When should you seek emergency care for kidney stones. What are the warning signs that require immediate medical attention. How to recognize severe symptoms that indicate a hospital visit is necessary. What treatments are available for kidney stones in the ER.

Recognizing Severe Kidney Stone Symptoms

Kidney stones can cause a range of symptoms, from mild discomfort to excruciating pain. Knowing when to seek emergency care is crucial for managing this condition effectively. Here are the key symptoms that warrant a trip to the emergency room:

• Sharp, intense pain in the side, back, or lower abdomen
• Severe pain during urination
• Blood in the urine (hematuria)
• Fever or chills
• Persistent nausea and vomiting
• Unbearable pain that continues to worsen

If you experience any of these symptoms, it’s essential to consult with a medical professional immediately. These signs may indicate that a kidney stone is causing a blockage in your urinary tract or has become infected, potentially leading to more serious health complications.

Understanding the Urgency: Why Immediate Care Matters

Why is it crucial to seek emergency care for severe kidney stone symptoms? When a kidney stone causes a blockage or becomes infected, it can lead to additional health issues and worsen existing symptoms. In some cases, urgent medical intervention, such as medication or surgery, may be necessary to prevent further complications.

Delaying treatment can result in increased pain, potential kidney damage, or the spread of infection. By seeking prompt medical attention, you can receive proper diagnosis and treatment, potentially avoiding more serious health consequences.

Kidney Stone Surgery Options and Recovery

If emergency care determines that surgery is necessary to treat your kidney stones, there are several options available. Understanding these procedures and their recovery times can help you prepare for what lies ahead:

1. Shock Wave Lithotripsy (SWL)

This non-invasive procedure uses shock waves to break up kidney stones into smaller fragments that can pass through the urinary system naturally. Patients typically return home the same day and can resume normal activities within 2 to 3 days.

2. Ureteroscopy (URS)

In this minimally invasive procedure, a thin surgical tool called an ureteroscope is inserted through the urethra to view and treat the stones. A laser is used to break up the stones, which are then removed using a basket-like device. Like SWL, patients usually go home the same day and recover within 2 to 3 days.

3. Percutaneous Nephrolithotomy (PCNL)

For larger stones or those in difficult positions, PCNL may be necessary. This procedure involves making a small incision in the back or side to insert a nephroscope, which is used to view, break up, and remove the stones. Patients typically stay overnight in the hospital and return to normal activities after 1 to 2 weeks.

Post-Surgery Care and Potential Complications

After kidney stone surgery, your doctor may insert a tube in your kidney or a stent in your ureter to help drain urine. While these devices aid in recovery, they may cause some discomfort. Stents are usually removed 4 to 10 days after the procedure.

It’s common to experience some discomfort or notice blood in your urine as stone fragments pass through your system. However, if you experience severe pain, fever, or other concerning symptoms, it’s important to contact your healthcare provider immediately.

Preventing Future Kidney Stones: Lifestyle Changes and Medical Management

While dealing with a kidney stone emergency is crucial, preventing future occurrences is equally important. Here are some strategies to reduce your risk of developing kidney stones:

1. Stay hydrated by drinking plenty of water throughout the day
2. Limit sodium and animal protein intake
3. Increase consumption of citrus fruits and vegetables
4. Maintain a healthy weight
5. Avoid excessive caffeine and alcohol consumption

Your doctor may also recommend specific dietary changes or medications based on the type of kidney stones you’ve experienced. Regular follow-up appointments can help monitor your condition and adjust prevention strategies as needed.

Understanding Kidney Stone Formation: Causes and Risk Factors

Why do kidney stones form in the first place? Kidney stones develop when there’s an imbalance of water, salt, and minerals in your urine. This imbalance can lead to the formation of small crystals that gradually grow into stones within your kidneys.

Several factors can increase your risk of developing kidney stones:

• Dehydration
• Diet high in sodium, sugar, and animal protein
• Obesity
• Certain medical conditions (e.g., gout, inflammatory bowel disease)
• Family history of kidney stones
• Certain medications

Understanding these risk factors can help you take proactive steps to prevent kidney stone formation and avoid future emergencies.

When to Consult a Urologist: Beyond Emergency Care

While emergency care is crucial for severe symptoms, ongoing management of kidney stones often requires the expertise of a urologist. When should you consider scheduling an appointment with a urologist?

• After experiencing your first kidney stone
• If you have a history of recurrent kidney stones
• When you’re struggling with persistent urinary symptoms
• If you have a family history of kidney stones and want to discuss prevention strategies

A urologist can provide comprehensive care, including detailed metabolic evaluations, personalized prevention plans, and long-term management strategies to reduce your risk of future kidney stone formation.

Diagnostic Tools and Tests for Kidney Stones

How do healthcare professionals diagnose kidney stones, especially in an emergency setting? Several diagnostic tools and tests may be used to confirm the presence of kidney stones and determine their size and location:

1. CT Scan

A computerized tomography (CT) scan is often the preferred method for diagnosing kidney stones in the emergency room. It provides detailed images of the urinary system and can detect even small stones.

