Urinary calculi
Introduction
Introduction to urinary stones Urinary calculi are a general term for kidney, ureter, bladder, and urethra stones. However, kidney and ureteral stones are common. Clinical manifestations vary depending on where the stone is located. Sudden onset of severe low back pain, traction less abdomen, frequent urination, urgency, dysuria, urine turbidity, and even blood or gravel in the urine as the main clinical manifestations. Abdominal X-ray plain film can be seen with stone shadows, or B-mode ultrasound can be seen with stone light. Traditional Chinese medicine literature refers to stone shower, sand drenching, blood drenching (obvious blood). Urinary calculi can cause urinary tract injury, obstruction, and infection, resulting in impaired renal function. basic knowledge Sickness ratio: 5-15% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary tract obstruction, renal colic, urinary calculi, uremia
Cause
Urinary stone cause
Stone classification:
1 Urinary stones with unknown causes and unclear mechanisms are called primary urinary stones.
2 metabolic urinary stones, the most common of these stones, caused by metabolic disorders in the body or kidney urinary calculi, such as hyperthyroidism, idiopathic urinary calcium caused by increased urinary calcium, increased uric acid excretion of gout, kidney A large increase in phosphate when tubulic acidosis occurs. Most of the stones formed by the base are urate, carbonate, and cystine jaundice stones.
3 secondary or infectious stones. Mainly for the bacterial infection of the urinary system, especially the bacteria that can decompose urea and Proteus can decompose urea into free ammonia to alkalize the urine, and promote the formation of stones by phosphate and carbonate as the core of the bacteria or pus. In addition, the formation of stones is related to race (less black incidence), heredity (genetic trend of cystine stone), gender, age, geographical environment, eating habits, nutritional status, and urinary tract diseases such as urinary tract stenosis and benign prostatic hyperplasia. .
In fact, many factors affect the formation of urinary stones. Salts that form stone crystals in the urine are supersaturated, and the inhibition of crystal forming substances and the presence of nuclear matrix in the urine are the main factors for the formation of stones.
(1) Epidemiological factors
Includes factors such as age, gender, occupation, socioeconomic status, dietary composition and structure, water intake, climate, metabolism, and genetics. Upper urinary calculi occur in 20 to 50 years old. More men than women. The peak age of onset in men is 35 years. Women have two peaks, 30 and 55 years old. During the Second World War, the incidence of upper urinary tract stones decreased, and the incidence during the interstitial period and in the past four decades increased significantly, suggesting that it was related to changes in economic income and dietary structure. Experiments have shown that the animal protein and refined sugar in the diet increase, and the cellulose is reduced, which promotes the formation of upper urinary tract stones. Drinking plenty of water dilutes the urine and reduces the formation of crystals in the urine. Equal high temperature environment and reduced activity are also influencing factors, but occupation, climate and so on are not the single determinants.
(two) urine factors
1. Too much stone material is discharged: the amount of calcium, oxalic acid and uric acid in the urine increases. Long-term bed rest, hyperparathyroidism (resorbable hypercalciuria), idiopathic hypercalciuria (absorbed hyperuricemia) intestinal absorption of calcium or renal hypercalciuria - tubular reabsorption Calcium reduction), other metabolic abnormalities and renal tubular acidosis, etc., all increase urinary calcium excretion. Gout, urine continues to be acidic, chronic diarrhea and thiazide diuretics increase uric acid excretion. Increased endogenous synthetic oxalic acid or increased absorption of oxalic acid in the intestine can cause hyperoxaluria.
2. Urine acidity is reduced and pH is increased.
3. Reduced urine output, increasing the concentration of salts and organic matter.
4. The amount of crystal forming substances in the urine is reduced, such as citric acid, pyrophosphate, magnesium, acid mucopolysaccharides, and some trace elements.
(3) Abnormal anatomical structure
Such as urinary tract obstruction, resulting in crystal or matrix deposition in poor drainage, urine retention secondary urinary tract infection, is conducive to the formation of stones.
(four) urinary tract infection
The cause of most calcium oxalate stones is unknown. Calcium phosphate and ammonium magnesium phosphate stones are associated with infection and obstruction. Uric acid stones are related to gout. Cystine stones are a rare familial hereditary disease caused by the excretion of large amounts of cystine in the urine.
