diseases

Renal Calculi (Kidney Stone)

Introduction
Kidneys are the organs which help the body get rid of its waste products. These waste products are thrown out of the body through the urine. The waste products consist of various toxic substances, as well as some normal salts and minerals (which are present in excess in the body).

Normally, these salts pass easily through the urine. But, in certain conditions, the salts get deposited in the urinary tract, and this leads to the formation of a stone. Renal calculi are more prevalent in males than in females.

Definition
"Calculus" means a stone. Renal calculi refer to the formation of stones in the kidneys, which mainly consist of the aggregates of crystals of the normal constituents of urine.

Causes and risk factors
The causes can be grouped into different categories for a better understanding, as follows:

Environmental and dietary: (where due to any of the these factors, there is increased excretion of the normal mineral salts present in the urine)
. Decrease in the urine volume when the environmental temperature is high or the fluid intake of the patient is reduced.
. When a person consumes diet containing higher concentration of proteins, sodium (salt), or reduced concentration of calcium.
. Increased excretion of salts in the urine.
. Decreased concentration of citrates (a constituent of urine, which normally keeps calcium in solution).

Other medical conditions:
. Hyperparathyroidism (increased functioning of the parathyroid gland), which leads to increased calcium excretion in the urine, increasing the chances of stone formation.
. Ileal disease (a part of the intestine), results in increased absorption and excretion of oxalate.

Inherited conditions:
. Genetic factors also play a role in certain people.

According to the main mineral constituent of the stone, they can be of various types: oxalate calculus, phosphate calculi, uric acid and urate calculi, cystine calculi, and xanthine calculi.

Also, depending on the position of the stones in the urinary tract, they can be termed as kidney stones, bladder stones or ureteric stones.

Risk factors
. Persons with vitamin A deficiency are at a higher risk of developing kidney stone.
. Dehydration leads to increased precipitation of the salts in the kidney, hence increasing the chances of stone.
. Patients having recurrent urinary infections.
. Patients, who are on complete bed rest, are at a higher risk.
However, in developed countries, mostly, calculi are seen in healthy young people without any single predisposing factor or any abnormality in the investigations.

Screening and diagnosis
. In most of the patients, the presence of a stone is not known for a long period, unless it produces any symptoms or it is accidentally diagnosed during other investigations. Most of the stones remain silent.
. The majority of the symptoms are produced either due to the passage of the stone through the ureters (narrow tubes carrying urine from the kidney to the bladder), or due to a secondary bacterial infection.
. Pain is the leading symptom.
. In some cases, there may be a fixed renal pain in the loins, which may be aggravated by movement or while climbing the stairs.
. In majority of the cases, the patient who is previously not having any symptoms, suddenly becomes aware of the sever pain, which develops in the loins and radiates from the flanks to the groins.
. The pain starts increasing steadily and then reaches its peak within a few minutes.
. The patient may experience this intense pain for 2 hours, after which it may subside or may continue for hours or days.
. During the attack, the patient becomes anxious. He may have profuse sweating and vomiting.
. There may be an increased frequency of urination, dysuria (painful urination), strangury (painful passage of a few drops of urine), or hematuria (passage of bloody urine) during the attack.
. After the attack of renal colic subsides, there may remain a residual intermittent dull pain in the loins or back.
. In case the patient develops urinary tract infection, he may present with fever, chills, burning urination etc.
. Very rarely, the patient may develop complications like anuria (complete absence of urine in 24 hours), due to the obstruction of the ureters.
. Some other complications like severe infection or impaction of the stone in the ureters may occur producing severe constant pain.

Diagnosis
. Diagnosis can be easily made based on the history obtained from the patient. But, a few investigations may be advised to confirm the diagnosis.
. Urine examination: It is a very common test routinely advised for the confirmation of diagnosis of renal calculus. It may show the presence of amorphous material, or blood, or pus in case of a stone.
. Radiological examination: Opaque stones can be seen (phosphate calculi, cystine calculi).
. Excretion urography: Here, a dye is injected in the kidneys and its excretion is recorded at specific intervals after injecting the dye, with the help of a ultrasonography.This helps to find out the non-opaque stones, their position, their size and also the functioning of the other kidney.

Treatment
. Conservative treatment is helpful only in cases of stones less than 0.5cm diameter. It consists mainly of hydrotherapy. . The treatment aims at dissolving the stone, or aiding the passage of the stone with the urine. . If the attempts to dissolve the stone fail, surgical intervention may b e advised, which consists of endoscopic or an open surgery.Endoscopic surgery is preferred over the open surgery now a days. . Another way of dissolving the stones is through extra corporeal shock wave lithotripsy (where, shock waves generated outside the patient's body are focused on the stone; so that it gets fragmented and can easily pass through the urinary tract.) . Though, any of the means stated above may be helpful in eliminating the stone, there is every possibility of its recurrence.

Homoeopathic treatment
. In homoeopathy, acute remedies prescribed during an attack of renal colic, act very efficiently in relieving the pain of the patient.
. Other symptoms of burning micturition, blood in urine, painful urination, and increased frequency of urination will also be relieved.
. After the attack of the colic has subsided, we may give homoeopathic constitutional medicines based on the patient's physique and mentality, his nature of previous complaints etc.i.e. Considering the patient as a whole, and not only his complaints of the renal stone.
. This constitutional medicine will remove from the patient, his tendency of formation of stones; and thus prevent recurrence of the stone.
. Thus, homoeopathic remedies can very effectively be used either during an acute attack of colic or during the silent period. It can effectively control the acute symptoms as well as remove the tendency of the stone formation.

Patient care
. During an attack of renal colic, bed rest is the immediate treatment
. Application of warmth to the affected site may also help in reducing the pain.
. The patients, who are diagnosed as having renal stones, are advised to drink at least 2 litres of water per day.
. Restriction of sodium intake in diet (intake of salt) to prevent recurrence of oxalate stones.
. Avoid vitamin D supplements as they increase calcium excretion in the urine.
. Also, increase dietary calcium intake, but avoid calcium supplements in the form of tablets.

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