Kidney stones (renal calculi) is the abnormal accumulation of crystalline material (such as calcium, oxalic acid, uric acid, cystine, etc.) in the kidneys due to the common diseases of the urinary system, frequent diseases, male incidence is more than female, occurring more often in young adults, there is no significant difference in incidence of the left and right sides of the body, 90% of the containing calcium, of which calcium oxalate stones are the most common. 40% to 75% of the patients with kidney stones have varying degrees of low back pain. Larger stones with minimal mobility manifest as aching discomfort in the lower back, or vague or dull pain with increased physical activity. Colic caused by smaller stones often occurs suddenly as a sharp, paroxysmal, cutting pain in the lower back and abdomen. Stones can occur in any part of the urinary system, but often start in the kidney, kidney stones are mostly located in the renal pelvis or calyx, can be discharged into the ureter and bladder, ureteral stones almost all from the kidneys.

Basic introduction English name ：kidney calculi English alias ：? Consultation department ：Urology Department Most common group ：Young and middle-aged men Common causes ：Metabolic abnormalities of the body, obstruction of the urinary tract, infection, foreign bodies, etc. Common symptoms ：Lumbar and abdominal cramps, nausea and vomiting, irritability, abdominal distension, hematuria, etc. Etiology,Classification,Clinical manifestations,Examination,Diagnosis,Treatment, Etiology The process of formation of kidney calculi is the result of certain factors that cause the urinary crystalline material concentration or solubility is reduced, and is supersaturated, precipitating stones. The process of kidney stone formation is caused by certain factors that increase the concentration or decrease the solubility of the crystalline material in the urine, which becomes oversaturated, precipitates crystals and grows and accumulates in the local area, eventually forming stones. There are many factors that influence stone formation, including age, gender, race, genetics, environmental factors, dietary habits and occupation. Metabolic abnormalities (e.g. hyperparathyroidism, hypercortisolism, hyperglycemia), prolonged bed rest, nutritional deficiencies (vitamin B 6 deficiency, magnesium-deficient diets), obstruction of the urinary tract, infections, the use of foreign bodies and medications are the most common etiologic factors for stone formation. Thirty-two components of urinary stones have been known, the most common component being calcium oxalate, and other components of stones such as magnesium ammonium phosphate, uric acid, calcium phosphate, and cystamine (an amino acid). Kidney stones are rarely composed of just one type of crystal, and most have two or more, with one being the predominant one. Classification 1. Classification according to the composition of the stone (1) Calcium oxalate stones are the most common, accounting for 71% to 84%. The urine is acidic, characterized by hard, unbreakable, rough, irregular, brown, easy to damage the tissue caused by hematuria. x-ray characteristics of the stone in the deeper mottled, irregular edges, sometimes in the shape of the renal pelvis or calyx. (2) calcium phosphate stones urine alkaline, characterized by friable, rough, irregular, gray, yellow or brown, often caused by urinary tract infection and obstruction. Most of them are mixed with calcium oxalate or magnesium ammonium phosphate to form a stone. x-ray is clear, laminar pattern is more obvious, filling the whole renal pelvis and calyx, was antler-shaped. (3) urate stones urine persistent acidic, characterized by hard, smooth, granular, yellow or brown-red, uric acid metabolism is abnormal. Most are composed of a single uric acid, which is faintly visible or not visible on X-ray. (4) magnesium ammonium phosphate stones belong to the infectious stones, characterized by smooth, polyhedral or vertebral, faster enlargement, mostly associated with recurrent urinary tract infections and urinary tract anatomical anomalies. x-ray imaging is clear, the density of the stone is not uniform. (5) cystine stones for rare hereditary disease, 82% of cystinuria patients occur cystine stones, 35% occur in infants or children. They are characterized as soft, smooth, waxy, yellowish to yellowish brown, and their crystals are hexagonal. They are easily visualized on X-rays because of their sulfur content. 2. Categorized according to the location of the stone can be divided into renal pelvic stones, renal calyx stones, renal parenchymal stones. Pelvic stones are the most common and renal parenchymal stones are rare. Clinical manifestations The symptoms of kidney stones depend on the size and shape of the stone, its location, and the presence of complications such as infection and obstruction. Most patients with kidney stones are asymptomatic unless the stone falls from the kidney into the ureter causing a blockage of urine in the ureter. Common symptoms include lower back and abdominal cramps, nausea, vomiting, irritability, bloating, and hematuria. If combined with a urinary tract infection, chills and fever may also occur. Acute renal colic often makes the patient's pain unbearable. 1. Asymptomatic Small stones with smooth surfaces can be excreted in the urine without causing obvious symptoms, and stones fixed in the renal pelvis and lower calyces without infection can also be asymptomatic. Even for large antler stones, if they do not cause obstruction or infection in the calyx or renal pelvis, they can be asymptomatic for a long period of time, or only have mild discomfort or soreness in the renal area. 2. Pain (1) swelling or dull pain mainly due to the larger stones in the renal pelvis or calyx pressure, friction or cause fluid accumulation. (2) colic by smaller stones in the renal pelvis or ureter movement, *** ureter caused by spasm. The pain often comes on suddenly and starts in the back, waist or ribcage, radiates down the ureter to the lower abdomen, inner thighs, and outer ***, and can be accompanied by difficulty urinating, nausea and vomiting, and profuse sweating. 