clinical picture depends mainly on the location of the stone. Kidney stones may not manifest themselves, and sometimes cause pain in the lumbar region and microhematuria. The pain is usually aching, aggravated by exertion, and especially by jolting. The stone can disrupt the flow of urine from the renal pelvis and cause renal colic - a sudden attack of constant intense arching pain in the lumbar region or in the corresponding half of the abdomen with a spread sometimes to its lateral and lower sections. Renal colic is often accompanied by reflex paresis of the intestine (nausea and vomiting , abdominal distension, delayed stool and gas) and dysuria (frequent painful urination and false urge). In renal colic, the patient is restless, torn, often changes the position of the body in bed. There is pain when tapping in the lumbar region. After resolving an attack, red blood cells are usually detected in urine tests; possible appearance of protein, leukocytes, epithelial cells. Treatment of renal colic should be under the supervision of a physician. Before examining it, it is impossible to use painkillers that distort the clinical picture, since similar symptoms can be observed in some acute diseases of the abdominal organs; perhaps the appointment of antispasmodics (no-shpy, atropine).
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, the inner surface of the thigh, and frequent urination often occurs.
The diagnosis is made on the basis of the clinical picture (pronounced pain syndrome with characteristic irradiation, patient restless behavior, dysuria), anamnesis, laboratory and instrumental studies - X-ray examination (review and excretory urography), radionuclide renography, ultrasound of the kidneys and urinary tract.
Treatment consists of removing the stones, eliminating the causes of their formation, and the associated inflammatory changes. In cases where the stones of the kidney cups do not cause significant clinical manifestations, preferably conservative treatment. A significant role in the conservative treatment of urolithiasis is played by a balanced diet, appointed 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 study of already allocated stones.
When oxalaturia and oxalate stones limit the consumption of products containing an excess of oxalic acid and citric acid (sorrel, lettuce, spinach, pepper, legumes, currants, citrus, etc.). Patients are recommended food rich in vitamins of group B, A - boiled meat, fish, vegetable oil, cereal dishes, beets, cucumbers, watermelons, melons, non-acidic varieties of apples, pears, plums, etc. Patients with uraturia and urate stones limit food consumption containing purine (cocoa, coffee, chocolate, meat), and recommend a dairy-vegetable diet. When phosphaturia and phosphate stones limit the consumption of dairy products, eggs, etc., exclude products and medicines alkalizing urine (lemons, alkalis, etc.), recommend products that contribute to its acidification (meat, fish, fats, vegetable oils and others). When urolithiasis is recommended to increase fluid intake to 2 - 2.5 liters per day. It has been shown that mineral waters that have a diuretic effect, have antispasmodic and anti-inflammatory effects: with urate and oxalate stones or urine salts and acidic urine - Essentuki No. 4, Slavyanovskaya, Smirnovskaya, Berezovskaya and others, which reduce urine acidity. It is advisable to drink Arzni, Naftusya and others with patients with phosphate stones and phosphaturia in alkaline urine.
Small stones (up to 0.5 cm in diameter) are expelled from the kidneys and ureters with the help of various drugs, including antispasmodic drugs, physiotherapy, physical therapy and water loads (heavy drinking in the absence of renal colic). Stones larger than 0.5 cm in diameter are crushed or surgically removed. Remote extracorporeal lithotripsy is widely used to crush urinary stones due to sound and other types of directional energy. In the later stages of the disease with the loss of kidney function and severe purulent-inflammatory complications produce nephrectomy.
The prognosis for timely and proper treatment is relatively favorable. After surgical treatment, patients are shown prolonged anti-relapse treatment, taking into account the chemical composition of the stones, the reaction of urine, the presence of urinary infection, and the state of kidney function. With concomitant pyelonephritis anti-inflammatory therapy is carried out. Patients with urolithiasis should be in the dispensary registration, the main tasks of which are observation, anti-relapse treatment and timely hospitalization.