Prevention
Urinary stone prevention
Life prevention
1, pay attention to the dietary structure, the formation of urinary stones and diet structure have a certain relationship. Therefore, attention to adjusting the dietary structure can prevent the recurrence of stones. Diet conditioning should take a different approach depending on the composition of the urinary stone. For example, patients with calcium oxalate stones should eat less foods with high calcium oxalate content, such as spinach, tomatoes, potatoes, and strawberries.
2, treatment of urinary calculi caused by some of the primary disease of hyperparathyroidism (parathyroid adenoma, adenocarcinoma or proliferative changes, etc.) can cause calcium and phosphorus metabolism disorders in the body and induce calcium phosphate stones. In this way, it is necessary to treat the parathyroid gland first. Obstructive factors in the urinary tract, such as tumors, benign prostatic hyperplasia, and urethral stricture, can cause accumulation of urine, causing "aging" of urine. After the organic matter in the urine is "aged", it may become enlarged and become amorphous micro-stones. Therefore, treatment of certain primary diseases of urinary calculi is also very important to prevent stone recurrence.
3. Prevention and treatment of urinary tract infections. Urinary tract infection is the main local factor of urolith formation, and is directly related to the prevention and treatment of urolithiasis.
4, taking Chinese medicine at regular intervals, with Chinese medicine money grass and sea gold sand soaked in water, is conducive to the discharge of small stones in the body. If conditions permit, you can also find a Chinese medicine practitioner to open a simple Chinese medicine prescription according to your own condition.
5, drink more water. Should develop the habit of drinking more water to increase the amount of urine, called "internal washing", is conducive to the elimination of a variety of salts and minerals in the body. Of course, you should pay attention to drinking water hygiene, pay attention to water quality, and avoid drinking too much calcium.
6, more activities. Usually have more activities, such as walking, jogging, etc. When you have good physical strength, you can also jump in place, which is also beneficial to prevent recurrence of urinary stones.
Diet prevention
Urinary calculi are common diseases of the urinary system, including kidney stones, ureteral stones, urethral stones and bladder stones. Kidney stones are chemicals composed of calcium oxalate that can cause renal colic. Currently, doctors recommend a method to reduce calcium intake in the diet to prevent recurrence of kidney stones.
The dietary structure is adjusted according to the composition of the stones, and the diet for preventing stones is decided.
1, uric acid stones should be low-grade diet, bladder acid stones should use a low methionine diet. Fruits and vegetables can turn the urine into alkaline, which is better for preventing uric acid and cystine stones. Meat foods make the urine acidic, which is better for preventing infection of stones.
2, the use of low calcium, low phosphorus diet for phosphate stones, calcium-containing kidney stones should avoid high calcium, high salt, high oxalic acid, high animal protein, high animal fat and high sugar diet.
3, using a high-fiber diet, it is generally believed that patients with kidney stones should eat less salt and animal protein, adhere to a large number of drinking water, keep urine volume in 2000 ~ 3000 ml / day, this not only to prevent the recurrence of kidney stones It also ensures calcium intake and is good for other aspects of the body.
Complication
Urinary calculi complications Complications, urinary tract obstruction, renal colic, urinary calculi, uremia
The health hazards of urinary calculi are mainly manifested in three aspects: local damage caused by stones on the urinary tract, urinary tract obstruction caused by stones, and urinary tract infection:
1. Local damage :
Smaller stones can move freely in the urinary tract, easily eroding the urinary tract mucosa and causing bleeding and renal colic, but this local damage is still relatively light. Larger, relatively fixed or staghorn urinary calculi, although the pain is not serious, but can compress the urinary tract mucosa for a long time, causing epithelial shedding, tissue ulceration, so that the stone and the ureteral wall form adhesion, serious may also Cause cancer.
2, urinary tract obstruction:
Renal and ureteral stones are most likely to be at the junction of the pelvis and ureter (the first stenosis), the ureter spans the iliac vessels (the second stenosis) and the ureteral bladder entrance (the third stenosis), causing urinary tract obstruction. After urinary tract obstruction, the ureter and renal pelvis above the obstruction will expand and accumulate water. The hydronephrosis can be divided into mild, moderate and severe hydronephrosis. When the hydronephrosis occurs, the kidney parenchyma is squeezed, affecting kidney function. If the hydronephrosis is not relieved for a long time, severe cases may cause loss of function of the entire kidney function. If the bilateral urinary tract is severely obstructed, it may lead to uremia.
3, urinary tract infections:
Urinary tract obstruction complicated by bacterial infection, secondary hydronephrosis can form renal empyema, severe urinary tract infection may also cause septicemia, threatening human life. In addition, urinary tract infections promote the formation of stones and increase the volume of the original stones.
