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Encyclopedia > Kidneystone
Kidney stone
Ultrasonic instrument and kidney stone
ICD-10 N200
ICD-9 592.0
DiseasesDB 11346
MedlinePlus 000458
eMedicine med/1600

Kidney stones, also known as nephrolithiases, urolithiases or renal calculi, are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. They vary in size from as small as a grain of sand to as large as a golf ball. Kidney stones typically leave the body in the urine stream; if they grow relatively large before passing (on the order of millimeters), obstruction of a ureter and distention with urine can cause severe pain most commonly felt in the flank, lower abdomen and groin. Kidney stones are unrelated to gallstones. Image File history File links Download high resolution version (3897x2744, 329 KB) Title: Ultrasonic instrument and kidney stone Image ID: 4172 Photographer: Unknown Restrictions: Public Domain Abstract: Photograph-One 5x7 photograph, with a slip of paper taped to the back. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... A calculus is a concretion of mineral salts that forms in an organ or duct of the body. ... It has been suggested that crystallization processes be merged into this article or section. ... Dietary minerals are the chemical elements required by living organisms, other than the four elements Carbon, Hydrogen, Nitrogen, and Oxygen which are ubiquitous in organic molecules. ... Urine is liquid waste excreted by the kidneys and is produced by the process of filtration. ... Human kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Transverse section of ureter. ... Pain is an unpleasant sensation which may be associated with actual or potential tissue damage and which may have physical and emotional components. ... A flank is the side of either a horse or a military unit. ... In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ...

Contents


Aetiology

Conventional wisdom has held that consumption of too much calcium can aggravate the development of kidney stones, since the most common type of stone is calcium oxalate. However, strong evidence has accumulated demonstrating that low-calcium diets are associated with higher stone risk and vice-versa for the typical stone former. General Name, Symbol, Number calcium, Ca, 20 Chemical series alkaline earth metals Group, Period, Block 2, 4, s Appearance silvery white Atomic mass 40. ... Calcium oxalate is a chemical compound that forms needle-shaped crystals. ...


Other examples of kidney stones include struvite (magnesium, ammonium and phosphate), uric acid, calcium phosphate, or cystine (found only in people suffering from cystinuria). The formation of struvite stones is associated with the presence of urease splitting bacteria (Klebsiella, Serratia, Proteus, Providencia species) which can split urea into ammonia, most commonly Proteus mirabilis. Struvite is an ammonium magnesium phosphate mineral with formula: (NH4)MgPO4·6(H2O). ... General Name, Symbol, Number magnesium, Mg, 12 Chemical series alkaline earth metals Group, Period, Block 2, 3, s Appearance silvery white Atomic mass 24. ... Fumes from hydrochloric acid and ammonia forming a white cloud of ammonium chloride Ammonium is also an old name for the Siwa oasis in western Egypt. ... In inorganic chemistry, a phosphate is a salt of phosphoric acid. ... Uric acid is an organic compound of carbon, nitrogen, oxygen and hydrogen and the structure shown right: Uric acid is the final oxidation product of purine metabolism in the human body and is found in small amounts in urine. ... Calcium phosphate is the name given to a family of minerals containing calcium ions (Ca2+) together with orthophosphates (PO43-), metaphosphates or pyrophosphates (P2O74-) and occasionally hydrogen or hydroxide ions. ... Cystine is an oxidized dimeric form of cysteine. ... Ë Cystinuria is an inherited autosomal recessive disorder and is characterized by the formation of cystine stones in the kidneys, ureter, and bladder. ... Helicobacter Pylori Urease drawn from PDB 1E9Z. Urease (EC 3. ... Binomial name Proteus mirabilis Hauser 1885 Proteus mirabilis is a Gram-negative, facultatively anaerobic bacterium. ...


Symptoms

Kidney stones are usually asymptomatic until they obstruct the flow of urine. Symptoms can include acute flank pain (renal colic), nausea and vomiting, restlessness, dull pain, hematuria, and possibly fever if infection is present. Acute renal colic is described as one of the worst types of pain that a patient can suffer from. But there are also people who have no symptoms until their urine turns bloody—this may be the first symptom of a kidney stone. The amount of blood may not be sufficient to be seen, and thus the first warning can be microscopic hematuria, when red blood cells are found in the microscopic study of a urine sample, during a routine medical test. In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ... Pain is an unpleasant sensation which may be associated with actual or potential tissue damage and which may have physical and emotional components. ... Renal colic is a type of pain commonly caused by kidney stones. ... For other uses, see Nausea (disambiguation). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... In medicine, hematuria (or haematuria) is the presence of blood in the urine. ... See Fever for the Kylie Minogue album; Fever is also a song by Otis Blackwell. ... Infection is also the title of an episode of the television series Babylon 5, and the English title of the Japanese film Kansen. ... Acute may refer to: An acute accent is a diacritic character. ...


