We have seen what kidney stones are and why they form. Today, we will explore together the symptoms of kidney stones and the solutions available to diagnose it, treat it and prevent recurrence.
I remind you briefly that i kidney stones they are “pebbles”, of variable size, which are formed by the aggregation of one or more substances present in the urine, such as, for example, mineral salts (such as calcium) or organic compounds (such as uric acid). Com "it is easy to imagine, these pebbles can be obstruct the normal outflow of urine, both provoke injuries along the course of the urinary tract. In the most serious case, the stone continues to grow, completely occupying the kidney cavity in which it is located and thus compromising the functionality of the kidney itself. When a stone, pushed by urine, migrates from the kidney to the ureter and obstructs it more or less completely, the so-called renal colic. These colic are notoriously characterized by episodes of severe pain in the side, which often also extends to the abdominal and genital region. Normally, colic occurs suddenly. The pain of renal colic is typically spasmodic, intense and lasts several minutes. The severity of the pain is such that it is described as similar or even greater than that of a childbirth, and it is a common cause that pushes patients to go to the emergency room. It is possible that during the passage in the urinary tract the pebble causes lesions causing the appearance of blood in the urine. In addition to colicky pain, sometimes the presence of kidney stones can be associated with other symptoms, such as difficulty urinating, urge urination, nausea and vomit. The presence of fevergenerally suggests a urinary tract infection. However, I remind you that kidney stones of small size, therefore not obstructing, can also be asymptomatic and spontaneously eliminated without creating any disturbance.
As for the diagnosis, L'urinalysis and theultrasound of the kidney they are usually sufficient to identify a stone. The urinalysis is able to highlight traces of blood not visible to the naked eye, and allows to analyze the composition of the urine. In particular, the examination includes the evaluation of urinary volume and pH and can establish the concentration of substances such as calcium, phosphorus, sodium, uric acid, oxalate, citrate, cystine and creatinine. For this purpose the analysis of at least two samples collected in 24 hours. Finally, to complete the metabolic assessment, theblood exam completed and theurine culture in case of urinary infections. Blood tests can show elevated levels of BUN and creatinine, which in turn can indicate dehydration or the presence of an obstructive stone. Another very important examination, especially useful for establishing the most appropriate therapeutic protocol, is the analysis of chemical composition of the kidney stone. Moving on to instrumental investigations, the initial evaluation must include a renal ultrasound. This examination provides sufficiently detailed information without exposing the patient to radiation. In particular, renal ultrasound is able to identify possible dilations of the kidney and urinary tract or the very presence of stones in the kidney cavities. The doctor may also resort to other diagnostic techniques, such as radiography standard of the abdomen or the CT scan without contrast. The abdomen radiography allows you to establish the number, size and location of the stones. Above all, it allows calculations made up of calcium oxalate and calcium phosphate stones to be evaluated, because they are radio-opaque. On the other hand, it is not effective in case of proximity of the stones with the skeletal system or in the aggregations of uric acid or cystine, since these stones are invisible to X-rays, ie radiolucent.However, these calculations can be highlighted with the CT scan.
Kidney stone therapy provides on the one hand the management of renal colic, to mitigate the pain, and on the other hand the use of a pharmacological or surgical treatment for dissolve or eliminate the stone. We have already seen how smaller stones can be expelled spontaneously, sometimes asymptomatically. In order to facilitate their expulsion, rest is first of all provided, associated with the change in dietary regimen and to a increase in the daily intake of liquids. The latter approach involves the intake of high quantities of low-mineral or minimally mineralized water, to cause urine excretion of more than 2 liters over a 24-hour period. This type of therapy, based on the "increase of" water intake, is called hydropinic and should be practiced only if recommended by the doctor, since in some cases it could be quite dangerous. drinking therapy is based on a rather simple concept: increasing the volume of urine favors the spontaneous expulsion of small kidney stones and hinders their progressive growth. Generally, in the case of small stones, up to 5-7 mm, the spontaneous expulsion process can take approximately 2 to 15 days.
If the stone does not obstruct the urinary tract, drug therapy is based on the use of diuretics And disinfectants of the urinary tract to ward off any infections. Uric acid kidney stones have the favorable characteristic of dissolving completely by alkalizing the urine, i.e. increasing its pH. This is achieved through a medical therapy based on citrates and bicarbonates to be taken orally. Cystine stones, on the other hand, often cause complex and bulky formations that are very hard and difficult to treat. Drug therapy is also useful for the control of pain caused by renal colic. Given the intensity of the pain, they are administered in hospital analgesics and antispasmodics intravenously, waiting for the spontaneous expulsion of the stone, which must move from the ureter into the bladder. The administration of antispasmodics has the purpose of reducing the contractility of the smooth muscles, thus facilitating the progression of the calculus from the ureter to the outside. If spontaneous expulsion is not possible and the drugs prove ineffective, we proceed with the removal of the kidney stones or their crushing by shock waves.
To eliminate a stubborn stone, which does not want to know that it is expelled, different techniques can be used. The choice of the most appropriate intervention naturally depends on the characteristics, dimensions, localization and number of calculations. There are also conditions that make certain procedures contraindicated; for example, extracorporeal lithotripsy, which we will see shortly, is not indicated in pregnant women or in the case of aortic aneurysms. Renal lithotripsy is therefore included among the treatment options. This technique consists of a literal bombardment of the stone through a beam of shock waves, which has the purpose of breaking it into small fragments which are then spontaneously expelled. The probe that generates these sound shock waves can be positioned outside or inside the body. Extracorporeal lithotripsy is indicated for the fragmentation of small stones. It is a clearly minimally invasive therapeutic method, used above all. for some calcium oxalate stones, struvite stones and uric acid stones. If the stone is very large or hard in consistency, such as those of cystine or calcium oxalate monohydrate, extracorporeal lithroxia offers very little hope of success. Therefore, in these cases, it is necessary to bombard the calculations from the inside through percutaneous or transurethral lithotripsy. The percutaneous technique, which means through the skin, involves the practice of an "incision in the side, under the ribs; through this hole an instrument is inserted which, under ultrasound guidance, allows you to reach the kidney, open a passage, shatter the calculus and remove the fragments. It is therefore a surgical operation, albeit minimally invasive. Transurethral lithroxia, also called urethrolithotripsy, is instead an endoscopic technique. In practice, thin probes are inserted through the urethra, traced back to the point where the calculation stopped, at this point the probes can emit acoustic waves or laser beams that shatter the stone.The resulting fragments can then be eliminated together with the urine or removed with small pliers or "baskets". In cases so complex that the endoscopic or percutaneous approach is not recommended, it may be necessary to resort to open surgery, which involves opening the 'abdomen.
With regard to the prevention of kidney stones, it is recommended to pay attention tohydration, drinking enough especially in the summer and in the presence of physical activity. Attention also to the diet, as the composition of the urine is directly related to nutrition. The food plan must be personalized and planned together with a specialist, because it must be adapted to the type of stones to which the patient is subject. There are many aspects to consider and include the consumption of proteins, vegetables, dairy products, alcohol, salt and urinary pH.
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