Our kidneys constantly cleanse the body of all kinds of toxins and harmful substances. But what to do if stones appear in them? Kidney stones, or urolithiasis, is one of the most common diseases of the upper urinary system. In this article, we will look at the general principles of how to treat kidney stones and what preventative measures are available.

Why do stones appear?

Excessive consumption of coffee and chocolate is a factor that increases the likelihood of developing kidney stones.

It's no secret that a stone can come out, but after some time a new one appears in its place. In order to prevent the re-formation of stones, you need to have a good understanding of the reasons that contribute to their occurrence:

1. Insufficient fluid intake. If the body experiences a shortage of water, it begins to be absorbed back, and the urine becomes more concentrated, so the salts dissolved in it precipitate more easily and form stones. For normal kidney function, you need at least 8-12 glasses of fluid per day, including during hot periods.
2. . Daily physical activity (walking, aerobics, running) promotes rhythmic shaking of the body and better removal of “sand” from the upper parts of the urinary system. Inactivity and a sedentary lifestyle limit this possibility of self-purification.
3. Regular consumption of coffee or chocolate. Some studies have revealed an interesting pattern: when drinking 2 or more cups of coffee per day, the risk of developing kidney stones increases sharply. According to one version of the possible explanation for the reasons for this pattern, it is believed that these substances increase the concentration of stone-forming substances (for example, calcium) in the urine.
4. Infection of the urinary system. If an area of ​​the mucous membrane of the renal pelvis or calyces becomes inflamed, then the epithelium from this place is quickly exfoliated, microorganisms and leukocytes die. If the urine is concentrated, then stone formation may well begin on these microscopic particles, just as the formation of most hailstones begins with a small speck of dust.
5. Nutrition. Some foods contribute to the formation of stones of various types (for example, meat products contribute to the formation, significant consumption of oxalic acid).
6. Other factors contributing to stone formation: excess weight, hard water, etc.

Good habits are the best treatment for your kidneys

To prevent the growth of existing stones or the formation of new ones, the following habits will be most effective:

1. Drink plenty of fluids. You need to drink enough liquid to produce at least 1.5 liters of urine per day. In this case, the kidneys are well cleansed; salts are practically not inclined to crystallize in the collecting system. Visually, urine should be transparent and almost colorless and odorless. On hot days, it is recommended to regularly do “water shocks” during relative coolness to cleanse the kidneys: taking about 500 ml of water or 1 liter at a time in a fairly short period of time (for example, within half an hour). The meaning of the “water shock” is to activate urine formation and thus “cleanse” the kidneys. Instead of water, you can eat watermelon. In case of edema or symptoms of heart failure, the optimal amount of fluid for “water shock” is determined together with the doctor.
2. Daily 2-hour vigorous walking or aerobics class for at least 40 minutes 5 times a week.
3. Don't get too cold. Try to wear things that keep your lower back area warm. Light clothing of the lower half of the body in cold weather can provoke the development of pyelonephritis and other diseases of the urinary system, and they trigger the process of stone formation.
4. Observe the rules of personal and intimate hygiene. Avoid sexually transmitted diseases. The infection can travel up the ureter and affect the kidneys.
5. Avoid excessive consumption of coffee, chocolate, cocoa, strong tea and similar foods and drinks. Instead, periodically drink cranberry juice, decoctions of diuretic and anti-inflammatory herbs.
6. Follow the diet recommended for stones of this type (oxalates, urates, phosphates).
7. If possible, normalize your weight, drink soft water, etc.

Expulsion and dissolution of stones

In some cases, kidney stone disease cannot be treated without surgical intervention.

1. Phytotherapy. Canephron, phytolysin, urolesan, pol-pal, knotweed and other herbal preparations and preparations are most popular in the treatment of urolithiasis. It must be remembered that there are certain indications and contraindications, so before using the product, you should consult a doctor.
2. Lithotripsy (destruction of stones): remote, contact, etc.
3. Surgical removal: endoscopic or classical.
4. Unconventional methods: the most popular method is drinking water treated with a magnetic field.

Which doctor should I contact?

If symptoms similar to signs of urolithiasis appear, you should not self-medicate, but contact a nephrologist or urologist for diagnosis. The doctor will select the optimal treatment option depending on the type of stones, their size and quantity. Additionally, you can consult a nutritionist on nutrition issues for urolithiasis.

It should be noted that the first symptoms indicating the occurrence of kidney stones include piercing, sharp pain in the lower back, as well as in the lateral abdomen. This pain is called renal colic. It can be so pronounced that the sick person is unable to find a comfortable position, no matter how hard he tries. As a rule, the appearance of this pain syndrome is facilitated by spasm and increased peristalsis of the urinary tract. Often the pain spreads to the thighs, genitals, groin and suprapubic areas. In addition, symptoms such as nausea, frequent urination, vomiting and bloating may be added.

Very often, to relieve pain, specialists resort to narcotic drugs. Often such intense pain is associated with the movement of a stone from the kidneys, which subsequently stopped in some part of the ureter. If the pain in the lower back is not sharp, dull in nature, then the cause is a fairly large stone that gets in the way of the outflow of urine. In addition, the patient may observe an admixture of blood in the urinary secretions. The fact is that sometimes after an attack of renal colic, small stones can pass out in the urine themselves, which provokes damage directly to the mucous membrane of the urinary tract.

If the stone has formed in the renal pelvis, then the pain is localized in the groin area. It is worth considering that in rare cases, urolithiasis can occur completely without any pain syndrome and not differ in certain symptoms. True, there is a danger of unpleasant consequences in the form of kidney infection. After all, in the body, as a rule, nothing passes without a trace.

What are the causes of urolithiasis?

The main causes of urolithiasis are: impaired water-salt metabolism, hard water and food overloaded with minerals, infection in the kidneys, changes in the acid-base balance, stagnation of urine, long-term dehydration, the presence of an inflammatory process in the mucous membranes of the kidneys.

What is the treatment for urolithiasis?

Currently, this disease is treated conservatively as well as surgically. Conservative medical therapy consists of following a special diet and using a variety of medications based on the clinical picture of the disease. In addition, the use of antibacterial drugs is very often recommended. There are medicines created on a plant basis that help slow down the process of stone formation. These include: “Phytolysin”, “Prolit”, “Cyston”, “Cistenal”. However, before using these medications, you must consult your doctor. In addition, painkillers and antispasmodics are prescribed. Surgical treatment methods include crushing kidney stones and surgery. Basically, this technique is used in the presence of stones of large diameter, due to which the urinary tract is blocked, and it is not possible to remove them independently.

Medium-sized stones are most often formed in the kidneys. When they are fixed at the site of formation, there may not be any symptoms. However, when a stone moves along the ureter in places of greatest narrowing, the stone clogs the ureter - symptoms of renal colic appear.