2. Ultrasound

This non-invasive imaging technique uses sound waves to create images of the kidneys and urinary tract. While less detailed than a CT scan, it’s often used as an initial screening tool, especially for pregnant women or children.

3. X-rays

Traditional X-rays can sometimes detect kidney stones, particularly if they contain calcium. However, they’re less sensitive than CT scans or ultrasounds.

4. Urinalysis

A urine test can detect blood in the urine and signs of infection. It may also provide clues about the type of kidney stones present.

5. Blood Tests

Blood tests can check for elevated levels of certain minerals that contribute to stone formation and assess overall kidney function.

These diagnostic tools help healthcare providers determine the most appropriate treatment plan, whether it’s emergency intervention or ongoing management.

Medication Options for Kidney Stone Management

While surgery may be necessary for larger stones or severe cases, medications play a crucial role in managing kidney stones and preventing their recurrence. What are some common medication options used in kidney stone treatment?

1. Pain Relievers

Over-the-counter or prescription pain medications can help manage the discomfort associated with passing kidney stones.

2. Alpha Blockers

These medications can relax the muscles in your ureter, making it easier to pass small stones.

3. Diuretics

Certain diuretics can help increase urine production, potentially flushing out small stones and preventing new ones from forming.

4. Alkali Citrate

This medication can help prevent certain types of kidney stones by making your urine less acidic.

5. Thiazide Diuretics

These medications can help reduce calcium excretion in the urine, lowering the risk of calcium stone formation.

Your healthcare provider will determine the most appropriate medication based on the type of kidney stones you have and your overall health status.

Long-Term Outlook: Living with Kidney Stones

What does the future hold for someone who has experienced kidney stones? While kidney stones can be a painful and often recurrent condition, with proper management and lifestyle changes, many people can reduce their frequency and severity.

Key aspects of long-term kidney stone management include:

• Regular follow-up appointments with your healthcare provider
• Adhering to prescribed medications and dietary recommendations
• Staying vigilant about hydration and dietary choices
• Monitoring for early signs of stone formation
• Maintaining overall kidney health through regular exercise and a balanced diet

By taking a proactive approach to your kidney health, you can minimize the impact of kidney stones on your daily life and reduce the likelihood of future emergencies.

Remember, while kidney stones can be a challenging condition to manage, with the right care and prevention strategies, you can maintain your quality of life and keep your kidneys healthy for years to come.

When should you go to the hospital for kidney stones? Kidney stone surgery recovery | UC Irvine Health

When should you go to the hospital for kidney stones? Kidney stone surgery recovery | UC Irvine Health | Department of Urology

Certain kidney stone symptoms and changes in symptoms may indicate the need to consult with a primary care provider or visit the emergency room.

You should go to the hospital or seek medical attention for these kidney stone symptoms:

• A sharp pain in the side, back or lower abdomen
• Pain when urinating
• Blood in the urine (hematuria)
• Fever or chills
• Nausea and vomiting
• Experiencing immense pain, becoming unbearable

If you encounter any of these symptoms you should always consult with your physician so that you can be properly diagnosed and the condition of your stone can be understood. When patients experience excruciating abdominal pain, fever, chills, or sudden changes in urinary patterns, this can mean that the stone is causing a blockage in the patient’s urinary tract or is possibly infected.

A blockage or an infected stone may cause additional health issues, worsen current symptoms, and bring additional symptoms such as nausea and vomiting. Should this occur, patients must visit the emergency room immediately. The patient will likely require some type of medical intervention such as medication or surgery.

Types of kidney stone surgery and recovery include:

• Shock wave lithotripsy (SWL): Shock waves are applied outside of the body to break up the stones into fragments small enough to be able to exit through the patient’s body in the urine. Patients can return home the same day as the procedure, returning to normal activities within 2 to 3 days.
• Ureteroscopy (URS): An ureteroscope (surgical tool) is inserted, without making an incision or cut on the patient, to view the stones inside the patient’s kidney. A laser is then used to break the stone and a basket-like device is used to carefully remove the stones from the patient’s body. Patients can return home the same day as the procedure, returning to normal activities within 2 to 3 days.
• Percutaneous nephrolithotomy (PCNL): A nephroscope (surgical tool) is inserted via a small incision in the back or side of the patient to view, break up, and remove the stones inside the patient’s body. It is typically utilized for larger stones or stones more difficulty positioned. Patients are required to stay overnight at the hospital the same day as the procedure, returning to their normal activities after 1 to 2 weeks.

At the end of the surgery, once the stones are removed, the surgeon may insert and leave a tube in the kidney or a stent in the ureter (the tube that connects the kidney and the bladder) to help drain urine from the kidney. A stent is a thin, semi-rigid plastic tube that helps allow urine to pass from the kidneys to the bladder. However, the stent may cause some discomfort and will normally be removed 4 to 10 days after the procedure. Some patients may experience some discomfort or blood in urine when urinating due to the fragments of the stone exiting the patient’s body.