Diagnosis & Investigation

Diagnosis is usually made on the basis of the location and severity of the pain, which is typically colic in nature (comes and goes in spasmodic waves). Radiological imaging is used to confirm the diagnosis and a number of other tests can be undertaken to help establish both the possible cause and consequences of the stone. Ultrasound imaging is also useful as it will give details about the presence of hydronephrosis (swelling of the kidney - suggesting the stone is blocking the outflow of urine). It will also show the 10% of stones that do not have enough calcium to be seen on x-rays (radio-opaque stones). Renal colic is a type of pain commonly caused by kidney stones. ...


The relatively dense calcium renders these stones radio-opaque and they can be detected by a traditional X-ray of the abdomen that includes Kidneys, Ureters and Bladder—KUB. This may be followed by an IVP (Intravenous Pyelogram)(IVU - IntraVenous Urogram is the same test by another name) which requires about 50ml of a special dye to be injected into the bloodstream that goes straight to the kidneys and helps outline any stone on a repeated X-ray. These can also be detected by a Retrograde pyelogram. Computed tomography, a specialized X-ray, is by far the most accurate diagnostic test for the detection of kidney stones. In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... KUB is a TLA for Katholieke Universiteit Brussel In medical ultrasonography, a KUB is an X-ray of the abdomen and pelvis; the acronym stands for kidney, ureter and bladder. ... An intravenous pyelogram (also known as IVP, pyelography, intravenous urogram or IVU) is a radiological procedure used to visualise disturbances of the urinary system, including the kidneys, ureters, and bladder. ... Retrograde Pyelogram is a urology procedure where the physician is trying to find a kidney stone. ... CT apparatus in a hospital Computed tomography (CT) (also known as CAT Scan), originally known as computed axial tomography (CAT) and body section roentgenography, is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the internals of an object from...


Investigations typically carried out include:

  • Microscopic study of urine, which may show proteins, red blood cells, pus cells, cellular casts and crystals.
  • Culture of a urine sample to exclude urine infection (either as a differential cause of the patient's pain, or secondary to the presence of a stone)
  • Blood tests: Full blood count for the presence of a raised white cell count (Neutrophilia) suggestive of infection, a check of renal function and if raised blood calcium blood levels (hypercalcaemia).
  • 24 hour urine collection to measure total daily urinary calcium, oxalate and phiosphate.

In medicine, differential diagnosis (sometimes abbreviated DDx) is the systematic method physicians use to identify the disease causing a patients symptoms. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... White blood cells (a. ... Neutrophilia (or neutrophil leukocytosis) is a condition where a person has a high number of neutrophil granulocytes in their blood. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Hypercalcaemia is an elevated calcium level in the blood. ...

Treatment

A 2-mm kidney stone.
A 2-mm kidney stone.

Stones less than 5 mm in size usually will pass spontaneously, with diclofenac usually providing effective pain management. However the majority of stones greater than 6 mm will require some form of intervention, especially so if the stone is stuck causing obstruction and infection of the urinary tract. Image File history File links Kstone. ... A millimetre (American spelling: millimeter), symbol mm is an SI unit of length that is equal to one thousandth of a metre. ... Diclofenac (marketed as Voltaren®, Voltarol®, Diclon® and Cataflam®) is a non-steroidal anti-inflammatory drug (NSAID) taken to reduce inflammation, such as in arthritis or acute injury. ... Pain management is the discipline concerned with the relief of pain. ...