Symptoms of renal colic

General symptoms:

• Paroxysmal pain - periodically worsening
• Possible increase in body temperature

Laboratory signs:
General urine analysis :

• Salts in urine
• Red blood cells in urine
• Cloudy urine

Symptoms of stones of various locations

Symptoms of stones in the renal calyx

The renal calyx is the initial section of the urinary tract into which the collecting ducts of the nephrons of the kidneys open. In each kidney, filtered urine accumulates in the renal pelvis, passing through a system of calyces (there can be from 6 to 12 in each kidney).

Most often, calyx stones are small in size and are excreted in the urine. With excessive urination (during heavy drinking, drinking alcohol, taking diuretics). Possible exacerbation of pain due to the active advancement of stones.
Nature of pain:

• Paroxysmal pain
• Pain is localized in the lumbar region in the lower abdomen or in the groin area.
• The pain worsens with shaking and active movements.

Symptoms of stones in the renal pelvis

The renal pelvis is the most capacious part of the urinary tract of the kidney; all urine produced in the kidney flows into it and accumulates. Each kidney has 1 pelvis into which the renal calyces open and from which the ureters originate.
More often, medium-sized or large (coral-shaped) stones form in the pelvis.

Medium sized stones most often cause a serious condition - blockage of the ureter and an attack of renal colic.
Symptoms of renal colic:
General symptoms:

• Paroxysmal pain - periodically worsening,
• The pain occurs suddenly, more often with movement, shaking, or drinking too much liquid or alcohol. Changing position does not reduce pain.
• Possible increase in body temperature
• Pain can radiate to the lumbar region, lower abdomen, or groin area (depending on the level of ureteral obstruction).

Coral stones fixed in the renal pelvis, do not cause renal colic, but can lead to frequent infectious diseases of the kidneys (pyelonephritis, pyelitis), and in some cases cause atrophy of the entire kidney.

Stones in the ureters

The intensity of pain in urolithiasis depends on the location of the stones, their size and the smoothness of the surface.

Localization of the stone in the upper third of the ureter

• Pain in the lumbar region
• The pain is acute, periodically subsides (but not completely), with periods of intensification
• Changing body position does not affect the intensity of pain
• Pain may radiate to the sides of the abdomen

Localization of the stone in the middle third of the ureter manifests itself with the following symptoms:

• The pain is localized in the lateral projection of the abdomen - along the lower costal edge
• Gives to the iliac and groin areas
• Changing body position does not affect the intensity of pain.

Localization of the stone in the lower third of the ureter manifests itself with the following symptoms:

• Localization of pain – lower abdomen, groin area
• Pain radiates to the scrotum/outer labia
• Feeling of bladder fullness
• Frequent urge to urinate
• Urination itself is painful and does not lead to the sensation of emptying the bladder

Bladder stones

External manifestations of bladder stones are:

• Periodic pain in the lower abdomen
• Pain may radiate to the perineum and external genitalia
• Pain intensifies or occurs with movement
• When urinating, the stream of urine may suddenly stop; if you change your body position, the flow of urine may resume.

Causes of stone formation

External factors contributing to the development of stones:

• Climate (dry, leading to frequent dehydration)
• Soil structure – affects the electrolyte composition of food
• The chemical composition of water - the excess presence of salts in water can contribute to an increase in their concentration in the urine. The acidity of water is also of great importance for stone formation in the urinary organs.
• Regime and amount of fluid intake – insufficient fluid intake increases the risk of stone formation.
• Daily routine – a sedentary lifestyle contributes to the formation of stones
• The composition of daily food consumed is excessive consumption of meat products, foods with a high content of purine bases (peas, sorrel, spinach, etc.).

Internal factors for the development of urolithiasis:

• Urinary tract infections: cystitis, urethritis, prostatitis, pyelonephritis
• Infectious diseases of other organs (angina, furunculosis, osteomyelitis)
• Diseases of the digestive tract: colitis, pancreatitis, cholelithiasis, hepatitis
• Anomalies in the development of the kidneys, ureters, and bladder.

Diagnosis of urolithiasis

The diagnosis of urolithiasis is made based on the following data:

Symptoms of the disease

1. periodically occurring sharp pain (like colic) in the lumbar region, lower abdomen or groin area)
2. incomplete emptying of the bladder
3. burning sensation in the urethra when urinating

Data on the treatment performed - A previous diagnosis of urolithiasis and the effectiveness of the treatment help the doctor make the correct diagnosis and adequately adjust the treatment.

Examination and physical examination data of the patient

1. palpation of the abdomen - allows you to exclude many acute inflammatory diseases of the abdominal organs (pancreatitis, adnexitis, appendicitis, cholecystitis). These diseases may be similar in appearance and symptoms to an attack of renal colic.
2. tapping the abdomen and lumbar region - allows you to exclude or identify signs of diseases such as radiculitis, lumbago, pyelonephritis.
3. external examination of the patient - the patient’s forced position (in which he feels a decrease in pain), the presence of edema, skin color may indicate many diseases of the urinary system.

Ultrasound data– often this examination alone makes it possible to accurately diagnose urolithiasis and identify the shape, size and location of stones.

CT diagnostic data This examination allows you to accurately diagnose urolithiasis and identify the shape, size and location of stones.

X-ray contrast diagnostic data – This method is used for a more detailed study of the flow of urine through the urinary tract and allows us to identify at what level there is a blockage of the urinary ducts.

Data from a general urinalysis study– the presence of urolithiasis may be indicated by the following data:

1. Increased density of urine
2. Presence of unchanged red blood cells
3. Presence of high salt concentration
4. Detection of sand in urine

Treatment of kidney stones with medications

Direction of treatment	Why is it appointed?	How to use?**
Antispasmodics: No-shpa Papaverine Diprofen Galidor	Antispasmodic drugs relieve spasm of the ureter and ensure relaxation of its wall. Due to this, the pain syndrome is reduced and the passage of stones is facilitated.	No-shpa: 0.04 – 0.08 g. Available in tablets of 0.04 g. Papaverine: 0.04 – 0.08 g 3 – 5 times a day. Available in tablets of 0.01 and 0.04 g. Diprofen: 0.025 - 0.05 g 2 - 3 times a day. Available in tablets of 0.05 g. Galidor: 0.1 – 0.2 g 1 – 2 times a day. Available in tablets and dragees of 0.1 g. Also, these drugs are used for renal colic by injection, strictly as prescribed by the doctor.
Painkillers: Baralgin Took Tempalgin Tetralgin Pentalgin	Painkillers are mainly used during an attack of renal colic to relieve pain.	A single dose of analgin for adults is 0.5 - 1 g. It can be used in tablets or solution for injection. The maximum daily dose is 2 g.
Antibacterial drugs	Antibiotics are prescribed when an infection is associated with urolithiasis.	The choice of antibacterial drugs can only be made strictly by a doctor after an examination.

**Prescription of medications, determination of dosage and time of administration is carried out only by the attending physician.