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When to Go to the ER for Kidney Stones

When you suddenly experience severe pain in the abdomen, your mind races to what could be causing the problem — is it your gallbladder, a cyst (if you’re a woman), or your kidneys? Has your time on this earth finally reached an end? While that last question may be a little dramatic, most people experiencing sudden, extreme pain usually only think about one thing while in the moment — how to make the pain stop.

When the cause is kidney stones, a trip to the emergency room is typically your best bet. But, what if you’re not yet experiencing excruciating pain? How do you know when severe is severe enough?

Causes of Kidney Stones

When there is an imbalance of water, salt, and mineral water in your urine, you may begin developing small crystals that turn into stones within your kidneys. As the stones grow in size, they can lead to severe pain and other symptoms. But, before enlarging, they’re often resolved without any medical interference.

Kidney stones typically occur when you’re drinking less water than what your body needs. People in warmer climates are often more susceptible, as they sweat more and require more water to stay hydrated. But, other factors can increase your risk of developing kidney stones — including:

• High blood pressure
• Diabetes
• Obesity

Signs of Kidney Stones

It’s not uncommon for kidney stones to begin to occur but resolve without any medical treatment. In these minor cases and similar mild cases, it’s fairly common not to experience any symptoms. However, kidney stones, if left untreated, can enlarge and become infected — posing a dangerous problem. When this happens, you’ll experience:

• Severe pain in the abdomen, groin, genitals, or side
• Blood in your urine
• Fever and chills
• Severe nausea and/or vomiting

When to Go to the ER for Kidney Stones

In addition to the symptoms above, you should visit the emergency room immediately if you have:

• A fever higher than 101.5 degrees Fahrenheit
• Burning during urination
• Cloudy or foul-smelling urine
• Intolerable pain
• Certain medical conditions that make passing a stone more dangerous — such as diabetes or decreased kidney function

At the ER, you’ll be administered an x-ray and/or CT scan of your abdomen and pelvis. This is to determine that you do have kidney stones and are not experiencing symptoms of a different condition. Once confirmed, you’ll be prescribed medications to help alleviate the pain and manage your symptoms.

In some cases where the kidney stone has grown too large, surgery may be required. When this is the case, you’re administered a non-invasive shockwave treatment procedure — or something similar — to remove the enlarged kidney stone.

Treatment for Kidney Stones

In some cases, an ER visit isn’t necessary. This includes not having severe symptoms, but still feeling some discomfort around the abdomen, groin, genitals, and side area. When this is the case, there are three main ways to treat your kidney stones:

• Allowing the stone to pass on its own
• Using medications to help the stone pass
• Surgery to treat or remove the stone

Your treatment options are dependent on the size and location of the kidney stone. A good rule of thumb is that if your kidney stone is larger than 5 millimeters, then you’ll likely need surgery to remove the mass.

Preventing Kidney Stones

To lower your risk of kidney stones, you should drink the suggested amount of water per day. For the average adult, this should be eight 8-ounce glasses of water each day. This increases when experiencing warmer conditions — such as from warmer climates or exercising. Since obesity can also raise your risk, if your BMI is within the obese range, you should talk to your doctor about making lifestyle changes and creating a diet plan that works with your body type.

Emergency Services in Colorado Springs and Texas

If you or a loved one are showing signs of kidney stones, we can provide the care you need. If you have questions or need immediate treatment, your nearest Complete Care location is ready to help, no matter the time of day or night. We offer a variety of services to help you and your family in your time of need. No appointments are necessary.

Find the Complete Care location nearest you.

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Kidney stones – symptoms and treatment

Urolithiasis is a disease characterized by the formation of calculi – stones – in the tracts of the urinary system. It occupies one of the leading places in terms of prevalence in the world among urological diseases.

The kidney is one of the organs where stones are most often localized. The formation of kidney stones is also called nephrolithiasis.

What causes kidney stones

To date, there is no single cause for the formation of kidney stones. It is known that the development of nephrolithiasis is affected by disturbances in metabolic processes. These disturbances lead to the formation of insoluble salts, which then form into stones. The formation of stones may be associated with the quality of nutrition, endocrine diseases, climate characteristics and hereditary predisposition.

It is customary to distinguish two groups of the disease development factor: exogenous and endogenous.

