Urinary calculus

Urinary calculus:

Oxalate calculus consists of calcium oxalate and is popularly known as the mulberry stone, being covered with sharp projections. These projections cause the kidney to bleed and altered blood is precipitated on the stone. Such stones are usually single and are extremely hard.

Phosphatic calculus consists of calcium phosphate but this may be combined with ammonium magnesium phosphate and, rarely, composed of the latter only. In an alkaline urine, it grows rapidly and may fill the renal calyces, taking on their shape and then being known as Staghorn calculus. These stones are smooth, soft and crumble easily.

Uric acid and urate calculus is hard, smooth and, because it is uncommonly found singly, is typically faceted.

Cystine calculus only occurs in the urinary tract of those with Cystinuria, a genetic disorder affecting renal and intestinal handling of lysine, arginine, ornithine and cystine. Such stones are usually soft, multiple, may assume a cast of the renal pelvis and calyces and only appear in acid urine.

A combination of any of the above may be found in one calculus.

kidney stone

Aetiology:

1) Drinking less water:   Dehydration leads to an increased concentration of urinary solutes and tends to cause them to precipitate.

2) HOT CLIMATES – cause increase in concentration of solutes by excessive sweating resulting in precipitation of calcium.

3) Dietary Factors – Diet rich in red meat, fish, eggs can give rise to aciduria. Diet rich in calcium – milk, spinach, rhubarb etc produce calcium oxalate stones. Diet lacking in vitamin A causes desquamation of renal epithelium and the cells form a nidus around which the stone is deposited.

4) Renal Infection – Organisms such as streptococci, staphylococci, proteus, pseudomonas, klebsiella & E.coli produce recurrent urinary tract infection, producing urea which causes stasis of urine precipitates calcium formation.

5) Prolonged Immobilisation – from any cause, eg: paraplegia is liable to result in skeletal decalcification with increase in urinary calcium favouring the formation of calcium phosphate calculi.

6) Inadequate Urinary Drainage – as in cases of horse shoe kidney, undescended kidneys are more vulnerable for development of stones due to stasis.

Kidney Stones Risk Factors-

• Being overweight or obese
• A diet high in protein, sodium and/or sugar
• Dehydration and not drinking enough fluids
• Family history and personal history
• Diabetes
• Urinary tract infections
• Some rare, inherited disorders
• Excessive calcium, vitamin D, vitamin C, or supplements
• Metabolic disorders
• Gastric/ intestinal bypass surgery
• Gout disease
• Crohn's disease

Kidney stone risks (Diet and Medical factors):

• Diet-

1. Not enough fluids
2. Calcium supplements
3. High animal protein diet
4. High sugar diet
5. High sodium diet
6. High spinach diet
7. Low phytate diet (wheat, rice, barley, beans)

• Medical-

1. Diabetes
2. Obesity
3. Gout
4. Crohn's disease
5. Gastric/ intestinal bypass surgery
6. Primary hyperparathyroidism

Clinical features:

1.RENAL PAIN:  A calculus which is static in the renal pelvis or calyces may not give rise to any symptoms and may only be found co-incidentally on routine radiological examination. 

A mobile calculus in the renal pelvis may give rise to lumbar pain and haematuria both of which are made worse by exercise or movement and are relieved by rest. 

2) URETERIC COLIC: A calculus which enters the ureter may give rise to an attack of renal colic which is characterized by intense pain, usually accompanied by vomiting. If the calculus remains, either temporarily or permanently, in the ureter, repeated intermittent attacks of colic may occur and hydro-ureter, hydro-nephrosis or atrophy of the kidney parenchyma may supervene due to back pressure of urine. 

3.Vesical calculus gives rise to increased frequency of micturition and pain in the lower abdomen, particularly on movement and on emptying the bladder.

4) HAEMATURIA – is common with oxalate stones. The quantity of blood lost is small, but it is fresh blood.

5) URINARY TRACT INFECTION – fever with chills & rigors, pyuria, burning micturition & increased frequency of micturition may occur. In severe cases, even septicaemia can quickly develop.

Clinical features:

• Gross hematuria
• Nausea and vomiting
• Frequent or painful urination
• Dull pain when stone remains in kidney
• Episode of flank pain radiating to the groin when small stones pass into the ureters

Clinical Manifestations:

• Severe flank pain
• Abdominal pain
• Nausea and vomiting
• Fatigue
• Elevated temperature, BP, and respirations
• Steady Pain
• Pain on urination, Pink, red or brown urine
• Oliguria and anuria in obstruction
• Hematuria
• Renal colic
• Hydronephrosis

Diagnostic evaluation:

• Blood
• Urine-analysis
• Cystoscopy
• X-ray
• CT sean, MRI
• Intravenous urogram (IVU) or intravenous pyelogram
• USG
• KUB

Complication of renal stone:

1. Calculous hydronephrosis – occurs due to back pressure producing renal enlargement. Due to the stretching of the renal capsule, it results in pain in the loin & an associated palpable kidney mass suggests hydronephrosis.

2. Calculous pyonephrosis – The kidney is converted into a bag of pus when hydronephrosis becomes infected.

3. Renal failure – Bilateral staghorn calculi may be asymptomatic until they present with uraemia.

4. Squamous cell carcinoma-

Homoeopathic medicines :

1. Cantharis

2. Lycopodium

3. Sarsaparilla

4. Nux-v

5. Berberis Vulgaris Q

6. Hydrangea Arborescens Q

7. Pareira Brava Q