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Kidney stones

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VOL: 100, ISSUE: 01, PAGE NO: 31


- A kidney stone (renal calculus) is a hard mass developed from crystals that separate from the urine and build up in the kidneys.



- Calculi contain calcium combined with oxalate or phosphate.



- A small crystal attracts further crystallisation and in this way calculi can become enlarged.



- Small calculi leave the body via the urine without being noticed.



- A less common calculus, struvite, is caused by urinary tract infection.



- Renal calculi occur in 15 per cent of Caucasian men and six per cent of women in industrialised nations, with recurrence in about half of patients (Bihl and Meyers, 2001).



- Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders such as hyperparathyroidism are linked to calculus formation.



- More than 70 per cent of people with renal tubular acidosis develop renal calculi (National Kidney and Urologic Diseases Information Clearinghouse, 2003).



- Cystinuria and hyperoxaluria are rare, inherited metabolic disorders that often cause renal calculi.



- Calculi are more likely to occur if the body is dehydrated and the urine concentrated.



- Familial history of calculi increases the likelihood of them developing.



- If a calculus becomes stuck in the ureter, the muscle wall goes into spasm (renal or ureteric colic), which is extremely painful.



- The pain may be referred to the lower abdomen and into the groin.



- Blood in the urine is a common sign of renal calculi.



- Urinary urgency and a burning sensation on urination.



- Calculi can block the urinary tract, which can affect the continuing function of the kidney.



- Total obstruction can destroy kidney function - removal is required.



- Description of the pain and possibly the retrieval of calculi from the urine is often enough for a diagnosis to be made.



- It is confirmed by X-ray or intravenous urogram, in which an injected dye is used to show the calculus on an X-ray.



- No treatment is required for small asymptomatic calculi.



- Plenty of fluid will help small calculi pass spontaneously.



- Strong analgesia may be required when calculi pass through the ureter.



- Larger calculi may require removal by fibre-optic endoscope.



- An alternative treatment is extracorporeal lithotripsy, in which acoustic shock waves are used to break up the stones. The fragments can then be passed in the urine.







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