Exogenous include:

• Climate – features of soil, flora and fauna
• Unbalanced nutrition
• Working conditions – hazardous production, increased physical activity, hot shops
• Lifestyle – monotonous and sedentary work, inactive rest
• Vitamin A and B deficiency

Endogenous include:

• Presence of infectious diseases
• One functioning kidney
• Kidney anomalies
• Vesicorenal reflux – backflow of urine from the bladder into the upper urinary tract
• Presence of foreign bodies
• Injuries of the urinary system
• Diseases which involve prolonged bed rest

Symptoms of kidney stones

• Pain in the abdomen and lower back
• Increasing pain on exertion
• Hematuria – blood in urine
• Frequent urge to urinate
• Nausea and vomiting
• Turbid urine
• Temperature increase
• Increased blood pressure
• Leukocyturia – an increased content of leukocytes in the urine, indicating inflammatory and infectious processes in the body
• Puffiness

The first signs of kidney stones include the occurrence of pain. The nature of the pain depends on the location of the stones. If there are no violations in the outflow of urine, then the pain can be aching, but not strong.

If, due to stones, obstruction occurs in the renal pelvis, renal colic begins. This condition is characterized by severe and acute pain in the lumbar region, which radiates to the groin and abdomen.

In children, the symptoms of kidney stones may not be accompanied by colic in the organ, but other manifestations of the disease are the same as in adults. It will be possible to confirm nephrolithiasis in a child only with the help of diagnostics.

Types of kidney stones

Stones can be classified according to several criteria. By localization, the disease is unilateral or bilateral. If stones form in the kidneys, they are also classified into renal pelvis stones and renal calyx stones.

They are small, medium and large in size. The size of small ones is no more than 3 millimeters, medium – up to 10 millimeters, large – more than 10 millimeters.

A variety of kidney stones in composition:

• Phosphate kidney stones – consist of ammonium, magnesium phosphate and carbonate apatite. Formed due to bacteria that break down urea. The formation of phosphate stones is affected by various bladder problems. Among them are his neurogenic dysfunction and prolonged catheterization. In women, phosphates occur 2 times more often than in men. These stones are also called struvite stones.
• Oxalate kidney stones – calcium salts of oxalic acid. Oxalate stones are found in the majority of patients with urolithiasis. The reasons for their formation may be a lack of vitamins, potassium and magnesium, as well as too frequent intake of food containing calcium, oxalates, purines and uric acid. Calcium oxalate does not dissolve in kidney stones.
• Urate kidney stones – consist of crystals of uric acid or its salts. Stones occur when purine synthesis is impaired, which is responsible for protein metabolism, tissue neoplasm, growth, and energy metabolism. Patients with oncology and myeloproliferative diseases are at risk. Urate stones can also occur with gout, a disease characterized by increased deposition of uric acid salts in body tissues.
• Cystine kidney stones – stones are formed in the hereditary disease of cystinuria. In cystinuria, there is no absorption of the amino acid cystine in the renal tubules. The amino acid itself does not dissolve in acidic urine, so it precipitates in the form of crystals and stones. Most cystine kidney stones are found in men, but in general they are rare.
• Cholesterol kidney stones are made up of cholesterol. They have a soft texture, so it is easier to excrete from the body. Such stones are rare.

Coral-like kidney stones stand out separately. They are coral-like in shape and are more common in women with urinary tract infections. [3]

Coral nephrolithiasis is considered one of the most complex manifestations of urolithiasis. This is due to the large size of the calculi and their ability to occupy part or the entire cavitary system of the kidney.

Coral stones may fill the pelvis and then begin branching into calyxes. All this leads to a decrease in kidney function and requires surgical treatment.

What color are kidney stones and their structure features

The color of kidney stones depends on their type. For example, urate kidney stones are made up of uric acid crystals and are therefore yellow-brown in color. In structure, they are dense and have a smooth or slightly rough surface.

Dark and black kidney stones are characteristic of scallops. They are dense and with a prickly surface. Cholesterol stones are soft, their color is black. Phosphate stones have a fragile structure, they have a grayish or white color.

Cystine stones are characterized by a yellowish-white color. The stones themselves are soft, rounded and with a smooth surface.

Why kidney stones are dangerous

One of the most serious complications of kidney stones can be pyelonephritis. This is an infectious disease that affects the kidneys. The acute form of pyelonephritis is characterized by fever, chills and cloudy urine.

Another possible complication is hydronephrosis. This is an expansion of the renal pelvis and calyces due to impaired outflow of urine. Symptoms of the disease include pain in the lumbar region, hematuria, and infrequent urination. If timely treatment is not started, hydronephrosis can lead to kidney failure.

Complications are also possible:

• Renal papillary necrosis – destruction of the papillae of the kidneys, which may be accompanied by renal colic, hematuria, fever, back pain.
• Pyonephrosis is a severe purulent inflammation of the kidney that can lead to necrosis of the kidney tissue.
• Paranephritis is a disease accompanied by purulent inflammation of the perirenal fat capsule.

All these complications can significantly affect the patient’s life, and with the development of renal failure, a fatal outcome is possible.

How to remove kidney stones

Removal of kidney stones is possible provided they are small in size – up to 5 millimeters. In this case, it is necessary to take special drugs, follow a diet and perform therapeutic exercises.