Dissolving stones with medications

Drug name		Why is it appointed?	How to use?
Treatment of urate stones
Allopurinol and synonyms: Allozyme Hello Allopron Allupol Milurite Zilorik Remid Purinol Sanfipurol	Allopurinol inhibits the activity of xanthine oxidase, an enzyme that converts hypoxanthine*** V xanthine****, and xanthine – in uric acid*****. Reduces the deposition of urate (uric acid salt) in organs and tissues, including the kidneys. Prescribed for the treatment of urolithiasis with the formation of urate stones and other diseases accompanied by an increase in the level of uric acid in the blood (gout, hyperuricemia, leukemia, myeloid leukemia, lymphosarcoma, psoriasis, etc.)			Allopurinol is available in tablets of 0.1 and 0.3 g. Dosages: adults with a slight increase in uric acid in the blood: first 0.1 g daily, then 0.1 - 0.3 g; adults with a significant increase in uric acid in the blood: in the first 2 weeks, 0.3–0.4 g daily (3–4 doses per day, 0.1 g each), then 0.2–0.3 g daily ; children: at the rate of 0.01 - 0.02 g of medicinal substance per kilogram of body weight. Contraindications: significant impairment of liver and/or kidney function; pregnancy. While taking the drug, periodic monitoring of uric acid levels in the blood is carried out. If allopurinol is discontinued, then on days 3–4 the level of uric acid in the blood rises to its original value. Therefore, the drug is prescribed in courses for a long time. The tablets are taken before meals.
Etamide	The drug promotes more intensive excretion of urates in the urine. Reduces the content of uric acid salts in urine.			Ethamide is available in tablets of 0.35 g. Dosages: adults - 0.35 g 4 times a day (course duration - 10 - 12 days, then a break of 5 - 7 days, and another course lasting a week). Contraindications: severe liver and kidney diseases. The tablets are taken before meals.
Urodane A combination drug is a mixture of the following medicinal substances (contents are given per 100 g of medicinal product): piperazine phosphate – 2.5 g; hexamethylenetetramine – 8 g; sodium benzoate – 2.5 g; lithium benzoate – 2 g; sodium phosphate – 10 g; sodium bicarbonate – 37.5 g; tartaric acid – 35.6 g; glucose – 1.9 g.	Urodane alkalinizes urine. The main active ingredient is piperazine phosphate. It combines with uric acid to form soluble salts.			The drug is available in granules intended for dissolution in water. Adults take Urodan before meals by dissolving 1 teaspoon of granules in ½ glass of water. Frequency of administration – 3 – 4 times a day. The course of treatment is 30 – 40 days.
Uralit-U A combined drug that includes: sodium citrate potassium citrate citric acid	Uralit-U can be used to dissolve existing urate stones and prevent the formation of new ones. The drug is effective for cystine stones (see below).			The drug is available in the form of granules, which are packaged in 280 g jars. The jar is accompanied by a set of indicator papers designed to control the acidity of urine. The dose is selected by the attending physician, depending on the data shown by the indicator papers. To dissolve stones, urine acidity levels must have a certain value. Contraindications: infections of the genitourinary system and detection of bacteria in the urine, severe circulatory disorders.
Blémarin. A complex preparation that includes the following components: 39.9 parts citric acid 32.25 parts sodium bicarbonate 27.85 parts sodium citrate	The drug has the ability to dissolve urates and other types of urinary stones.			Blemaren is produced in the form of granules, packaged in 200 grams. A measuring spoon and indicator strips are included to determine the acidity of urine.
Solimok. A complex preparation that includes the following components: 46.3% potassium citrate 39% sodium citrate 14.5% citric acid 0.1925% glucose 0.075% dye	The drug is capable of dissolving urinary stones, mainly urates.			Solimok is produced in the form of granules, packaged in 150 g jars. Dosage regimen: 2.5 g in the morning after meals 2.5 g at lunch after meals 5 g in the evening after meals
Treatment of phosphate stones
Dry madder extract. A medicinal product based on herbal raw materials, which contains: madder extract Georgian madder extract	Purposes of prescribing the drug: loosening of urinary stones, which are formed by magnesium and calcium phosphates; antispasmodic effect: by relieving spasms of the ureters and renal pelvis, madder extract facilitates the passage of small stones; diuretic effect: promotes the removal of stones and salts from the kidneys.			Madder extract is available in the form of tablets of 0.25 g. Take 2-3 tablets 3 times a day, after dissolving them in a glass of water. The course of treatment usually lasts from 20 to 30 days and can be repeated after 1 - 1.5 months.
Marelin Composition of the drug: dry madder extract – 0.0325 g; dry horsetail extract – 0.015 g; dry goldenrod extract – 0.025 g; monosubstituted magnesium phosphate – 0.01 g; korglycon – 0.000125 g; kellin – 0.00025 g; sodium salicylamide – 0.035 g.	Effects of Marelina: helps soften kidney stones, which consist of calcium phosphates and oxalates; relieves spasm of the ureters and renal pelvis, facilitating the passage of small stones; relieves inflammation in the genitourinary system.			The drug is available in tablet form. Methods of application: to destroy existing stones: 2 - 4 tablets 3 times a day, course of treatment - 20 - 30 days, after which they take a break of 1 - 1.5 months, and then repeat the course of treatment again; to prevent relapses after removal of kidney stones: 2 tablets 3 times a day for 2 - 3 months, if necessary, repeat the course of therapy after 4 - 6 months. Taking Marelin can provoke an exacerbation of gastric ulcers and inflammatory bowel diseases. Therefore, patients with pathologies of the digestive system are prescribed the drug with caution, taking it strictly after meals.
Treatment of oxalate stones
Marelin(see above)
Spilled Herbal preparation, dietary supplement (included in the radar).	Helps dissolve oxalate stones. Improves metabolic processes in the body and the composition of urine. Contains organic acids, tannins, potassium.			The drug is available in the form of pills and capsules, the composition of which varies slightly. Dosages and method of taking capsules for adults: from 1 to 2 capsules 2-3 times a day, course of treatment – ​​4 – 6 weeks. Dosages and method of taking pills for adults:
Collections of medicinal plants for preparing decoctions and oral administration: · collection No. 7; · collection No. 8; · collection No. 9; · collection No. 10.	They are medicines that are officially used in urology. Effects of medicinal plants included in the compositions: · diuretic; · litholytic(promote the dissolution of oxalate stones); · antispasmodic(eliminate spasms of the urinary tract and promote the passage of small stones).			The dosage is determined by the attending physician. The preparations are brewed in boiling water, take 1 - 2 tablespoons 3 times a day.
Treatment of cystine stones
Penicillamine	A drug that can form a compound with cystine called penicillamine cysteine ​​disulfide. It dissolves in urine much more easily, and this helps reduce the formation of cystine stones.			Penicillamine Available in capsules and soluble film-coated tablets. Dosage of the drug: adults - 1-4 g per day (usually prescribed 2 g per day); · for children – at the rate of 300 mg per kilogram of body weight per day.
Tiopronin	Capable of forming soluble compounds with cystine. It is used for high levels of cystine in urine (excretion of more than 500 mg of cystine per day), in cases where penicillamine is ineffective.			Drug dosages: · children under 9 years of age: first, 15 mg of Tiopronin is prescribed for each kilogram of body weight, the indicated dosage is divided into three doses, then it is adjusted depending on the content of cystine in the urine; adults: first, a dosage of 800 mg is prescribed daily, then it is adjusted depending on the content of cystine in the urine, but not more than 1 gram per day.
Sodium bicarbonate(soda) Potassium citrate	Drugs that alkalinize the urine, promoting the dissolution of cystine stones (the solubility of cystine depends on the pH of the urine: the lower the acidity, the better it dissolves).			Sodium bicarbonate dosage: 200 mg per kilogram of body weight daily. Potassium citrate dosage: 60 – 80 HONEY per day (prescribed by a doctor).
Uralite (see above)
Treatment of struvite stones
For struvite stones, drug therapy is ineffective. The stone is destroyed using special methods or removed surgically.

