urinary stones

Summary

Urinary calculi (urinary lithiasis, renal calculi or kidney stone) are crystals that group together and lose their solubility, forming a kind of “stone” that can be eliminated in the urine or can lodge in the urinary ducts, thus causing pain, obstruction of urine and in more serious cases, urinary infections .

Patients, for the most part, have an imbalance of salts and minerals present in the blood. It is a condition that may be due to the type of diet or even facilitated by the existence of another clinical condition such as gout, diabetes mellitus and obesity, for example. Dehydration is one of the factors that is closely linked to cases of calculus, which is why cases increase a lot in the summer, when we lose fluid not only through urine, but also through sweat.

It is estimated that around 12% of the world’s population currently suffer from urinary stones and that one in every 200 people may suffer from a kidney stone in their lifetime. Some people have a higher risk of developing the disease due to several factors such as low water intake, genetic factors, among others, 24% of the population has a greater predisposition to form calculus.

The patient with urinary calculus may be asymptomatic, in which case it may remain for years without diagnosis and treatment. The fame of the disease comes from symptomatic cases where the patient has hematuria and very painful nephrotic cramps that can last up to 1 hour.
The diagnosis of the condition is made by imaging tests such as tomography and ultrasound. Currently, the most used exam is the helical computed tomography without contrast.

Treatment depends on the size of the crystal and the location of the calculation in the urinary system, and aims to remove the calculation, which is through the use of medications and subsequent elimination through the urine; through the degradation of calculations into smaller crystals and subsequent elimination in the urine; aspirations of the calculus by instruments through small incisions or, in extreme cases, through surgical removals.

Most cases have a natural improvement, with the natural expulsion of the stone. About 20% of cases need intervention/treatment.

According to the Mayo Clinic , in the United States, 3 tips help prevent kidney stones: drink more water, reduce salt intake and reduce meat consumption.

Definition

Calculus are mineral or organic substances present in excess in the blood and consequently in the urine, which have grouped together, lose their solubility and are deposited in the form of small crystals. Usually these crystals, called calculi, are excreted in the urine, but depending on their size and shape, they can get stuck in the body’s organs and ducts, causing pain and clinical complications.

The formation of calculations is called lithiasis. The calculations are deposited in the urinary tract (kidney, pelvis, urethra, bladder). Their compositions can be different, so the therapeutic strategies will be adapted to the calculations, as well as to the part of the urinary tract affected.

Various types of calculi can be found in various organs such as the pancreas, the gallbladder, the salivary glands, the lacrimal pathways or even the urinary tract.

Stone size
Small stones (less than 5 mm in diameter) can be present in the body without causing symptoms. On the other hand, large stones (10 mm or more) often lead to important symptoms such as severe pain.

Epidemiology

It is estimated that about 12% of the world’s population suffers or may suffer from urinary stones at least once in their lives. In the United States, an article in Prevention magazine from May 2018 estimated that about 1 in 11 Americans may have kidney stones at least once in their lifetime.

Studies also show that 12% of men and 5% of women aged 70 suffer from kidney stones. The risk of suffering from urinary stones again is around 50% after 10 years of the first episode.

Furthermore, the occurrence of kidney stones is higher among patients with a body mass index above 30.

According to the Secretary of Health of São Paulo, the number of kidney stones increases by 30% in the summer. At this time of year, in addition to losing fluid through urine, we also lose it through the pores, through sweat, becoming more dehydrated.

Most cases have a natural improvement, with the natural expulsion of the stone. About 20% of cases need intervention/treatment.

Several years ago it was believed that the prevalence of urinary stones was higher in men than in women. However, at least in 2018 in the United States, the prevalence was about the same among men and women. In other words, almost as many women suffer from urinary stones as men.

Causes

In general, they are calcic (based on calcium phosphates), oxalic (based on calcium oxalate) or uric (based on uric acid or urates).

It is important to know that identifying the type of calculation (stone) makes it possible to know the exact cause and prevent the appearance of new kidney calculations.

– Calcium stones are formed when the urine is very alkaline (basic urinary pH greater than 7). They migrate little, have serious consequences in the renal region and can recur, despite their extraction.