However, if you suspect the occurrence of stones, you do not need to self-medicate. It is necessary to contact a specialist, undergo an examination and get accurate appointments. This will help to get rid of the symptoms and eliminate the cause of the disease.

Kidney stone diagnostics

To confirm the diagnosis of nephrolithiasis, you need to make an appointment with a urologist. At the appointment, the patient talks about his complaints, and the doctor examines him, examines the clinical picture and then sends him for blood and urine tests.

The patient then undergoes an examination that the urologist deems appropriate to evaluate the condition of the kidney.

Ultrasound examination for nephrolithiasis is the most effective diagnostic method. [7] Ultrasound will allow to determine the occurrence of a stone in the pyelocaliceal system of the kidney and assess the condition of the organ for signs of inflammation and the development of renal failure.

Computed tomography is also prescribed from the studies. Using this diagnostic method, it is possible to determine the structure and density of the stones, as well as how close they are to the skin. Knowing these parameters helps to prescribe the most effective treatment.

During the passage of x-rays, an overview image is taken, on which the shadow of the stones is recorded. However, this study may be ineffective. This is because some stones are not considered X-ray positive. Among such calculi, for example, cystine kidney stones. In the picture, they will be poorly visible or not visible at all.

Radiation diagnosis or excretory urography makes it possible to assess the functional state of the kidneys. In the study, the patient is injected intravenously with a contrast agent and then pictures are taken. Radiation diagnostics is contraindicated in case of allergy to a contrast agent.

How to treat kidney stones: conservative method

The choice of the correct treatment for kidney stones depends on the clinical picture of the patient. The doctor may prescribe conservative methods or surgery.

Conservative treatment of kidney stones is aimed at the stone expelling effect and at the dissolution of stones.

Independent discharge of stones is possible only if their diameter is not more than 4 millimeters. To achieve a waste of formations, the doctor may prescribe:

• Keeping active
• Performing special physical exercises
• Drinking habits
• Use of analgesics and antispasmodics

Treatment of kidney stones with drugs is prescribed to dissolve small stones and to relieve pain. If the formation of stones does not require surgical intervention, the patient may also be recommended spa treatment.

Kidney stone diet

Therapeutic nutrition can affect the pathology and slow down the growth of stones. But the principles of diet therapy depend on the type of kidney stones.

Also, with a diet, it is determined what water to drink with a kidney stone. Mineral waters have a positive effect. They help restore disturbed mineral metabolism, increase the solubility of salts in the urine. Mineral water helps to maintain the result of treatment and reduce the risk of recurrence.

Nutrition for oxalate stones

Nutrition for oxalate kidney stones is aimed at balancing the content of acidic and alkaline substances. The peculiarity of such nutrition is in observing the drinking regime – a person should drink up to 2-2.5 liters of fluid per day.

The amount of carbohydrates, ascorbic acid, table salt and gelatin is limited. It is also possible to restrict dairy products.

What is allowed to eat:

• Meat and fish – 100 grams per day or 150-200 grams every other day
• Meat products – dairy and dietary sausages, sausages
• Eggs
• Butter and vegetable oils
• Buckwheat, oat, barley and millet groats
• Pasta
• Bread and flour products
• Vegetables and fruits – cucumbers, cabbages, peas, eggplants, turnips, pumpkins, lentils, apricots, bananas
• Soups
• Sauces
• Squash caviar

From drinks, tea, jelly, compote, weak coffee are allowed.

What is not recommended to use:

• Legumes
• Liver, kidney and salted fish
• Salted cheeses
• Salted vegetables
• Meat, mushroom, fish broths and sauces
• Salty snacks
• Canned food
• Caviar
• Chocolate and candies

Strong coffee and cocoa are excluded from drinks.

Diet for phosphate stones

The diet for phosphate kidney stones is aimed at acidifying the urine. This will prevent the formation of phosphate salts. At the same time, you should observe the norm of nutrition and prevent the complete absence of vitamins in the diet.

What you can eat:

• Meat and fish in any form
• Eggs
• Butter and vegetable oils
• Salo
• Cereals
• Bread
• Flour products
• From vegetables – green peas and pumpkin
• Mushrooms
• Sour apples
• Cranberries and cranberries

From drinks, weak tea and coffee, rosehip broth are allowed.

What is not recommended to eat:

• Smoked products
• Pickles
• Canned vegetables
• Vegetables
• Dairy products – cheese, yogurt, cream, cottage cheese
• Meat fats

From drinks it is recommended to exclude juices.

Nutrition for uric acid stones

The uric acid kidney stone diet helps in alkalizing the urine, which stops the growth of stones. [1] During the period of therapeutic nutrition, you should increase fluid intake, drink alkaline mineral water.

What you can eat:

• Flour products
• Dairy products
• Eggs
• Fats
• Fruit
• Cereals
• Vegetables
• Sweets

From drinks, tea, weak coffee, juices, fruit drinks, kvass are allowed. The diet should contain vitamins A, B, B6, C.