In many cases non-invasive Extracorporeal Shock Wave Lithotripsy may be used. Otherwise some form of invasive procedure is required; with approaches including retrograde ureteral, percutaneous nephrolithotomy or open surgery, and using laser, ultrasonic and mechanical (pneumatic, shock-wave) forms of energy to fragment stones. A lithotriptor is a medical device used in the non-invasive treatment of kidney stones (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver). ... This article is in need of attention from an expert on the subject. ... In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Lithotomy from Greek for lithos (stone) and thomos (cut), is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the bladder and kidneys (urinary calculus) and gallbladder (gallstones), that cannot exit naturally through the urethra, ureter or biliary duct. ... A typical modern surgical operation For other uses, see Surgery (disambiguation). ... Lasers range in size from microscopic diode lasers (top) with numerous applications, to football field sized neodymium glass lasers (bottom) used for inertial confinement fusion, nuclear weapons research and other high energy density physics experiments. ... Ultrasound is sound with a frequency greater than the upper limit of human hearing, approximately 20 kilohertz. ...


A single study at the Mayo clinic has suggested that Lithotripsy may increase subsequent incidence of diabetes and hypertension,[1] but has it has not been felt warrented to change clinical practice at the clinic.[2]


Secondary Prevention

Preventive strategies include dietary modifications and sometimes also taking drugs with the goal of reducing excretory load on the kidneys:[3]

  • Drinking enough water to make 2 to 2.5 litres of urine per day.
  • A diet low in protein, nitrogen and sodium intake.
  • Restriction of oxalate-rich foods and maintaining an adequate intake of dietary calcium is recommended. There is no convincing evidence that calcium supplements increase the risk of stone formation.
  • Taking drugs such as thiazides, potassium citrate and allopurinol depending on the cause of stone formation.

Certain foods may increase the risk of stones: spinach, chocolate, peanuts, cocoa, tomato juice, grapefruit juice, apple juice, soda (acidic and contains phosphorus) tea and coffee (high levels of oxalate). In the U.S., the South has the highest incidence of kidney stones, a region where sweet tea is the drink of choice. Other drinks are associated with decreased risk of stones, including wine, lemonade and orange juice. Although it has been said that the diuretic effects of alcohol can result in dehydration which is important for kidney stones sufferers to avoid, there are no data demonstrating an effect of it to increase the prevalence of stones. It is important to recognize that one of the recognized medical therapies for prevention of stones is thiazides, a class of drugs usually thought of as diuretic. These drugs prevent stones through an effect independent of their diuretic properties: they reduce urinary calcium. Nonetheless, their diuretic property does not preclude their successful use as stone preventive. Caffeine does acutely increase urinary calcium excretion, however coffee with its high oxalate content has been known to cause stones in some patients and should be used in extreme moderation. The litre or liter (see spelling differences) is a unit of volume. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless Atomic mass 14. ... General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Atomic mass 22. ... The oxalate (also ethanedioate) ion is (COO)22− (oxalic acid minus two hydrogen ions). ... Wikipedia does not yet have an article with this exact name. ... General Name, Symbol, Number potassium, K, 19 Chemical series alkali metals Group, Period, Block 1, 4, s Appearance silvery white Atomic mass 39. ... Chemical strucutre of citric acid. ... Allopurinol is a white, powdery drug used to treat gout. ... Binomial name Spinacia oleracea L. Spinach (Spinacia oleracea) is a flowering plant in the family Amaranthaceae, native to central and southwestern Asia. ... Chocolate most commonly comes in dark, milk, and white varieties, with cocoa solids contributing to the brown coloration. ... Binomial name Arachis hypogaea L. The peanut or groundnut (Arachis hypogaea) is a species in the pea family Fabaceae native to South America. ... Cocoa beans in a cacao pod Cocoa is the dried and partially fermented fatty seed of the cacao tree from which chocolate is made. ... Tomato juice is a juice made from squeezed tomatoes. ... Binomial name Citrus × paradisi Macfad. ... Apple juice (sometimes abbreviated AJ) is the fruit juice product originally manufactured from the pressing of apples. ... Look up soda in Wiktionary, the free dictionary. ... Tea leaves in a gaiwan. ... Coffee in beverage form. ... A diuretic is any drug that elevates the rate of bodily urine excretion (diuresis). ... Dehydration is the removal of water (hydor in ancient Greek) from an object. ... Wikipedia does not yet have an article with this exact name. ...


