yulius hermantoUrinary Stone Diseases
April 22nd 2009 16:05
Introduction
Urinary stone disease is a disease that caused by formation of crystal (stone) in urinary tract.
The symptoms depend on location, size, duration, etc.
Up to 12% of population have this disease. Men have a higher incidence than women, but incidence seems to be same in older ages and children. Peak incidence is around 20-30 years.
White men also have higher incidence. 50% of people who has the disease, will experience recurrence. Family history will increase the risk by factor of three.
Classification and Pathophysiology
Kidney Stones broadly classified to calcareous (calcium containing) stones, which are radio-opaque, and non-calcareous stones.
Kinds of Urinary Stone
1. Calcium (Calcium oxalate, Calcium Phosphate) 60-80%
2. Struvite (associated with infection) 10-15%
3. Uric acid 5-10%
4. Cystine 1%
5. Other (xanthine, indinavir, indigo, etc.) 1%
Principle of crystal formation is supersatured of mineral components in urine or in simple words, the minerals is no longer soluble in urine. Some important factors involved in crsytal formation are mineral components itself, inhibitors, pH, and nucleation.
General concepts of crystal formation
We can see from figure above, that many factors involved in.
Men have higher incidence because physiologically women secrete less oxalate and more citrate influence by estrogen. Renal morphology also involved because abnormal morphology gives chances for minerals to accumulate and reach its saturation level, also difficult to excrete crystal that has been formed. Hot climate decreased urine volumes, mineral more fast to reach saturate level.
Ones a nucleus (nidus) or core of crystal is formed, minerals is easier to crystallized because saturate level is lower.
Metabolic abnormalities also play role in this, such as: hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitriuria. Because it will cause abnormal concentration of stone forming minerals in urine. In general, any kind of hyper is more difficult to treat than hypo.
Some of patients may have genetic disease of cystine excretion in urine, cystine is insoluble in urine. Infection of urinary tract, especially by urease producing bacteria, because it will lead to struvite stone formation.
You should consult your doctor if you have those disease.
Signs and symptoms
You should consider urinary stone disease if you feel pain around flank (lower abdominal) region that radiates to gonad region (scrotum/ major labia), intermittent pain (colic pain). And the pain is not related to any precipitating event and is not relieved by postural changes or nonnarcotic medications. Those are the classical signs.
Good news is usually pain is unilateral, so crystal is formed in one side only. Why this happen still unknown.
But the symptoms are related to location of crystal. Owing to the shared splanchnic innervation of the renal capsule and intestines, hydronephrosis and distention of the renal capsule may produce nausea and vomiting. Thus, acute renal colic may mimic acute abdominal or pelvic conditions.
As the stone approaches to bladder, lower-quadrant pain radiating to the tip of the urethra, urinary urgency and frequency, and dysuria are characteristic, mimicking the symptoms of bacterial cystitis.
Signs that can be recognized such as blood in urine, often writhing in distress, trying to find a comfortable position, tenderness of lower quadrant may be present.
Diagnosis
The doctor will asked several question about your symptoms, habits, family history to form constructive hypothesis. Then he/she will conduct physical examination to exclude other possibilities. He/she will palpate, touch your belly and area around it. If you feel pain just say it, don't hide it.
To confirm the diagnosis, you will have to follow supporting examination, such as USG, X-ray, IVP, CT-Scan or Renogram. You can discuss about modalities that can be used. USG is the cheapest, but less specific. IVP is no longer recommended for diagnosis because potential of renal toxicity. CT-Scan is more recommended, but it more expensive.
Besides imaging exam, sometimes you will have Laboratory analysis of stone, of course it is being done after the stone is out. The important of stone analysis is to confirm diagnosis and for prevention for recurrence.
Also maybe several check up for metabolic abnormalities.
Treatment
The doctor will exclude emergency situation first, if you don't have it, he/she will go to next step.
If your stone isn't big enough (<5mm), you can have conservative therapy, because chance of self passage is high. But if your is big enough you will be referred to urologist.
Then you will be manage depend on location, density of the stone, and size.
Some of modalities are Extracorporeal Shock Wave Lithotripsy, Uretroscopy, Ureterorenoscopy, Percutaneus Lithotomy, and maybe some case need laparotomy.
Discuss the benefits and risks of each modalities.
I'm sorry, if my english isn't well. Maybe some words miss-spell. That's the information that i could give.
References
1. Parmar, M.S., Kidney Stones. 2004. BMJ;328; 14-20
2. Teichman, J.M.H. Acute Renal Colic from Ureteral Calculus. 2004. NEJM;350; 684-93
3. Portis, A.J., Sundaram, C.P., Diagnosis and Initial Management of Kidney Stones. 2001. AAFP; 63;7: 1329-38
4. Prof. Sja'bani Lecture in Faculty of Medicine Gadjah Mada University 2009
Urinary stone disease is a disease that caused by formation of crystal (stone) in urinary tract.
