Etiology
• (Septic stones, are more frequent as women suffer more from urinary tract infections) and have a direct relationship to body mass index
• It consists of a polycrystalline aggregate consisting of varying amounts of a crystalline and organic matrix.
Excessive urine required for stone formation.
• Supersaturation depends on urine pH, ionic activity, dissolved substance density and composition ability.
The stones are mainly composed of a crystalline component.
Stone hammer
It consists mainly of protein and small amounts of hexose and hexosamine
Calcium-containing stones
Calcium oxalate----- 60%
Hydroxyapatite------ 20%
Brochet --------------- 2%
Calcium free stones
Uric acid ------------ 7%
Struvite ------------- 7%
Cysteine ---------- - 1-3%
Triamterene -------- <1%
Silica ---------------- <1%
Factors that facilitate the formation of calcium stones
Hypercalciuria
It is defined as the amount of calcium in the urine greater than 200 mg/day. There are different types such as absorptive, absorptive and renal hypercalciuria.
Hyperoxaluria
It is defined as the daily urinary oxalate amount still greater than 40 mg/day after a proper diet. The causes of calcium oxalate stones will be. Causes of primary hyperoxaluria include malabsorption states in inflammatory bowel disease, celiac disease, bowel resection, and dietary consumption of excess oxalate or its substrates.
Excessive uric acid
Excess uric acid in the urine has been associated with calcium stones.
lack of blood sugar
Low pH in urine
Renal tubular acidosis (most common type 1 stone formation)
Non-calcium stones
Struvite
Struvite stones are composed of magnesium, ammonium, and phosphate.
It can often be found in the form of Double sided deer antler in the kidneys.
• It consists of a polycrystalline aggregate consisting of varying amounts of a crystalline and organic matrix.
Excessive urine required for stone formation.
• Supersaturation depends on urine pH, ionic activity, dissolved substance density and composition ability.
The stones are mainly composed of a crystalline component.
Stone hammer
It consists mainly of protein and small amounts of hexose and hexosamine
Calcium-containing stones
Calcium oxalate----- 60%
Hydroxyapatite------ 20%
Brochet --------------- 2%
Calcium free stones
Uric acid ------------ 7%
Struvite ------------- 7%
Cysteine ---------- - 1-3%
Triamterene -------- <1%
Silica ---------------- <1%
Types of stone and its properties
Calcium stonesFactors that facilitate the formation of calcium stones
Hypercalciuria
It is defined as the amount of calcium in the urine greater than 200 mg/day. There are different types such as absorptive, absorptive and renal hypercalciuria.
Hyperoxaluria
It is defined as the daily urinary oxalate amount still greater than 40 mg/day after a proper diet. The causes of calcium oxalate stones will be. Causes of primary hyperoxaluria include malabsorption states in inflammatory bowel disease, celiac disease, bowel resection, and dietary consumption of excess oxalate or its substrates.
Excessive uric acid
Excess uric acid in the urine has been associated with calcium stones.
lack of blood sugar
Low pH in urine
Renal tubular acidosis (most common type 1 stone formation)
Non-calcium stones
Struvite
Struvite stones are composed of magnesium, ammonium, and phosphate.
It can often be found in the form of Double sided deer antler in the kidneys.
Struvite stones are made of bacteria that break down urea such as Proteus, Pseudomonas, Providencia, Klebsiella, Staphylococci, and Mycoplasma.
They alkalize the pH of urine.
The urine pH of the affected patient ranges between 6.8-8.3.
rarely less than 7.0
Severe diuresis does not prevent struvite stones.
Medication for gallstone removal.
Uric Acid
Low pH, low urine volume, and hyperuricemia are the top three causes.
The incidence of uric acid is high in people with gout or myeloproliferative disease who are being treated with cytotoxic drugs for their malignancy.
High uric acid levels are often due to dehydration and excessive purine intake.
Patients urine pH is consistently less than 5.5
Pure uric acid stones are not opaque.