Treatment of urinary stones with folk remedies

Type of stones	Type of treatment (mineral waters, infusions, decoctions, diet)	Goal of treatment	How to prepare (decoction, tincture, composition and principle of diet)
Struvite	Traditional methods of treatment for struvite stones, like all conservative methods, are ineffective.
Phosphates	Plant infusions: rose hip knotweed grape quarryman's thigh barberry		Rosehip infusion: 3 tablespoons of dry berries per glass of boiling water, leave for 6 hours. Knotweed infusion: take 20 g of dry plant and brew in 200 ml of boiling water. Infusion of grape leaves: 1 tbsp. Brew a spoonful of dry leaves in 1 tbsp. boiling water, leave for 15 - 20 minutes, strain. Infusion of femoral quarry: 1 tablespoon of rhizomes is brewed in 1 glass of boiling water. Can be mixed with infusion of rose hips and honey. Typically, infusions of these plants are taken 2–3 times a day.
	Herbal collection: 2 parts corn silk 2 parts birch leaves 1 part juniper berries 1 part snakeweed root 1 part burdock root 1 part steelberry root	They have diuretic, antispasmodic, and some litholytic effects.	Brew 1 tablespoon of the mixture in 1 cup of boiling water. Boil for another 15 minutes. Take 1 glass of infusion 3 times a day.
	Herbal collection from the following plants: violet tricolor larkspur St. John's wort knotweed dandelion roots	They have diuretic, antispasmodic, and some litholytic effects.	Take the indicated dry plants in equal proportions. Pour one liter of boiling water. Infuse for some time. Take one glass of infusion three times a day.
Urats	Oats	Has a diuretic and antispasmodic effect.	Take the oat grains in the husk and rinse under tap water. Place in a thermos and pour boiling water over it. Leave for 10 – 12 hours. Then rub through a fine sieve. You will get porridge that you can eat for urolithiasis every day for breakfast. Add sugar and honey to taste.
	Herbal collection from plants: currant leaves – 2 parts; strawberry leaves – 2 parts; · knotweed grass – 1 part.	The listed herbs have a diuretic, antispasmodic, and some litholytic effect.	Mix the herbs in the indicated proportions, take a tablespoon of the resulting mixture. Brew boiling water in a glass, strain. Take the infusion 2 tablespoons before meals 3-4 times daily.
Oxalates	Watermelon diet	Watermelons have a strong diuretic effect and help remove sand from the kidneys.	For 1 - 2 weeks you need to eat watermelons with a small amount of rye bread. A particularly pronounced effect is observed from 17.00 to 21.00, when the human urinary system works most actively.
	Grapes (leaves, young tendrils, plant branches)		Take 1 teaspoon of the indicated parts of the plant, collected in the spring. Pour a glass of boiling water. Heat in a water bath for 2 – 3 minutes. Then leave for some time. Take ¼ cup 4 times a day.
Cystine	For cystine stones, medicinal plants are practically ineffective, since the development of the disease is associated with a hereditary disorder in the process of removing cystine from the body.

Attention! The use of traditional methods of treating urolithiasis is possible only after consultation with the attending physician.

Physiotherapy for urolithiasis

Type of treatment	Destination goals	How is it carried out?
Dynamic amplipulse therapy	The essence of the procedure: impact on the body with sinusoidal modular currents. : pronounced analgesic effect. Purpose	The procedure can be performed once to eliminate pain during an attack of renal colic. Special electrodes are applied to the area where the kidney and ureter are located. The exposure is carried out for a total of about 10 minutes.
	The essence of the procedure: exposure to a magnetic field on organs and tissues through the skin using special equipment. Effect on urolithiasis: Relieving pain, swelling, improving blood circulation and regenerative processes in tissues. Purpose: during an attack of renal colic, with severe pain.	The procedure takes 10–15 minutes. The total number of procedures is 5 – 10. Use two inductor cylindrical in shape: one of them is placed against the skin of the abdomen in the lower part of the ureter, and the other is passed from top to bottom along the movement of the stone.
Inductothermy	The essence of the procedure: exposure of organs and tissues to a high-frequency magnetic field. As a result, deep tissue heating and other effects occur. Effect on urolithiasis: Analgesic, antispasmodic effect (elimination of spasms of the ureters). Purpose: during an attack of renal colic, with severe pain.	A special inductor is placed against the skin, which has a cylindrical shape with a diameter of 12 cm. The procedure is usually carried out 30 minutes after aplipulse therapy. Duration: 30 minutes. It is performed once to relieve an attack of renal colic.
Electrical stimulation of the ureter with pulsed currents	The essence of the procedure: action on organs and tissues with pulsed current using special electrodes. Effect on urolithiasis: relieving swelling, spasm, inflammation. Improving blood flow and outflow of venous blood. Purpose	The procedure is carried out for 10 - 15 minutes daily, the total duration of the course is 6 - 7 procedures. The impact is carried out by two electrodes: one is placed on the lumbar region, the second - on the abdominal region in the projection of the ureter.
Electrical stimulation of the ureters with sinusoidal simulated currents	The essence of the procedure: exposure of tissue through the skin to sinusoidal simulated currents with specific characteristics through the skin. Effect on urolithiasis: pain reliever. Improving nutrition and blood supply to tissues. Relieving swelling and spasm of the ureters. Purpose: for the treatment of urolithiasis outside the period of exacerbation, when there is no urinary colic.	The procedure takes 12–15 minutes. After 4–5 procedures, a small stone should come off. If this does not happen, then increase the current strength and carry out several more procedures.
High-intensity pulsed magnetic therapy	See above.	The technique is the same as for relieving an attack of renal colic. The duration of the procedure is 10 – 15 minutes. The general course of treatment is 5 – 10 procedures.