What is not recommended to eat:

• Meat – meat products can either be completely excluded from the diet or severely limited
• Salted and pickled vegetables
• Fried food
• Smoked products
• Chocolate

From drinks it is not recommended to drink strong coffee, cocoa, soda.

Nutrition for cystine stones

During the cystine stone diet, emphasis is placed on fluid intake. The patient should consume 2.5-3 liters of fluid per day, alkaline mineral water. The diet also includes vitamins A and C.

Therapeutic exercises for kidney stones

Therapeutic gymnastics is the same effective method of conservative treatment as diet therapy. Physical activity increases the tone of the central nervous system, improves urine flow and stimulates metabolism. An active lifestyle stimulates the release of small stones and prevents the formation of new ones.

Exercise therapy is recommended to be combined with regular walks and compliance with the drinking regimen. Active sports will also have a positive effect. For example, cycling, rock climbing and yoga. The exercises themselves are aimed at shaking the body.

Some examples of exercises for kidney stones [6]:

• Sharp turns of the torso in different directions with outstretched arms
• High knee walking
• Pelvic lift in supine position
• Squat walking
• Alternate leg curl in prone position
• Pull knees to chest in supine position

Therapeutic exercises are contraindicated in acute pain syndromes, elevated temperature, the presence of large stones and infection. The exact lesson plan is formed individually. The choice of appropriate exercises depends on the age, gender and physical characteristics of the patient.

Phytotherapy for nephrolithiasis

Phytopreparations are used both to stimulate the discharge of small stones, and for prevention purposes.

One of the effective means is the extract of madder dye. It stimulates the loosening and removal of stones, and also reduces spasms.

A dry extract of horsetail can also be used. This extract has a diuretic effect and prevents the formation of new stones. In addition, it stimulates tissue regeneration, the function of the adrenal cortex and has a hemostatic effect. [9]

Other diuretic herbs can have a positive effect [5]:

• Knotweed
• Dill
• Lingonberry leaf
• Bearberry

When choosing herbal teas, you should consult with your doctor. He will tell you the most effective remedies that will also help relieve pain and improve the excretion of stones.

Indications for removal of kidney stones

If the size of the stones is more than 15 millimeters, they must be destroyed. For this, special procedures or an operation are prescribed.

Removal of kidney stones is indicated for the following manifestations of the disease:

• Stone increase
• Kidney dysfunction
• Obstruction – obstruction of the ureter
• Severe clinical manifestations that interfere with normal life – severe pain, blood in the urine
• Urinary tract infection [4]

Also, the removal of stones can be indicated if the patient wishes and if his work is associated with regular flights and long trips.

Minimally invasive techniques

External lithotripsy: laser fragmentation of kidney stones

Remote shock wave lithotripsy is one of the most effective ways to get rid of kidney stones. The technique consists in crushing stones without introducing instruments under the skin.

Crushing occurs due to the work of the lithotripter. This is an apparatus that generates a shock wave, thereby destroying stones. After crushing, the stones leave the body in the form of sand and small particles.

Remote removal of kidney stones with a laser is considered a modern way to get rid of stones. In addition to laser radiation, methods for generating shock waves can be electromagnetic, electro-hydraulic, piezoelectric. [2]

This technique is painless, but requires the most accurate diagnosis of the kidney. When the device is exposed to an organ with reduced functionality, the procedure can become traumatic and increase the risk of complications.

The most positive result is in the case when the size of kidney stones is not more than 2 centimeters. In this case, the procedure may not have the desired effect if the stones are located in the lower part of the cup.

Contraindications for external lithotripsy:

• Renal failure
• Acute kidney disease
• Overweight
• Pregnancy
• Stones larger than 2 centimeters
• Deformity of the musculoskeletal system
• Cardiovascular diseases
• Tumors of the kidneys
• Low blood clotting
• Narrowing of the ureter

During menstruation, the procedure is postponed to a later date.

Contact percutaneous nephrolithotripsy: crushing kidney stones with ultrasound

Nephrolithotripsy is an invasive technique, the principle of which is similar to extracorporeal lithotripsy. It differs in that in order to remove stones, the doctor needs to get into the cavitary system of the kidney. This is done through the organ cups.

The entrance itself occurs with a puncture – a puncture – of the pelvicalyceal system. Then the doctor inserts an endoscope into the formed channel. With visual observation, the apparatus crushes stones, after which their fragments are removed.

The crushing itself is performed by a lithotripter. The ultrasonic kidney stone crusher is more commonly used to remove large stones. This type of lithotripsy is safe for patients. The lipotripper can also be laser, pneumatic or electric pulse.

Nephrolithotripsy is effective for large and staghorn stones that cannot be destroyed using a remote technique.

The procedure is contraindicated in pregnancy and impaired blood clotting.