Cysteine
A genetic defect that causes abnormal intestinal mucosal and renal tubular uptake of dibasic amino acids, including cysteine, ornithine, lysine and arginine, causing cystine stones.
The familial story of the stone, the round appearance like the hour glass in the chart, the smooth border suggest this stone.
A diet low in methionine is required.
Cystine stones are resistant to ESWL (extracorporeal shock wave lithotripsy).
Cysteine stones are the hardest stones.
Xanthine
Xanthine stones secondary to congenital xanthine oxidase deficiency.
It is not opaque.
Medicine related stones
indinavir, triamterene, guaifenesin, ephedrine, indinavir
Protease inhibitors are effective and common treatments for patients with acquired immunodeficiency syndrome.
Indinavir is a routine protease inhibitor that causes radiolucent stones in up to 6% of patients.
There are two types of pain: renal colic (renal colic) and non-colic pain.
Straining of the collecting system or ureter often leads to renal colic. In contrast, non-colicky pain is the result of stretching of the renal capsule.
Going down the ureter, localized pain is noted as it spreads through the genital branch of the iliac nerve and the femoral nerve.
Hematuria
Infection
Approaching a gallstone patient for the first time
Anamnesis
- Pharmacological history (calcium, vitamin C, vitamin A, acetazolamide, steroid)
Diet, insufficient fluid intake, excessive fluid loss
Blood
Sodium, potassium, chlorine, carbon dioxide, urea, creatinine
Calcium
parathormone
uric acid
Urine
Urinalysis (pH, sedimentation of crystals)
Urine culture (urea-lysis organisms)
Rays
Radioactive stones: calcium oxalate, calcium phosphate, struvite, cysteine
Non-radioactive stones: uric acid, xanthine, triamterene
Intravenous pyelogram
Stone analysis
It is the best view.
The use of intravenous contrast is not required.
Uric acid stones may appear just like calcium oxalate stones.
• Intravenous pyelogram (IVP)
• DUSG films and guided ultrasound
It is the first method that is requested.
DUSG film and kidney ultrasound may be as effective as IVP in diagnosis.
• Retrograde pyelogram
Retrograde pyelography may be needed for small, radiologically clear smears.
• MRI
It is not enough to detect gallstone disease.
• Nuclear scintigraphy
Even small stones that are difficult to detect on conventional DUSG films can be identified by injecting bisphosphonate pens.
Fluid consumption (at least two liters)
Fruit juices (lemon, orange)
Reduce animal protein and reduce salt
Interventional therapy
Kidney stones not in the lower pole
<2 cm === ESWL
>2 cm === PNL
Renal lower pole stones
<1 cm === ESWL
1-2 cm=== Urethroscopy
>2 cm === PNL
Deer stones or antlers are septic stones and the primary method should be percutaneous nephrolithotomy to prevent infection from spreading.
It is the best way to wait for ureteral stones smaller than 5 mm, as they are more likely to pass spontaneously. Ureteroscopy or ESWL may be performed for large stones.
Contraindications to the use of shock wave to break up stones
• pregnancy
Uncorrected blood clot or bleeding diathesis
• Arterial aneurysm near the stone (renal or abdominal aorta)
Obstruction of the urinary tract away from the stone
• Technical problems (structural abnormalities) in targeting the pebble
Factors that negatively affect the performance of shock wave lithotripsy
• gallstone content (cysteine, bericht, calcium oxalate monohydrate)
• Stone attenuation 2: 1000 HU
Skin to gallstone distance of more than 10 cm 1 (morbid obesity)
• Renal anatomic malformations (Casole nephrosis, calcific diverticulum)
• Unpredictable anatomical problems in the lower palate (sub-pelvic angular narrowing)
They alkalize the pH of urine.
The urine pH of the affected patient ranges between 6.8-8.3.
rarely less than 7.0
Severe diuresis does not prevent struvite stones.
Medication for gallstone removal.
Uric Acid
Low pH, low urine volume, and hyperuricemia are the top three causes.
The incidence of uric acid is high in people with gout or myeloproliferative disease who are being treated with cytotoxic drugs for their malignancy.