– Oxalic lithiasis occurs due to a diet rich in oxalic acids (alasao, betteraba, certain fruits and vegetables).

– Uric lithiasis is formed by uric acid or urates. Uric acid is the final metabolite in the decomposition of purines, substances that are very important in the formation of DNA.

Other Stones 
– Other stones can develop as struvite stones, these stones are formed after a response to an infection, such as a urinary tract infection. According to the Mayo Clinic , these stones can grow quickly and reach a significant size.

– Cystine stones (cystinuria, in English: cystinuria ) are another form of lithiasis (stone formation) that occurs in people who suffer from a hereditary disease, that is, of genetic origin. The disease is characterized by excessive excretion by the kidneys of the amino acid cystine, which is concentrated in the urine. There are also other forms of lithiasis, rarer, than those mentioned in this file.

There are dietary factors that contribute to the formation of stones, such as:

– Insufficient fluid intake, especially water, which dilutes the urine and prevents the formation of crystals (dehydration). In the summer, it is possible to observe an increase in cases of urinary calculations. One of the causes is heat, but dry weather can also cause dehydration.

– Diet low in calcium

– Use of calcium as a supplement

– Diet high in animal protein

– Diet high in sugar (sucralose, fructose)

– Diet low in phytates (found in rice, rye, wheat, and bean products)

– Diet high in sodium

– Diet with frequent intake of spinach

– Consumption of alcoholic beverages, as it causes dehydration that facilitates the formation of microcrystals in the kidneys. Beer is the most harmful alcoholic drink for the kidney.

– Diet rich in red meat, fat and excess salt.

In addition, some diseases contribute to an increased risk of kidney stones, including:

– Primary hyperparathyroidism

– gout

– Obesity

– Diabetes mellitus

– Crohn’s disease

– Gastric or intestinal bypass surgery

Symptoms

Although it can be an asymptomatic condition, the symptoms of kidney stones are:
– Nephretic colic (main complication of urinary stones).
– Elimination of small crystals through the urine.

– Hematuria (blood in the urine that turns pink or red in color, or even cannot be seen with the naked eye)

– Digestive symptoms (nausea, vomiting)

– Painful urination

– Urgent need to urinate.

– A higher frequency than usual to urinate.

– Urine with a special smell.

Nephrotic colic are very intense pains that usually last from 20 to 60 minutes and can occur unilaterally in the lumbar region, between the hip and the rib. The pains occur due to obstruction of the excretory pathways. To get rid of the calculations, the organ contracts, causing pain and even distension.

Observation on the pains 
In the case of kidney stones, the pains can be very severe, appearing in the side and in the back, especially behind the ribs. Pain can also develop in the abdomen, that is, in the lower abdomen. The pain can appear as a wave (moments with pain and without pain) and vary in intensity (very severe pain and then mild). As seen above, pain can also occur when urinating.

Intensity of symptoms
In general, symptoms are more marked when calculations (stones) reach the ureter.

Diagnosis

The doctor will be able to diagnose urinary calculi through different means:
– X-ray of the abdomen (shows the calculations that are opaque)
– Abdominal computed tomography (more specifically, helical computed tomography without contrast is the most recommended in these cases)
– Ultrasonography (method used in the case of people with problems to perform radiation examinations such as pregnant women, as small stones or in the ureter may not be visualized using this method)
– ultrasound scan
– intravenous urography
– blood test: to measure the amount of calcium and uric acid in the blood
– urine test: to identify the presence of stones, urine test usually done over a 24-hour period
– analysis of stones, especially by means of laboratory methods.

Once the stones are diagnostic, it will be necessary to analyze how they affected the renal region. The treatment will be determined after analyzing the composition of the stones.

Complications

The main complication of urinary calculi is nephrotic colic.

Hydronephrosis is another possible serious complication of urinary stones that can affect the kidney, it is an obstruction of the flow and urinary tract.

If urinary stones are not treated they can trigger an infection, blockage of the kidney, and ultimately kidney failure (change in kidney function).