Treatment of urolithiasis in a sanatorium

Type of kidney stones	Sanatoriums and resorts where you can undergo treatment	The mineral waters used and the names of the most popular sources.
Oxalates	Kislovodsk Pyatigorsk Essentuki Zheleznovodskaya Berezovsk (Ukraine) Sairme (Georgia) Truskavets (Ukraine)	Dolomite Narzan Lermontovsky No. 2 Krasnoarmeysky No. 1, No. 7 Narzan Essentuki No. 20 Essentuki No. 4 (used only for rehabilitation purposes after stone removal) Smirnovsky No. 1, Slavyanovsky, Lermontovsky Berezovskaya Sairme No. 1, No. 4
Urats	Kislovodsk Essentuki Berezovsk-Ukraine Zheleznovodsk Sairme-Georgia Borjomi-Georgia Truskavets-Ukraine	Dolomite Narzan Essentuki No. 20 Essentuki No. 17 Essentuki No. 4 (only for uraturia, without stone); Berezovskaya them. Semashko Lermontovsky Smirnovsky No. 1, Slavyanovsky; Sairme Borjomi Naftusya, Truskavetskaya (bottle shop)
Cystine	Kislovodsk Essentuki Berezovsk-Ukraine Zheleznovodsk Sairme-Georgia Borjomi-Georgia Truskavets-Ukraine	Dolomite Narzan Essentuki No. 4 (only after stone removal, when the cystine content in the blood is increased), No. 17, No. 20 Berezovskaya them. Semashko Slavyanovsky Lermontovsky Smirnovsky No. 1 Sairme Borjomi Truskavetskaya Naftusya, (bottled)
Phosphates	Berezovsk (Ukraine) Kislovodsk Essentuki Zheleznovodsk Truskavets (Ukraine)	Berezovskaya Dolomite Narzan Essentuki No. 20 Drilling No. 54 Vladimirsky Smirnovsky No. 1 Naftusya Truskavets (bottled) – when using this mineral water, you need to constantly monitor the pH and composition of urine sediment

Methods for crushing stones in the kidneys and ureters(lithotripsy)

Method	Description	How it is carried out, indications and contraindications
External lithotripsy	One of the safest methods of treating urolithiasis. A special device is used that generates waves. They crush the stone, which breaks into a large number of small fragments. Subsequently, these small fragments pass away quite easily with a stream of urine.	The procedure is carried out within 40 – 90 minutes. Can be performed with or without anesthesia. Indications for extracorporeal lithotripsy: the presence of a small kidney stone or ureter (from 0.5 to 2 cm); The stone is well contoured on x-rays. Contraindications: pregnancy; inflammatory process in the kidneys; blockage of the lumen of the ureter and disruption of the outflow of urine; renal dysfunction; the patient’s serious condition, when it is simply impossible to lay him on the table for manipulation.
Contact lithotripsy	Endoscopic manipulation. Crushing kidney stones using shock waves generated by a device inserted through the urethra, bladder and ureter. Types of contact lithotripsy: Ultrasonic stone crushing. Using ultrasound, you can crush stones into small particles (up to 1 mm), and then remove them using special equipment. The technique allows you to destroy only stones of low density. Pneumatic stone crushing. It is carried out using a strong stream of air, using equipment that works on the principle of a jackhammer. Then the fragments are removed with special endoscopic forceps. This technology does not allow crushing very dense stones. Pneumatic crushing is not possible if the stone is located inside the kidney. Crushing stones using a laser. The most modern, effective technique. The laser beam is capable of destroying even relatively large and dense urinary stones, turning them into dust.	The intervention is performed under general anesthesia. The doctor inserts special endoscopic equipment through the urethra, penetrates the cavity of the bladder, and then into the ureter (if necessary, into the renal pelvis). Ultrasound, laser radiation or a jet of air are applied directly to the stone, so they do not harm surrounding healthy tissue. The duration of the manipulation depends on the shape, density and number of stones. 1 to 2 days after lithotripsy, the patient can be discharged home and begin their normal activities.
Percutaneous (percutaneous) contact lithotripsy	An endoscopic technique that involves bringing equipment for crushing stones through a puncture in the lumbar region. In this case, it is possible to crush large stones, as well as coral stones located in the renal pelvis and calyces.	The intervention is carried out under general anesthesia in a hospital. After percutaneous lithotripsy, the patient can be discharged from the hospital after 3 to 4 days.
Litholapoxia	Litholapoxia– endoscopic technique for destroying urinary stones located in the bladder cavity. To do this, the surgeon inserts a special instrument into the urethra - a lithotripter. Once the stone is destroyed, it can be removed using sucking or flushing the bladder cavity.	The intervention is carried out in a hospital under anesthesia.

Operations for urolithiasis

Today, open surgical interventions with an incision in the treatment of urolithiasis are used less and less due to the emergence of modern, low-traumatic and effective endoscopic techniques.

Indications for surgery for urolithiasis:

• large stones, when they cannot be crushed and removed without surgery;
• significant impairment of renal function, despite the fact that other treatment methods are contraindicated in this case;
• position of the stone: if it is located inside the kidney, then it is very difficult to crush it and remove it;
• complication in the form of a purulent process in the kidneys (purulent pyelonephritis).

Types of surgical interventions for urolithiasis:

Pyelolithotomy. Removal of urinary stone from the renal pelvis through an incision. Often such intervention is resorted to in the presence of large stones, coral stones.

Nephrolithotomy. A complex surgical intervention that is performed for particularly large stones that cannot be removed through the renal pelvis. In such situations, an incision is made directly through the kidney tissue.

Ureterolithotomy. An operation that is currently performed very rarely. This is the removal of a ureteral stone through an incision in the wall of the ureter. In most cases, the removal of such stones can be performed using endoscopic techniques, without an incision.

Help with renal colic

If you suspect an attack of renal colic, you must call an ambulance as soon as possible. It is not advisable to take any medications before the doctor arrives. They can blur existing symptoms and make diagnosis difficult when the doctor arrives on the scene.

If the pain bothers you on the left side, you can apply a hot heating pad to the kidney area and take antispasmodics (No-shpa, Drotaverine, Papaverine).

First aid is provided by the ambulance team on site and in the hospital emergency department, where the patient is taken. A combination of drugs is administered.

Mixture composition:

• analgin (or baralgin) – pain reliever;
• papaverine – antispasmodic (eliminates spasm of the ureters);
• Dibazol is an antispasmodic, lowers blood pressure.

Indications for hospitalization for urolithiasis

• after the medications are administered, the acute pain does not go away;
• increased body temperature, vomiting;
• lack of urine as a result of stone blocking the lumen of the ureter;
• an attack of renal colic is bilateral;
• the patient has only one kidney.