High uric acid levels are often due to dehydration and excessive purine intake.
Patients urine pH is consistently less than 5.5
Pure uric acid stones are not opaque.
Cysteine
A genetic defect that causes abnormal intestinal mucosal and renal tubular uptake of dibasic amino acids, including cysteine, ornithine, lysine and arginine, causing cystine stones.
The familial story of the stone, the round appearance like the hour glass in the chart, the smooth border suggest this stone.
A diet low in methionine is required.
Cystine stones are resistant to ESWL (extracorporeal shock wave lithotripsy).
Cysteine stones are the hardest stones.
Xanthine
Xanthine stones secondary to congenital xanthine oxidase deficiency.
It is not opaque.
Medicine related stones
indinavir, triamterene, guaifenesin, ephedrine, indinavir
Protease inhibitors are effective and common treatments for patients with acquired immunodeficiency syndrome.
Indinavir is a routine protease inhibitor that causes radiolucent stones in up to 6% of patients.
Symptoms and signs
PainThere are two types of pain: renal colic (renal colic) and non-colic pain.
Straining of the collecting system or ureter often leads to renal colic. In contrast, non-colicky pain is the result of stretching of the renal capsule.
Going down the ureter, localized pain is noted as it spreads through the genital branch of the iliac nerve and the femoral nerve.
Hematuria
Infection
Approaching a gallstone patient for the first time
Anamnesis
- Pharmacological history (calcium, vitamin C, vitamin A, acetazolamide, steroid)
Diet, insufficient fluid intake, excessive fluid loss
Blood
Sodium, potassium, chlorine, carbon dioxide, urea, creatinine
Calcium
parathormone
uric acid
Urine
Urinalysis (pH, sedimentation of crystals)
Urine culture (urea-lysis organisms)
Rays
Radioactive stones: calcium oxalate, calcium phosphate, struvite, cysteine
Non-radioactive stones: uric acid, xanthine, triamterene
Intravenous pyelogram
Stone analysis
Radiological examinations
• Computed tomographyIt is the best view.
The use of intravenous contrast is not required.
Uric acid stones may appear just like calcium oxalate stones.
• Intravenous pyelogram (IVP)
• DUSG films and guided ultrasound
It is the first method that is requested.
DUSG film and kidney ultrasound may be as effective as IVP in diagnosis.
• Retrograde pyelogram
Retrograde pyelography may be needed for small, radiologically clear smears.
• MRI
It is not enough to detect gallstone disease.
• Nuclear scintigraphy
Even small stones that are difficult to detect on conventional DUSG films can be identified by injecting bisphosphonate pens.
Treatment
MedicalFluid consumption (at least two liters)
Fruit juices (lemon, orange)
Reduce animal protein and reduce salt
Interventional therapy
Kidney stones not in the lower pole
<2 cm === ESWL
>2 cm === PNL
Renal lower pole stones
<1 cm === ESWL
1-2 cm=== Urethroscopy
>2 cm === PNL
Deer stones or antlers are septic stones and the primary method should be percutaneous nephrolithotomy to prevent infection from spreading.
It is the best way to wait for ureteral stones smaller than 5 mm, as they are more likely to pass spontaneously. Ureteroscopy or ESWL may be performed for large stones.
Contraindications to the use of shock wave to break up stones
• pregnancy
Uncorrected blood clot or bleeding diathesis
• Arterial aneurysm near the stone (renal or abdominal aorta)
Obstruction of the urinary tract away from the stone
• Technical problems (structural abnormalities) in targeting the pebble
Factors that negatively affect the performance of shock wave lithotripsy
• gallstone content (cysteine, bericht, calcium oxalate monohydrate)
• Stone attenuation 2: 1000 HU
Skin to gallstone distance of more than 10 cm 1 (morbid obesity)
• Renal anatomic malformations (Casole nephrosis, calcific diverticulum)
• Unpredictable anatomical problems in the lower palate (sub-pelvic angular narrowing)