Most of the kidney stones are located in the renal pelvis, followed by the infrarenal calyces. Unilateral stones are the most common, while bilateral stones account for 10% of the cases. Because the internal diameter of the ureter changes from thick to thin and there are multiple physiological stenoses, stones tend to stay in the lower 1/3 of the ureter. The clinical manifestations vary greatly depending on the etiology, composition, size, number, location, mobility, presence of obstructive infection and the degree of parenchymal damage of the kidney.
In mild cases, there may be no symptoms at all, while in severe cases, anuria, renal failure, toxic shock, and death may occur. If the stone is embedded in the ureteral junction or descends in the ureter, renal colic may occur, which is a sudden onset of paroxysmal knife-like pain that is so severe that the patient tosses and turns.
Due to the heavy damage to the mucosa caused by the stone, there is often hematuria in the naked eye. Pain and J hematuria are often induced when the patient is more active. When stones are complicated by infection, pus cells appear in the urine and there are symptoms of urinary frequency and canker sores. It is mostly seen in adult men. There are many treatment methods for kidney stones, which need to be selected by the hospital according to the specific location and size of the stones, such as drug de-stoning, lithotripter lithotripsy, surgery, etc. can achieve the purpose of radical treatment.
1.Preventing the formation and recurrence of stones
1.1.Remove the causes of kidney stone and actively treat the causes of stone formation, such as removal of parathyroid glands for primary hyperparathyroidism, treatment of malignant tumor, control of renal pelvis infection and removal of urinary tract obstruction, all are effective measures to prevent stone formation and recurrence.
1.2. General treatment
①Ensure sufficient water intake, preferably magnetized water with little minerals, so that the daily urine volume is >2000 ml, which can dilute urine, reduce crystal precipitation, flush the urinary tract and discharge tiny stones;
②Dietary composition should be based on the type of stones and the pH of urine. For calcium oxalate stones. For calcium oxalate stones, foods high in oxalic acid such as spinach, tomatoes, potatoes, beets, lobelia, nuts, tea, machinima, chocolate, etc. should be avoided. As well as foods high in calcium such as milk, cheese, etc. For idiopathic hypercalciuria, calcium intake should be restricted to reduce the urinary calcium content most; for non-high urinary calcium recurrent pieces of oxalic acid stones, a low-calcium diet is not necessary.
If a low-calcium diet leads to urinary oxalic acid excretion, the stone may form. |If a low-calcium diet leads to increased urinary oxalic acid excretion and stone formation, a low-calcium diet is also not recommended. Control sodium intake, excessive sodium intake can increase urinary calcium excretion. Eating purine diet in hyperuricemia and hyperuricuria, avoid eating animal offal, less fish and coffee, etc.
1.3. Drug treatment
1.3.1, hypercalciuria caused by primary hyperparathyroidism, sarcoidosis, hyperthyroidism, multiple myeloma, etc. should be treated accordingly. Other causes of the town to take the following measures: ① thiazide diuretics: dihydroketuria 50-100 ms / a, or the corresponding dose of other diuretics; ② sodium phosphate fiber resin: 2.5-5 g each time, when eating I Division to take. l Division should be appropriate to limit the intake of Ge acid, while supplementing calcium; ③ orthophosphate: 1.5-2.0 g / a phosphorus / has been vegetarian, divided into 3 -4 doses. Glomerular filtration rate of less than 30 ml/min and urinary tract infection is not used, because it can cause metastatic soft tissue calcification and infected stones.
1.3.2, enterogenic hyperoxaluria available magnesium hydroxide or magnesium oxide. Digoxin can correct intestinal absorption of fat malabsorption, but can not continue to inhibit the absorption of monoacid.
1.3.3, low urinary citrate containing calcium kidney stones usage is 3-6 g / d, divided into three doses. Some patients may have mild gastrointestinal reactions. Use with caution in renal insufficiency.
1.3.4 For uric acid stones, potassium citrate is preferred clinically at a dose of 30-60 mmoL/d. If the blood uric acid increases at the same time, it is advisable to add allopurinol and change to maintenance dose after controlling the blood uric acid concentration.
1.3.5. Cystinuria and cystine stones may be treated with D-penicillamine at 1-2 g/a in divided doses when treatment with adequate water (often >3L/d) and alkalinization of urine (pH >7.5) is ineffective. a-mercaptoacrylglycine has a similar mechanism of action to D-penicillamine, with fewer side effects.
1.3.6, Infectious stones long-term effective control of urinary tract infection, can limit the formation of infectious stones, and even make some formed stones dissolve. However, due to the low concentration of antibiotics in the stones, the bacteria cannot be completely killed fire, so it is difficult to make the urinary tract infection completely cured by simple antibacterial treatment.
2.Treatment of stones
The treatment of kidney stones has made great progress in recent years. Many kidney stones that required surgical treatment in the past can now be removed by extracorporeal shock wave lithotripsy or non-open surgery, or several methods can be used in combination to achieve satisfactory results. Internal therapy can be used for smooth round stones less than 0.5 cm in diameter, without urinary tract obstruction or infection, and with good renal function.
Lithotripsy is more effective for uric acid stones and cystine stones, but less effective for calcium stones and infected stones, and can be administered by portal, intravenous, ureteral trap, open nephrostomy cannula and percutaneous nephrostomy cannula. During the treatment period, the condition should be closely observed, regular radionuclide nephrogram and x-ray examination to understand the kidney function, and decide whether to include surgery.
3.Symptomatic treatment
3.1, renal colic treatment application of antispasmodic atropine or 654-2 intramuscular injection, can be combined with promethazine to enhance the efficacy, ineffective application of dulcolax or morphine, etc.
3.2.Treatment of urinary tract infection, see “urinary tract infection”.
3.3. If hematuria is obvious, use hydroxybenzylamine 0.1~0.2 g or hemostatic cyclic acid o.1 g, slowly injected intravenously, 3 times/d.
4.Discussion
The purpose of kidney stone treatment is not only to relieve the pain and protect the kidney function, but also to find and relieve the cause of the disease as much as possible to prevent the recurrence of stones. Treatment includes general treatment, etiology treatment, extracorporeal shock wave lithotripsy, intracavitary lithotripsy, lithotripsy treatment, surgical treatment, Chinese medicine treatment and food bait therapy and other comprehensive measures. General treatment includes drinking plenty of water and acupuncture therapy.
The daily urine volume should be maintained at 2000-3000ml as much as possible. Drinking a lot of water together with diuretic and antispasmodic drugs can promote the discharge of small urinary stones. In order to maintain the nighttime urine volume, in addition to drinking water before going to bed, it is advisable to drink water again after getting up at night to urinate. Dilute urine slows down the growth of stones and the recurrence of nodal rows after surgery. In the presence of infection, more urine most town promotes drainage and facilitates infection control.
In the case of renal colic, drinking more water may aggravate the colic, but if combined with acupuncture and antispasmodic drugs, it may help the stones to be expelled. If the stone is small and the patient is in good health, physical activity can be used and towel western medication can be applied to facilitate the stone’s discharge on its own. In the last decade, there has been a breakthrough in the treatment of kidney stones, and now the common treatment methods are extracorporeal shock wave lithotripsy (ESWL) and endoluminal urology.