Diet for urolithiasis

Type of stones	Dietary recommendations	Explanations
Urats	Limiting the consumption of foods containing purines - molecules that make up nucleic acids. Purines are mainly found in meat products.	Products rich in purines: animal and fish meat, offal, mushrooms, legumes, meat broths. It is recommended to consume dishes from them no more than once a week.
	Limiting the consumption of foods that interfere with the excretion of uric acid in the urine. Alcohol has this ability.	Patients with uric acid stones should not drink beer or red wine.
	The patient's diet should consist mainly of foods that do not contain purines: vegetables and fruits, milk and dairy products, eggs.	Recommended Products
		mild cheeses tomatoes potato Bell pepper buckwheat seeds and nuts eggplant fruits and berries	millet barley grits pasta cottage cheese
Oxalates	According to their chemical structure, oxalates are compounds of oxalic acid. Therefore, for oxalate urolithiasis, sorrel and foods rich in vitamin C are limited.	Limit in diet
		beets spinach salad Coffee and tea parsley celery jellies cocoa and chocolate beans (green)	carrot beef chicken sauerkraut sorrel sour apples lemons, oranges and other citrus fruits currants tomatoes
	Including a large amount of food rich in magnesium, calcium, and vitamin B6 in your diet.	Products containing essential substances: whole grains potato nuts	Authorized Products: dairy products (preferably consumed in the morning) cereals watermelons bananas apricots pears peas pumpkin cabbage potato
Phosphates and struvites	Limiting foods containing large amounts of calcium and alkaline reaction. Phosphates are calcium salts that form most intensively in an alkaline environment.	Foods that should be limited in case of phosphate urinary stones: cowberry currant cranberry limit consumption of all vegetables and fruits milk and dairy products cheeses and cottage cheese
	Limit foods that increase the production of gastric juice. The more hydrochloric acid is formed, the more acidic ions the body loses. This leads to additional alkalization of urine.	Limit intake of the following foods: carbonated drinks hot spices alcohol
	Limiting salt in the diet.	Consuming large amounts of salt causes the body to lose large amounts of calcium through urine.
	Increase the amount of foods in your diet that contain small amounts of calcium and are acidic. Increase your vitamin A intake.	Recommended Products: butter vegetable oil various soups pasta
	Drinking acidic drinks. They help increase the acidity of urine and prevent the formation of phosphates.	Juices and fruit drinks made from sour fruits and berries (apples, citrus fruits, cranberries, etc.) are recommended.
Cystine stones	Products high in cystine are strictly prohibited.	By-products: liver; spleen; kidneys, etc.
	It is necessary to limit foods that contain cystine in sufficiently large quantities.	meat and fish: 200–250 mg daily are allowed, no more than 5 days a week eggs: no more than 1 pc. in a day legumes Wheat flour
	Increase the content of foods rich in vitamins and biologically active substances in your diet.	watermelon oranges grape cowberry Birch juice pear pomegranate lemon strawberry	pear olives dogwood mandarin Rowan nuts carrot apples blueberry currant

How are kidney stones formed?

There are several theories regarding how kidney stones form and what causes them to appear. According to the latest data, stone formation is a complex process that is influenced by many factors:

• Genetic predisposition;
• Bad ecology;
• Nutritional Features;
• Region of residence - in some areas the water is hard and contains a lot of salts;
• Hormonal imbalance, especially parathyroid disorders;
• Metabolic disorders, in particular mineral metabolism;
• Anatomical features of the structure of the kidneys and urinary tract (weakness of the ligaments supporting the kidney);
• Deficiency of substances that slow down crystallization (citrate, pyrophosphate, nephrocalcin, uropontin);
• Inflammation in the renal pelvis;
• Taking sulfonamides and tetracyclines, nitrofurans together with ascorbic and other acids.

The combination of several of these factors leads to the patient developing chronic crystalluria– a pathology in which crystals of various salts appear in the urine. Stone formation is a complication of this condition. Depending on the pH of the urine and the type of salts, various stones (clusters of crystals) begin to form. Usually their place of birth is the collecting ducts and pelvis.

The process of stone formation begins with the concentration of salts in the urine increasing and them becoming insoluble. The salts crystallize around a colloidal “core,” a large organic molecule that forms the basis of a kidney stone. Subsequently, new crystals form and grow on this matrix.

Recent studies have found that almost all stones (97%) contain nanobacteria, so named because of their small size. These atypical gram-negative (not stained by the Gram method) microorganisms produce apatite (calcium carbonate) during their life processes. This mineral is deposited on the walls of kidney cells, promoting crystal growth. Nanobacteria infect the epithelium of the collecting ducts and the areas of the renal papillae, creating centers of calcium phosphate crystallization around themselves, and thereby contribute to the growth of the stone.

What stones form in the kidneys during urolithiasis?

The choice of treatment will depend on what kind of stones form in the kidneys during urolithiasis. In order to determine the type of stone, it is enough to take tests:

30% of women who suffered from urolithiasis before pregnancy experience exacerbations, especially in the third trimester. This is due to changes in the drinking regime and thickening of the mucous membrane of the ureteral walls. In addition, hormonal and anatomical changes in the pregnant woman’s body contribute to the development of inflammation around the stone, which leads to pyelonephritis.

Reasons for the appearance and exacerbation of urolithiasis in pregnant women.

• Violation of salt metabolism. During the period of bearing a child, phosphorus-calcium metabolism and reabsorption (reverse absorption from primary urine) of uric and oxalic acids are disrupted. Therefore, phosphates, urates and oxalates are predominantly formed.
• Decreased tone and dilation of the renal calyces and pelvis . Their volume increases 2 times compared to the period before pregnancy. And the decrease in tone leads to the fact that the sand is not removed from the kidney, but is overgrown with new crystals.
• Frequent urinary infections in pregnant women, in which mucus, pus and epithelial cells take part in the formation of the stone core. The infection rises from the bladder with vesicoureteral reflux (reverse reflux of urine), penetrates through the lymphogenous route with constipation or hematogenously with inflammatory bacterial diseases.
• Effects of the hormone progesterone to receptors in the urinary tract. Under its influence, the processes of formation and excretion of urine slow down. A decrease in the tone of the ureter from the 3rd to the 8th month causes stagnation of urine in the pelvis.
• Pathological kidney mobility may cause kinking of the ureter and impair the flow of urine. It develops due to the fact that the ligaments in pregnant women become more elastic and weakened.
• Uterine pressure. In the second half of pregnancy, the uterus deviates to the right and compresses the ureter, worsening urine dynamics. In this regard, pregnant women experience predominantly right-sided lesions.

Manifestations of urolithiasis in pregnant women. Doctors identify three mandatory symptoms:

Pain occurs in the upper part of the lower back and can radiate to the stomach, genitals, or leg. The woman is trying to take a forced position to alleviate the condition: on the healthy side, knee-elbow.

As the stone moves, the condition may improve, but dull pain in the lower back remains. It should be noted that attacks of renal colic in pregnant women are easier to tolerate than in other patients. This may be due to the increased elasticity of tissues during pregnancy.

Small stones pass almost asymptomatically and are indicated only by traces of blood detected during a general urine test. The passage of stones occurs mainly before 34 weeks, then the enlarged uterus puts pressure on the ureters and the risk of renal colic increases.