A high protein diet may partly be to blame. Protein from meat and other animal products is broken down into acids. The most available alkaline base to balance the acid from protein is calcium from the bones. The kidney filters from the blood and stores the calcium particles which have bonded with the acids. The more meat is eaten the more calcium is found in the kidneys. Over time, and when not properly removed, these particles bind together to form stones. One of the simplest fixes is to moderate animal protein consumption. A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... In nutrition, the diet is the sum of the food consumed by an organism. ... A base is: in mathematics: A number that is raised to a power, or base of an exponential function. ... General Name, Symbol, Number calcium, Ca, 20 Chemical series alkaline earth metals Group, Period, Block 2, 4, s Appearance silvery white Atomic mass 40. ... Various meats Cold Meat Salad Meat, in its broadest modern definition, is all animal tissue intended to be used as food. ...


Famous sufferers

In 271 or 270 BCE, the Greek Philosopher Epicurus died from a kidney stone blockage lasting a fortnight according to his successor Hermarchus and reported by his biographer Diogenes Laertius. (Redirected from 271 BCE) Centuries: 4th century BC - 3rd century BC - 2nd century BC Decades: 320s BC 310s BC 300s BC 290s BC 280s BC - 270s BC - 260s BC 250s BC 240s BC 230s BC 220s BC 276 BC 275 BC 274 BC 273 BC 272 BC - 271 BC - 270... (Redirected from 270 BCE) Centuries: 4th century BC - 3rd century BC - 2nd century BC Decades: 320s BC 310s BC 300s BC 290s BC 280s BC 270s BC - 260s BC 250s BC 240s BC 230s BC 220s BC 275 BC 274 BC 273 BC 272 BC 271 BC - 270 BC - 269... Bust of Epicurus Epicurus (Epikouros or Ἐπίκουρος in Greek) (341 BC, Samos – 270 BC, Athens) was an ancient Greek philosopher, the founder of Epicureanism, one of the most popular schools of Hellenistic Philosophy. ... A fortnight is a unit of time equal to two weeks: that is 14 days, or literally 14 nights. ... Hermarchus (in Greek EρμαρχoÏ‚), sometimes, but incorrectly, written Hermachus. ... Diogenes Laërtius, the biographer of the Greek philosophers, is supposed by some to have received his surname from the town of Laerte in Cilicia, and by others from the Roman family of the Laërtii. ...


The French Renaissance essayist Montaigne suffered from kidney stones. British statesman Samuel Pepys also suffered from kidney stones and was operated on, pre-anesthesia, to remove a large stone which he carried with him and used to try to persuade fellow sufferers to endure the painful surgery. His contemporary, John Wilkins, Bishop of Chester, could not face the prospect and died as a result. Michel Eyquem de Montaigne (February 28, 1533 - September 13, 1592) was an influential French Renaissance writer, generally considered to be the inventor of the personal essay. ... Samuel Pepys Samuel Pepys, FRS (23 February 1633 – 26 May 1703) was an English naval administrator and Member of Parliament. ... John Wilkins. ...


The author Isaac Asimov suffered from kidney stones, and wrote about how his pain was treated with morphine, saying that he feared becoming addicted to morphine if he ever needed it again. Isaac Asimov, photographed by Jay Kay Klein Dr. Isaac Asimov (c. ... Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. ... Addiction is a compulsion to repeat a behaviour regardless of its consequences. ...


Astronauts often get kidney stones because of an increase in the amount of calcium in their blood due to a loss of bone density in zero gravity. U.S. Space Shuttle astronaut Bruce McCandless II using a manned maneuvering unit (MMU) outside the Challenger in 1984. ...


See also

Nephrology is the branch of internal medicine dealing with the study of the function and diseases of the kidney. ... Urinary retention is a lack of ability to urinate. ... Urology is the field of surgery that focuses on the urinary tracts of males and females, and of the male reproductive system. ... Retrograde Pyelogram is a urology procedure where the physician is trying to find a kidney stone. ...

References and notes

  1. ^ Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW (2006). "Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup". J Urol 175 (5): 1742-7. PMID 16600747.
  2. ^ Ed Edelson. "Kidney Stone Shock Wave Treatment Boosts Diabetes, Hypertension Risk - Study suggests link, but doctors say it's too early to abandon this therapy", HealthFinder, National Health Information Center.
  3. ^ Goldfarb DS, Coe FL (1999, Nov 15). "Prevention of recurrent nephrolithiasis". Am Fam Physician 60 (8): 2269-76. PMID 10593318.
  • Coe FL, Evan A, Worcester E (2005). "Kidney stone disease". J Clin Invest 115 (10): 2598-608. PMID 16200192.

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