Kidney stone surgery

Kidney stones can be removed by open surgery or laparoscopy. Today, open surgery through a skin incision is performed less frequently due to trauma.

To remove a kidney stone, laparoscopy is considered a more modern technique. The operation is performed under anesthesia. The patient is made several incisions no more than 1 centimeter on the abdominal wall. After that, surgical instruments and a laparoscope are inserted into the holes. The doctor makes an incision in the pelvis and removes the stones. Then the organ is sutured and drainage is installed. If the patient does not start bleeding, all incisions are sutured.

Thanks to minimally invasive techniques, laparoscopy is also rarely used. An operation may be prescribed if other methods of treatment have not yielded results.

A nephrectomy is also possible – an operation to remove the kidney or part of it. It is carried out with acute complications, when the organ loses its functionality.

Recovery after surgery

In the first days after the operation, the patient is in the hospital under the supervision of a doctor. Also in the first days, renal colic is possible due to crushed stones, pain during urination and the presence of blood in the urine.

After discharge, you will need to visit a doctor regularly to assess well-being and remove the drainage. After about 2 weeks, you need to undergo an ultrasound scan and take tests.

After removing the stones, the patient should follow a diet, drinking regimen, take vitamins and undergo the prescribed therapy.

The duration of complete recovery of the body depends on the patient’s condition and the type of operation.

Prevention of kidney stones

To reduce the risk of kidney stones formation, it is recommended to follow preventive measures. These include:

• Drinking habits – drink up to 2. 5 liters of fluid per day to avoid recurrence and up to 1.5 liters in the absence of stones
• Regular and balanced diet without salt abuse
• Active lifestyle and regular walks
• Stress avoidance
• Herbal tea intake
• Urologist visit once a year

Preventive measures for patients after treatment should be selected individually – they depend on the nature of nephrolithiasis and the type of stones formed. The doctor will give suitable recommendations and prescribe special drugs.

Sources

1. Tareeva I.E., Kukhtevich A.V. Kidney stone disease // Nephrology. M.: Medicine, 2000. S. 413–421.
2. Komyakov B. K. Urology. – 2012. – 464 p.
3. Onopko V.F., Zelenkova S.V., Sysin S.A., Sharov V.N. On the issue of staghorn nephrolithiasis // Siberian Medical Journal (Irkutsk). – 2013. – No. 1
4. Nazarov T.Kh., Akhmedov M.A., Rychkov I.V., Trubnikova K.E., Nikolaev V.A., Tursunov A.I. Urolithiasis: etiopathogenesis, diagnosis and treatment // Andrology and Genital Surgery. – 2019. – No. 20 (3)
5. Bykov I.M. Kidney stone disease // Siberian Medical Journal (Irkutsk). – 1996
6. Zhukova S. D., Lukyanova L. M. Therapeutic physical culture in urolithiasis // Science-2020. – 2020. – No. 8 (44)
7. Lopatkin N. A., Pugachev A. G., Apolikhin O. I. etc. Urology. – 5th ed. – M.: GEOTAR-MED, 2004. – 520 p.
8. Alyaev Yu.G., Glybochko P.V., Pushkar D.Yu. Urology. Russian clinical guidelines. – 2017. – 544 p.
9. Kochkarov M.Kh., Shevchenko A.M. Preparations of mineral and vegetable origin used for the treatment and prevention of urolithiasis // Pharmacy and Pharmacology. – 2015. – No. 6 (13)

Kidney stones – causes, symptoms, diagnosis, treatment (removal, crushing), prevention in men and women 02 Prevention

Kidney stones are one of the common urological conditions, which is also called nephrolithiasis and is a consequence of urolithiasis. The disease is chronic and may not manifest itself for a long time. Therefore, many learn about the stones only after the first attack or a planned ultrasound as part of a medical examination or medical examination.

Kidney stones are more common in men, with the predominant lesion on the right side, and 25% of them have a bilateral location. With urolithiasis, in medicine, referred to as ICD, such formations are often found in all organs of the urinary system. However, initially they form in the kidneys, and then gradually migrate into the cavity of the bladder and beyond.

Causes

The primary provoking factor is always metabolic problems, congenital or acquired.

Other reasons for the formation of kidney stones include: monotonous food.

Insufficient fluid intake. For a healthy person, it is recommended to drink at least one and a half liters of pure water per day, not counting the one that comes with first courses, tea, compotes. If a person has already been diagnosed with KSD, then in this case the amount of fluid should be increased to 2. 5 liters.

Other factors that can trigger the disease include hyperparathyroidism, osteoporosis, osteomyelitis, spinal cord injuries, fractures and bone injuries, stomach diseases. All these diseases can become trigger factors for the formation of such stones.

Symptoms

Symptoms of kidney stones depend on factors such as their size, number, composition. Usually there are complaints of pain in the lumbar region, blood or pus in the urine, difficulty in its outflow. However, the main symptom of kidney stones is the pain that occurs with colic.