If severe pain occurs, you should immediately call an ambulance or take the pregnant woman to the emergency room of a hospital. Although the attack of colic itself does not pose a threat to the life of the mother or fetus, pain and excitement can cause spontaneous abortion or premature birth, especially in the later stages.

Diagnostics

How to prevent urolithiasis?

In order to prevent the appearance of stones, healthy people need to pay attention to the prevention of urolithiasis. But these recommendations will be especially useful for those who have crystals and sand in their urine or have been diagnosed with kidney stones.

Particular attention to prevention should be paid to people whose relatives suffer from urolithiasis. Since there is a high probability that the tendency to form stones is inherited.

Is it possible to dissolve kidney stones?

It is possible to dissolve kidney stones with the help of medications, but not all stones respond equally well to lysis.

Can be dissolved with medications:

• Urate stones;
• Cystine stones;
• Struvite stones;
• Phosphate stones.

Dissolution conditions

• Small diameter - stones smaller than 4 mm dissolve well. It is advisable to crush a stone larger than 2 cm into smaller fragments using remote or contact endoscopic crushing.
• Acid urine reaction. Acidic stones are more friable and amenable to lysis better.

The duration of the dissolution period takes from 2 months to six months.

Dissolution of urate stones. For dissolution the following are used:

Dissolution of cystine stones

• Tiopronin is a complexing agent that binds cystine. Provides dissolution of cystine stones. When taking it (800-1000 mg per day), it is necessary to consume a sufficient amount of liquid - 2.5-3 liters. The dose is divided into 2-3 parts, taken after meals.
• Penicillamine has a similar effect, but has a greater number of side effects compared to tiopronin. Take 500 mg 4 times a day, an hour before meals. The last evening dose should be increased. Before going to bed, you need to take an additional 0.5 liters of water.
• Captopril binds cysteine ​​in urine and removes it from the kidneys, preventing it from being converted to cystine. Gradually dissolves stones. Prescribe 20-50 mg 3 times a day, on an empty stomach.
• Drinking plenty of fluids normalizes the acidity of urine and reduces the concentration of salts.

Dissolution of struvite stones

• Litostat (acetohydroxamic acid). Blocks urease, an enzyme produced by bacteria, which is a component of struvite stones. Softens stones and leads to their crushing and excretion in urine. Take 250 mg 3-4 times a day.

Dissolving phosphate stones. Since these stones form in alkaline urine, measures aimed at acidifying it are taken to dissolve them.

• Methionine 500 mg 3-6 times a day increases the acidity of urine.
• Ammonium chloride 70–300 mg 3 times a day orally after meals prevents sedimentation in alkaline urine.
• Acetohydroxamic acid - 250 mg 3-4 times a day, after meals. Prescribed for urine oxidation when methionine and ammonium chloride are ineffective.
• Cranberry extract 2 tablets 3 times a day increases the acidity of urine and promotes the dissolution of phosphates.

Drinking regime- one of the most important components of therapy for any type of stones. If you do not consume enough liquid, the stones will decrease in size, but will remain in place, and then continue to grow. In addition, there is a risk of the formation of stones from the salts included in the medications. To prevent this from happening, you need to consume up to 3 liters of fluid per day. The daily volume of urine should be more than 2 liters.

To dissolve stones, it is extremely important to follow a diet and exclude foods that increase stone formation.

is a manifestation of urolithiasis, characterized by the formation of salt concretions (stones) in the kidneys. Accompanied by aching pain in the lower back, attacks of renal colic, hematuria, pyuria. Diagnosis requires CT and ultrasound of the kidneys, excretory urography, radioisotope nephroscintigraphy, and studies of biochemical parameters of urine and blood. Treatment of kidney stones may include conservative therapy aimed at dissolving stones, or their surgical removal (nephrolithotripsy, pyelolithotomy, nephrolithotomy).

General information

Kidney stones (renal stones, nephrolithiasis) are a common pathology. Specialists in the field of practical urology quite often encounter kidney stones, and stones can form in both children and adults. The majority of patients are men; stones are more often detected in the right kidney; in 15% of cases, bilateral localization of stones occurs.

Acquired disorders of salt metabolism can be caused by external (exogenous) and internal (endogenous) reasons. Among external factors, the greatest importance is given to climatic conditions and drinking regime and diet. It is known that in hot climates with increased sweating and a certain degree of dehydration, the concentration of salts in the urine increases, which leads to the formation of kidney stones. Dehydration can be caused by poisoning or an infectious disease that occurs with vomiting and diarrhea.

In the northern regions, stone formation factors may include a deficiency of vitamins A and D, a lack of ultraviolet radiation, and a predominance of fish and meat in the diet. Consumption of drinking water with a high content of lime salts, food addiction to spicy, sour, salty foods also leads to alkalization or acidification of urine and precipitation of salts.

Among the internal factors, there is hyperfunction of the parathyroid glands - hyperparathyroidism. Increased work of the parathyroid glands increases the phosphate content in the urine and the leaching of calcium from bone tissue. Similar disorders of mineral metabolism can occur with osteoporosis, osteomyelitis, bone fractures, spinal injuries, and spinal cord injuries. Endogenous factors also include gastrointestinal diseases - gastritis, peptic ulcers, colitis, leading to disruption of acid-base balance, increased excretion of calcium salts, weakening of the barrier functions of the liver and changes in the composition of urine.

Pathogenesis

The formation of kidney stones occurs as a result of a complex physicochemical process due to disturbances in colloid balance and changes in the renal parenchyma. A known role belongs to unfavorable local conditions in the urinary tract - infections (pyelonephritis, nephrotuberculosis, cystitis, urethritis), prostatitis, kidney anomalies, hydronephrosis, prostate adenoma, diverticulitis and other pathological processes that disrupt the passage of urine.

Slowing the outflow of urine from the kidney causes stagnation in the pyelocaliceal system, oversaturation of urine with various salts and their precipitation, and delayed passage of sand and microliths into the urine. In turn, the infectious process developing against the background of urostasis leads to the entry of inflammatory substrates into the urine - bacteria, mucus, pus, protein. These substances participate in the formation of the primary core of the future calculus, around which salts, which are present in excess in the urine, crystallize.

From a group of molecules, a so-called elementary cell is formed - a micelle, which serves as the initial core of the stone. The “building” material for the nucleus can be amorphous sediments, fibrin threads, bacteria, cellular detritus, and foreign bodies present in the urine. The further development of the stone formation process depends on the concentration and ratio of salts in the urine, urine pH, and the qualitative and quantitative composition of urinary colloids.

Most often, stone formation begins in the renal papillae. Initially, microliths form inside the collecting ducts, most of which are not retained in the kidneys and are freely washed out in the urine. When the chemical properties of urine change (high concentration, pH shift, etc.), crystallization processes occur, leading to retention of microliths in the tubules and encrustation of the papillae. In the future, the stone may continue to “grow” in the kidney or descend into the urinary tract.