Treatment

Urinary stones are treated according to their type, size, location and patient’s condition. If the calculation of a patient who tolerates pain well and manages to eat and hydrate has chances of being excreted (generally calculations with less than 5 millimeters) without a more invasive procedure, this patient can even be treated at home. Generally in these cases, it is advised that the patient reserve his urine, so that the expelled stone is analyzed in a laboratory in order to determine its content. In this way, the doctor can evaluate and plan the treatment to prevent the appearance of new calculations and even better conduct the treatment of a new calculation that appears.

Its treatment, in general, consists of administering non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Currently, alpha-adrenergic blockers are also used to accelerate the elimination of stones in the urine.
Some diuretics, such as thiazides, are often used in calcium urinary stones.

It is also necessary to take care of hydration and nutrition, and according to the calculation formed, adapt the intake of the following items:

– foods with a lot of oxalic acid: beets, sorrel, certain fruits and vegetables

– foods that, after being metabolized in the body, produce a lot of uric acid: veal rice, giblets, liver, herring)

Urinary pH should be monitored when urinary calculi are calcic.

It is also possible to extract or destroy calculations by:

– ultrasound (destruction of stones)

– percutaneous nephrolithotomy (extraction of the calculus through puncture of the renal cavities through the lumbar route)

– surgery

Larger stones, usually larger than 9 or 10 millimeters, do not pass through the urinary ducts. In such cases, it is necessary to extract or destroy the calculations through:

– Extracorporeal Shockwave Lithotripsy (ESWL)

– Ureteroscopy (passage of a thin, flexible tube through the urethra into the ureter and bladder)

– Percutaneous nephrolithotomy (extraction of the calculus through puncture of the renal cavities through the lumbar route)

– Percutaneous Ultrasound Lithotripsy (insertion of the ultrasound instrument through a small incision in the back towards the kidney, where ultrasound waves will reach the stone and break it into smaller pieces that can be eliminated in the urine .

– Endoscopic laser lithotripsy (a laser beam separates the stones in the ureter, thus allowing them to be eliminated in the urine)

– Endoscopic shock wave lithotripsy (normally used for stones smaller than 2 cm.)

– Surgery, it is only indicated in 10% of cases, when it is observed that the stone is stuck in the ureter and cannot go down. The surgery is usually performed through a small incision in the back.

Parathyroid Gland Surgery
In some cases, calcium stones are caused by an overactive parathyroid gland that results in a very high concentration of calcium in the blood. A small benign tumor in the parathyroid gland can cause this excess calcium. In this case, surgical removal of this small tumor can stop the appearance of kidney stones.

In case of nephrotic colic (acute complication of kidney stones), it is essential to:

– do not drink during the crisis (so as not to overload the affected kidney)

– decrease pain (NSAIDs)

– soothe spasms

After the pain subsides, it is advised to drink plenty of fluids to eliminate waste and help prevent the appearance of new calculations.

Herbal medicine

People with a tendency to form kidney stones can use the following medicinal plants:

Note: infusions can be taken 2 to 3 times a day.

– garlic , in the form of a condiment, in dishes

– lemon , lemon juice every morning, it is also possible to drink an orange juice. Ideal to prevent urinary stones, as these juices are rich in citric acid.

– juniper , in infusion

– nettle , in infusion, to prevent urinary calculi

– infused geranium: 1 dessert spoon for a cup of infusion

– hyssop in infusion: 20 grams for 1 liter of water

– birch , in infusion, to prevent urinary stones

– stonebreaker

– corn

– hibiscus

– Tea (black or green). According to a study, drinking a cup of tea a day reduces the risk of urinary stones.

Tips & Prevention

– Drink at least 2 liters of fluids a day

– Reduce your salt and protein intake (especially red meat, but also poultry and fish). Protein lowers the pH in the urine, which increases the calcium level. Salt also has a negative effect on stone formation.

– Eat more citrus fruits.

– Don’t drink sugary drinks like sodas, because they are high in glucose (a risk factor for kidney stones).

– In cases of urinary calculus, reduce foods rich in calcium oxalate ( oxalate foods ), such as beets, chocolate, nuts, sweet potatoes or spinach.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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