Therefore, once urinary stones are found, they should be given enough attention and actively treated.
Symptom
Urinary calculi symptoms Common symptoms Low back pain with frequent urination, urine... One side of the waist and abdomen suddenly "... Urine flow is fluctuating urinary dysfunction, blood urinary urinary retention, urinary flow interruption, sudden severe back pain, urinary weakness
The clinical manifestations of urinary calculi are quite different, and the mild cases are asymptomatic; the clinical manifestations are sudden onset, severe low back pain, and the pain is persistent or intermittent, and radiates along the ureter to the axilla, perineum and scrotum; hematuria or pyuria appear. , dysuria or interruption of urinary flow, etc., some may have symptoms of urinary tract infections such as frequent urination, urgency, and dysuria. In severe cases, urinary tract obstruction and renal function damage may occur. There are mainly six kinds of stone components, which are arranged in the order of the proportions: calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid (urate), cystine and jaundice stones. Most stones mix two or more ingredients.
Examine
Urinary calculi examination
X-ray diagnosis
Abdominal plain film: Abdominal plain film is the basic examination method for diagnosing urinary calculi. You can learn about the size, location, and physical shape of the stone. The light transmission of urinary calculi is related to its constituent components. About 90% of urinary calculi can not be penetrated by X-rays. It can be displayed on the plain film of the abdomen, which is called a positive stone. Stones that can penetrate the X-ray are called negative stones. The types of stones that can not be penetrated from the X-ray to the X-ray are: uric acid stones, cystine stones, ammonium magnesium phosphate stones, mixed stones, calcium oxalate stones, and the most opaque calcium phosphate stones. On the abdominal plain film, the calcium phosphate stone has a dense and smooth appearance, and the calcium oxalate stone has a low density. It is mulberry-like. According to the transparency of the stone in the abdominal plain film, the effect of extracorporeal shock wave lithotripsy can be preliminarily judged and predicted.
Intravenous pyelography
In order to further clarify the diagnosis of negative urinary calculi, identify calcified plaques and pelvic venous stones, and understand the abnormalities of kidney anatomy and function, intravenous pyelography is necessary on the basis of abdominal plain film. Intravenous pyelography can also determine the extent of hydronephrosis, residual renal parenchyma, degree of renal impairment, and presence or absence of urinary tract malformation. These information are helpful in selecting treatment options and predicting treatment outcomes. Before percutaneous nephrolithotomy, intravenous pyelography is helpful in the choice of renal puncture.
According to intravenous pyelography, the renal hydronephrosis is grade 4: grade I: renal pelvis, renal pelvis expansion. Renal small cup II flattened, no damage to kidney function; lI level: renal pelvis is sickle, kidney function is mildly impaired; Ill grade: renal cystic dilatation. Delayed development, thinning of the renal parenchyma, severely impaired renal function; Grade IV: glomerular expansion of the renal pelvis, delayed or undeveloped development, thinning of the renal parenchyma.
Retrograde urography
Retrograde urography is a supplement to intravenous pyelography. It is mainly used for patients with allergic reactions to intravenous pyelography. It can clearly show the location of stone obstruction and anatomical abnormalities of ureter and renal pelvis. Retrograde urography has caused some pain to the patient. And may cause retrograde infection. Not suitable for routine use. Can be replaced by CT three-dimensional reconstruction.
Ultrasonography
Ultrasonography has the advantages of non-invasive, reproducible, convenient, and high accuracy. It has become a routine examination item, which can show the size, location, hydronephrosis of the urinary calculi, the presence or absence of renal parenchyma, and urinary tract malformation. Under normal circumstances, clinical symptoms, urine examination, B-ultrasound, abdominal plain film can basically define the diagnosis of urinary calculi.
Diagnosis
Diagnosis and diagnosis of urinary calculi
The most common method for the diagnosis of urinary stones is B-ultrasound. It can be found in stones above 0.3mm. The skilled medical staff can use B-ultrasound to check the stones of the whole urinary system, which is intuitive, convenient and non-invasive. X-ray abdominal plain film, you can see most of the urinary calculi, for negative stones, the x-ray can penetrate the stone, so it can not be seen. X-ray angiography, for different ureteral stones, can be judged to be stones or stenosis. CT diagnosis results have the highest accuracy. But the cost is high. MRI costs are high and the detection rate is not very good. There are important examinations for some suspected urinary tumors.