Classification

Based on their chemical composition, there are several types of stones found in the kidneys:

• Oxalates. Consist of calcium salts of oxalic acid. They have a dense structure, black-gray color, and a spiky, uneven surface. They can form due to both acidic and alkaline urine reactions.
• Phosphates. Concretions consisting of calcium salts of phosphoric acid. Their consistency is soft, crumbly, with a smooth or slightly rough surface, and a whitish-grayish color. Formed by alkaline urine, they grow quite quickly, especially in the presence of infection (pyelonephritis).
• Urats. They are represented by crystals of uric acid salts. Their structure is dense, the color ranges from light yellow to brick red, the surface is smooth or finely pinpointed. Occurs when urine is acidic.
• Carbonates. Stones are formed by the precipitation of calcium salts of carbonic acid. They are soft, light, smooth, and can have different shapes.
• Cystine stones. The composition contains sulfur compounds of the amino acid cystine. The stones have a soft consistency, a smooth surface, a round shape, and a yellowish-white color.
• Protein stones. They are formed predominantly by fibrin with an admixture of bacteria and salts. The structure is soft, flat, small in size, white in color.
• Cholesterol stones. Rarely encountered; formed from cholesterol, have a soft crumbly consistency, black color.

Sometimes kidney stones form not of a homogeneous, but of a mixed composition. One of the most difficult options are coral stones, which make up 3-5% of all stones. Coral-shaped stones grow in the pelvis and in appearance represent its cast, almost completely repeating the size and shape of the organ.

Symptoms of nephrolithiasis

Depending on their size, quantity and composition, kidney stones can cause symptoms of varying severity. A typical clinical picture includes lower back pain, development of renal colic, hematuria, pyuria, and sometimes spontaneous passage of a kidney stone in the urine. Pain in the lower back develops as a result of a violation of the outflow of urine, can be aching, dull, and with sudden urostasis, when a stone blocks the renal pelvis or ureter, progress to renal colic. Coral stones are usually accompanied by a mild dull pain, while small and dense ones give a sharp, paroxysmal pain.

A typical attack of renal colic is accompanied by sudden sharp pain in the lumbar region, spreading along the ureter to the perineum and genitals. Reflexively, against the background of renal colic, frequent painful urination, nausea and vomiting, and flatulence occur. The patient is agitated, restless, and cannot find a position that alleviates the condition. The pain attack in renal colic is so severe that it is often stopped only by the administration of narcotic drugs. When stones obstruct both ureters, postrenal anuria and fever develop.

At the end of the attack, kidney stones often pass in the urine, and post-painful hematuria is possible. The intensity of hematuria can vary - from slight erythrocyturia to severe gross hematuria. Discharge of pus in the urine (pyuria) develops with inflammation in the kidneys and urinary tract. The presence of kidney stones does not manifest itself symptomatically in 13-15% of patients.

Diagnostics

Recognition of kidney stones is made on the basis of anamnesis, a typical picture of renal colic, laboratory and instrumental imaging studies. At the height of renal colic, sharp pain on the side of the affected kidney, a positive Pasternatsky sign, and painful palpation of the corresponding kidney and ureter are determined. To confirm nephrolithiasis, the following is performed:

• Laboratory diagnostics. Urine examination after an attack reveals the presence of fresh red blood cells, leukocytes, protein, salts, and bacteria. Biochemical examination of urine and blood to a certain extent allows us to judge the composition and causes of stone formation.
• Ultrasound. Using kidney ultrasound, anatomical changes in the organ, the presence, location and movement of stones are assessed. Right-sided renal colic must be differentiated from appendicitis, acute cholecystitis, and therefore an ultrasound of the abdominal cavity may be required.
• X-ray diagnostics. Most of the stones are identified already during survey urography. However, protein and uric acid (urate) stones do not reflect X-rays and do not produce shadows on urograms. They can be identified using excretory urography and pyelography. In addition, excretory urography provides information about morpho-functional changes in the kidneys and urinary tract, the localization of stones (pelvis, calyx, ureter), the shape and size of stones.
• Kidney CT scan. Computed tomography is the “gold standard” for diagnosis, as it allows you to see stones of any size and density. If necessary, urological examination is supplemented with radioisotope nephroscintigraphy.

Treatment of kidney stones

Conservative treatment

Treatment of nephrolithiasis can be conservative or surgical and in all cases is aimed at removing kidney stones, eliminating infection and preventing the re-formation of stones. For small kidney stones (up to 3 mm), which can be passed independently, plenty of water load and a diet excluding meat and offal are prescribed.

For urate stones, a dairy-vegetable diet that alkalizes urine and alkaline mineral waters (Borjomi, Essentuki) is recommended; for phosphate stones - take acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets), etc. Additionally, under the supervision of a urologist, medications that dissolve kidney stones can be used (for example, citrate therapy for urate stones).

First aid for renal colic

With the development of renal colic, therapeutic measures are aimed at relieving obstruction and pain. For this purpose, injections of platyphylline, metamizole sodium, morphine or combined analgesics in combination with atropine solution are used; A warm sitz bath is performed and a heating pad is applied to the lumbar region. In case of intractable renal colic, novocaine blockade of the spermatic cord (in men) or round ligament of the uterus (in women) and catheterization of the ureter are required.

Surgery

Surgical removal of stones is indicated for frequent renal colic, secondary pyelonephritis, large stones, ureteral strictures, hydronephrosis, kidney blockade, threatening hematuria, stones in a single kidney, coral stones. For nephrolithiasis, remote lithotripsy is used, which avoids any intervention in the body and removes fragments of stones through the urinary tract. For stones up to 2 cm in diameter, you can use the “flexible retrograde nephrolithotripsy” method, as well as percutaneous nephrolitholapaxy, which allows you to remove the stone through a puncture in the kidney.

Open or laparoscopic interventions to remove stones - pyelolithotomy (dissection of the pelvis) and nephrolithotomy (dissection of the parenchyma) are rarely resorted to, mainly when minimally invasive surgery is ineffective. In case of complicated kidney stone disease and loss of kidney function, nephrectomy is indicated. After removal of stones, patients are recommended spa treatment, lifelong diet, and elimination of associated risk factors.

Prognosis and prevention

In most cases, the course of nephrolithiasis is prognostically favorable. After removing the stones, subject to the instructions of the urologist, the disease may not recur. In unfavorable cases, calculous pyelonephritis, symptomatic hypertension, chronic renal failure, and hydropyonephrosis may develop.

For any type of kidney stones, it is recommended to increase the drinking volume to 2 liters per day; use of special herbal preparations; exclusion of spicy, smoked and fatty foods, alcohol; avoiding hypothermia; improving urodynamics through moderate physical activity and exercise. Prevention of complications of nephrolithiasis comes down to early removal of kidney stones and mandatory treatment of concomitant infections.