Kidney Stones

What is it?

Kidney stones consist of the development within the urinary tract of solid formations resulting from the precipitation of salts that aggregate into macro-aggregates from which actual stones develop. They are localised at various points along the urinary tract. The pain of renal colic is the aspect of the disease that most concerns and involves patients, but it is not the main clinical problem. In fact, the stone can cause an obstruction of the urinary tract that can damage the kidney itself if it persists for a long time. In its various forms, this disease now affects about 10% of the population, with high social costs. The reason for this high incidence is to be found in the lifestyle in western countries characterised by a diet rich in animal protein and low in vegetables and dairy products. Familial and hereditary factors also play a role in the pathogenesis of kidney stones. These factors manifest as various defects in urine composition, such as increased excretion of calcium, uric acid or oxalate and decreased excretion of citrate with consequent stone formation. Finally, the possible presence of a urinary tract infection should not be overlooked, which can seriously complicate the disease. Renal stone disease usually tends to recur, and in the case of idiopathic stone formation there is a 40-50% chance of recurrence after the first case within 5 years. Recurrence due to calculi secondary to systemic diseases such as cystinuria, primary hyperoxaluria or primary hyperparathyroidism is much more frequent.

Which are the symptoms?

The widespread use of ultrasound in urinary calculosis makes it possible to diagnose the disease at a completely asymptomatic stage. The initial clinical manifestation of nephrolithiasis is renal colic or renal-ureteral colic, which results from obstruction of the urinary tract. The main symptom is persistent colic pain, first in the side and then irradiating to the groin. The pain may be accompanied by nausea and vomiting. Kidney stones may also be associated with changes in urinalysis, such as typically the presence of blood in the urine, sometimes to the extent of macrohaematuria.

·         pain

·         haematuria

How is it diagnosed?

Ultrasonography remains the first level diagnostic method and can detect indirect or direct signs of urinary tract stones. Combination with abdominal radiography increases its accuracy and can also add important information about whether the stone is radiopaque or not. However, the most accurate examination is a CT scan (even at low intensity of radiation), which may be necessary to establish the diagnosis.

Suggested exams

How is it treated?

The prevention of recurrent kidney stone disease is based on an appropriately specialised approach that seeks to identify dietary factors and changes in urine composition that may lead to the formation of kidney stones. The need for drug therapy is then determined and an appropriate diet is prescribed to prevent stone formation. In the case of renal colic, it may be necessary to administer painkillers to help the stones to recede. The use of antibiotics may be necessary if there are infectious complications in the urinary tract. A variety of surgical treatments (shockwave lithotripsy, endoscopic or translombar treatment) are used to remove stones from the urinary tract, depending on the size, location and type of stone.

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