Renal lithiases

May 2017


Definition

Lithiases, also known stones, are clusters of substances that form a sort of solid mass. These clusters can be found in particular in the bile ducts bile when there is an overload of cholesterol, but also in the urinary tract. Stones in the urinary tract can be of different types, mainly calcium oxalate, but also uric acid or calcium phosphates. Stones may be removed spontaneously by natural means, but they can sometimes block a duct and cause an accumulation of liquid that cannot escape. In most cases, urinary stones will block the ureter, the tube that takes urine from the kidney to the bladder. The risk of nephrolithiasis is increased by the excessive consumption of certain foods like chocolate, meats and dairy products.

Symptoms

Nephrolithiasis may not cause any symptoms. It is when it obstructs part of the urinary tract that it becomes the cause of clinical signs consistent with those of renal colic:
  • pain located in the lumbar spine, lower back, present only on one side;
  • typically, the pain seems to move towards the genitals, bypassing the flank;
  • the pain is described as one of the most severe in medicine, and its evolution is punctuated by crisis periods without pain;
  • occasionally, urinary or other digestive disorders are present, but it is the unbearable pain that dominates the picture.

Sometimes, treated pain will disappear and not return, reflecting the natural elimination of the stone when it is small enough. Otherwise, the crisis continues or repeats.

Diagnosis

The diagnosis is made after:
  • a clinical examination mapping out all of the symptoms. If these are typical, no test is required prior to implementation of the pain treatment.
  • Blood tests are often necessary, especially when looking for biological signs of inflammation, and the study of kidney function.
  • A radiograph of the abdomen can help highlight the presence of stones, however, all types of stones are not visible on X-ray
  • An ultrasound is then made, and allows both the locating of the stones, but also the study of the urinary tract.
  • If the stones are expelled, either spontaneously or by removal, their composition should be studied by a test called infrared spectrophotometry.

Treatment

The initial goal is to relieve pain: this is usually done intravenously using anti-inflammatory drugs like ibuprofen, antispasmodics such as phloroglucinol and sometimes morphine in cases of very severe pain. If the stone does not drain spontaneously and is found in the urinary tract, it will be removed, according to its appearance, by extracorporeal shock wave lithotripsy, a technique that breaks it down via a shockwave used outside the body, or by ureteroscopy, which forces the stone to pass directly through natural means. A last option, surgery, is used for certain types of stones.

Related

Original article published by . Translated by Jeff. Latest update on October 26, 2016 at 09:42 AM by MarziaChiriatti.
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