The symptoms depend on location, size, duration, etc.
Up to 12% of population have this disease. Men have a higher incidence than women, but incidence seems to be same in older ages and children. Peak incidence is around 20-30 years.
Classification and Pathophysiology
Kidney Stones broadly classified to calcareous (calcium containing) stones, which are radio-opaque, and non-calcareous stones.
Kinds of Urinary Stone
1. Calcium (Calcium oxalate, Calcium Phosphate) 60-80%
2. Struvite (associated with infection) 10-15%
3. Uric acid 5-10%
4. Cystine 1%
5. Other (xanthine, indinavir, indigo, etc.) 1%
Principle of crystal formation is supersatured of mineral components in urine or in simple words, the minerals is no longer soluble in urine. Some important factors involved in crsytal formation are mineral components itself, inhibitors, pH, and nucleation.
General concepts of crystal formation
We can see from figure above, that many factors involved in.
Men have higher incidence because physiologically women secrete less oxalate and more citrate influence by estrogen. Renal morphology also involved because abnormal morphology gives chances for minerals to accumulate and reach its saturation level, also difficult to excrete crystal that has been formed. Hot climate decreased urine volumes, mineral more fast to reach saturate level.
Ones a nucleus (nidus) or core of crystal is formed, minerals is easier to crystallized because saturate level is lower.
Metabolic abnormalities also play role in this, such as: hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitriuria. Because it will cause abnormal concentration of stone forming minerals in urine. In general, any kind of hyper is more difficult to treat than hypo.
Some of patients may have genetic disease of cystine excretion in urine, cystine is insoluble in urine. Infection of urinary tract, especially by urease producing bacteria, because it will lead to struvite stone formation.
You should consult your doctor if you have those disease.
Signs and symptoms
You should consider urinary stone disease if you feel pain around flank (lower abdominal) region that radiates to gonad region (scrotum/ major labia), intermittent pain (colic pain). And the pain is not related to any precipitating event and is not relieved by postural changes or nonnarcotic medications. Those are the classical signs.
Good news is usually pain is unilateral, so crystal is formed in one side only. Why this happen still unknown.
But the symptoms are related to location of crystal. Owing to the shared splanchnic innervation of the renal capsule and intestines, hydronephrosis and distention of the renal capsule may produce nausea and vomiting. Thus, acute renal colic may mimic acute abdominal or pelvic conditions.
As the stone approaches to bladder, lower-quadrant pain radiating to the tip of the urethra, urinary urgency and frequency, and dysuria are characteristic, mimicking the symptoms of bacterial cystitis.
Signs that can be recognized such as blood in urine, often writhing in distress, trying to find a comfortable position, tenderness of lower quadrant may be present.
Diagnosis
The doctor will asked several question about your symptoms, habits, family history to form constructive hypothesis. Then he/she will conduct physical examination to exclude other possibilities. He/she will palpate, touch your belly and area around it. If you feel pain just say it, don't hide it.
To confirm the diagnosis, you will have to follow supporting examination, such as USG, X-ray, IVP, CT-Scan or Renogram. You can discuss about modalities that can be used. USG is the cheapest, but less specific. IVP is no longer recommended for diagnosis because potential of renal toxicity. CT-Scan is more recommended, but it more expensive.
Besides imaging exam, sometimes you will have Laboratory analysis of stone, of course it is being done after the stone is out. The important of stone analysis is to confirm diagnosis and for prevention for recurrence.
Also maybe several check up for metabolic abnormalities.
Treatment
The doctor will exclude emergency situation first, if you don't have it, he/she will go to next step.
If your stone isn't big enough (<5mm), you can have conservative therapy, because chance of self passage is high. But if your is big enough you will be referred to urologist.
Then you will be manage depend on location, density of the stone, and size.
Some of modalities are Extracorporeal Shock Wave Lithotripsy, Uretroscopy, Ureterorenoscopy, Percutaneus Lithotomy, and maybe some case need laparotomy.
Discuss the benefits and risks of each modalities.
I'm sorry, if my english isn't well. Maybe some words miss-spell. That's the information that i could give.
References
1. Parmar, M.S., Kidney Stones. 2004. BMJ;328; 14-20
2. Teichman, J.M.H. Acute Renal Colic from Ureteral Calculus. 2004. NEJM;350; 684-93
3. Portis, A.J., Sundaram, C.P., Diagnosis and Initial Management of Kidney Stones. 2001. AAFP; 63;7: 1329-38
4. Prof. Sja'bani Lecture in Faculty of Medicine Gadjah Mada University 2009
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