Initially, the pain starts in the lower back, and then the pain spreads to the lower abdomen. Sometimes there are complaints of nausea and even vomiting. Pain during colic is very strong, a person literally does not find a place and rushes around the whole apartment, trying to find a position so that the pain becomes less.

After the stones have passed from the kidneys in the urine, the attack ends. Severe hematuria appears, and pus may also appear in the urine, which happens with the development of an inflammatory process.

However, in 25% of cases, kidney stones in women and men do not give any manifestations, and the person may not even be aware of the presence of such a disease.

Classification

Stones are different in composition, as they are formed from various substances. Most common types:

1. Oxalates. They contain salts formed during the reaction of calcium and organic oxalic acid. They are dense, have a black or dark gray color. There are many bumps on the surface, some look like spikes. Able to form with alkaline or acidic urine.
2. Phosphates. They also contain calcium salts, but formed by reaction with phosphoric acid. They are soft, crumble easily, with a smooth surface that may have slight roughness. Color whitish gray. They form in an alkaline environment, rapidly increase and often accompany pyelonephritis.
3. Urats. Formed by salts of uric acid. Dense, different colors, smooth. Formed in an acidic environment.
4. Carbonates. Composed of calcium carbonate salts. They are quite soft, light, come in different shapes.
5. Cystine. Formed from an amino acid called cystine. They are white, soft, smooth and rounded.
6. Protein. Formed from fibrin. Also soft, flat shape, white.
7. Cholesterol. Rarely diagnosed. Formed from cholesterol, brittle and black.
8. Mixed or staghorn, which grow in and occupy the entire renal pelvis. After extraction, they look like a cast of the pelvis.

Kidney stones vary in size. By localization, they can be found not only in the paired organ itself, but also in the underlying organs.

Diagnostics

What to do if there is a suspicion of kidney stones? Of course, you should visit a doctor. At the initial stage, usually a therapist who will refer the patient for a consultation with a nephrologist. Sometimes you may need to see an endocrinologist, gastroenterologist, urologist. In case of acute colic, you should immediately call an ambulance.

Before laboratory diagnostics, a person is interviewed and examined. Next, urine and blood tests are performed, which often helps to identify the cause of the formations and evaluate their composition. On ultrasound, you can evaluate a possible change in the organ, the location of the formations, and identify their movement. Ultrasound also helps to make a differential diagnosis and distinguish the disease from appendicitis, an attack of acute cholecystitis.

Plain radiography helps to identify almost all stones, but this does not apply to those consisting of protein and urates: they are not visible in the pictures. Such formations are determined by the method of urography or pyelography.

But CT remains the best method. On the obtained images, formations of any size and composition can be detected. This study can be supplemented with nephroscintigraphy.

Treatment

Treatment of kidney stones includes both conservative therapy and diet, lifestyle changes. If all this does not help, then surgical methods are used.

Diet for kidney stones becomes essential. Proper nutrition will help prevent their recurrence. All people with this diagnosis are advised to reduce the amount of salt consumed, limit protein of any origin. If the stones are urate, beer, wines, pickles, smoked meats, offal, all coffee and chocolate products are banned. To speed up the removal of stones, doctors recommend drinking a lot and increasing physical activity.

How else to remove kidney stones? Phytotherapy has a good therapeutic and preventive effect. Most often, doctors recommend that people with KSD take Cyston or Canephron. They can help with small calculi, but will not cope with large ones.

If a patient is diagnosed with urates, they can be dissolved with citrate mixtures. For this, the ability of urate stones to dissolve when mixed with certain media is used. But the dissolution process is long and slow, requiring constant monitoring by a urologist and urine tests.

Kidney stones can be removed by lithotripsy. In this case, the crushing of stones occurs directly in the kidneys, but without the introduction of any instrument. Most often, the procedure is prescribed for diagnosed KSD and small calculi. Some time ago, such devices were available only in large hospitals and research centers. Now the method of lithotripsy has become available to almost all people with an established diagnosis.

Kidney stone surgery is indicated if the stone is stuck in the ureter and cannot pass on its own. It provokes severe and prolonged colic, which is not treated with drugs.

Two options are available here: either transurethral contact lithotripsy or percutaneous nephrolithotripsy, which removes the largest stones. Open operations for KSD are practically not performed today due to their duration and the possible development of complications.

Prophylaxis

Prevention of kidney stones should be done from a young age. It is important to establish proper nutrition, drink at least 1.5 liters of clean water every day, and play sports. Urine analysis should be carried out regularly and, based on the results of its acidity, an appropriate diet should be selected with the help of a nutritionist.

For prophylactic purposes, it is recommended to conduct an ultrasound of the kidneys every year, and at the first symptoms of the disease, consult a doctor who will help get rid of the disease at an early stage, preventing the development of renal colic.

The author of the article:

Pavlova Olga Grigorievna

general practitioner, nephrologist

work experience 30 years

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