3. Hematuria Hematuria is often accompanied by pain. Sometimes the patient has no pain, only hematuria or a minimal amount of blood, which is not visible to the naked eye. Most medical examinations include a urine test and a microscopic examination of the sediment after centrifugation of the urine. If you see an excessive number of red blood cells, it means that there is hematuria, which is sometimes an early sign of kidney stones. 4. History of stone evacuation During episodes of pain and hematuria, sand or small stones may be excreted in the urine. The stone passes through the urethra with a blockage of the urinary flow and a tingling sensation in the urethra. After the stone is expelled, the urinary flow immediately recovers and the patient feels relaxed and comfortable. 5. Symptoms of infection The combination of infection can appear pus urine, acute attack can have cold, fever, back pain, urinary frequency, urinary urgency, urinary pain symptoms. 6. Renal insufficiency One side of the kidney stone caused by obstruction, can cause the side of the hydronephrosis and progressive renal hypoplasia; bilateral renal stone or isolated kidney stone caused by obstruction, can develop into renal insufficiency. 7. Urinary closure Bilateral renal stones causing obstruction of both urinary tracts, isolated kidney or the only functioning kidney stone obstruction can occur urinary closure, one side of the renal stone obstruction, the opposite side of the reflex urinary closure can occur. 8. Lumbar mass In severe hydronephrosis due to stone obstruction, a mass may be detected in the lumbar or upper abdomen. Tests 1. Urinalysis can detect the presence or absence of urine sugar, urine protein, red blood cells, white blood cells, crystals, bacteria and so on. 2. Blood tests Blood tests that show a high white blood cell count indicate a possible infection, and blood can also be drawn to check kidney function and calcium concentration in the blood. 3. X X-ray X-ray is the most important method of diagnosing urinary tract stones. It includes urography, excretory urography, retrograde pyelography, and percutaneous nephrolithography. 4.B Ultrasound can make a diagnosis of the presence or absence of stones in the kidney and the presence or absence of other co-morbidities, to determine the presence or absence of hydronephrosis in the kidney. It's a great way to find out what's going on in your life, and it's a great way to find out what's going on in your life, and it's a great way to find out what's going on in your life. However, ultrasound also has certain limitations, it can not identify the calcification of the kidney and stone, can not visualize the relationship between the stone and the kidney, and can not see the specific impact of the stone on the kidney, and more importantly, ultrasound can not provide sufficient evidence on how to treat the stone. 5. CT Examination CT examination is currently the first choice for stone diagnosis. CT examination can show the size of the kidney, outline, kidney stones, hydronephrosis, renal parenchymal lesions and renal parenchymal residual conditions, but also identify renal cysts or hydronephrosis; can be identified outside the urinary tract caused by urinary obstruction of lesions, such as the retroperitoneal tumor, pelvic tumors, etc.; can also be used for the treatment of the disease, the cause of the disease is not the same as the disease. Tumors, pelvic tumors, etc.; enhancement imaging can understand the function of the kidneys; for acute renal failure caused by stones, CT helps to establish the diagnosis. 6. Magnetic **** vibration MRI water imaging and MRI raw image combination, more accurate and comprehensive, for the diagnosis of urethral dilatation is very effective, especially for renal impairment, allergy to contrast, contraindication to X-ray examination, but also suitable for pregnant women and children. 7. Physical Examination During an attack of renal colic, there is percussion pain and pressure pain in the renal region on the affected side. In cases without obstruction, physical examination may show no positive signs or only mild percussive pain in the affected area. Diagnosis The diagnosis of renal stones should include determining the presence of stones, the presence or absence of complications, and the etiology of stone formation. The diagnosis is not difficult in those with a typical clinical presentation or with stones discharged from the urine. By understanding past medical history, dietary habits, family history, medication use, and various laboratory and ancillary tests, an etiologic and pathophysiologic diagnosis can be made, and the presence of complications can be determined.

Treatment The first step should be symptomatic treatment. If you have a colic attack with pain medication, if you find a combination of infection or obstruction, you should first control the infection according to the specific situation, if necessary, ureteral intubation or pyelostomy, to ensure that the urine drainage is smooth, in order to facilitate the control of infection, to prevent the damage of renal function. At the same time, actively search for the cause of the disease, according to the different components and etiology of the treatment and prevention program, from the root of the problem, try to prevent the recurrence of stones. 1. General Treatment (1) Drink a lot of water Smaller stones are likely to be pushed by a large amount of urine, flushing and discharged, and the increase in urine will also help control the infection. (2) adjust the diet Diet composition should be based on the type of stone and urine pH. In patients with calcium oxalate stones, a high oxalate diet should be avoided and intake of foods such as spinach, beets, tomatoes, nuts, cocoa and chocolate should be limited. Calcium intake should be restricted in patients with idiopathic hypercalciuria. Eat a low-salt diet and control sodium intake. Those with high uric acid should eat a low purine diet, avoid animal offal, and eat less fish and coffee. (3) to remove the causal factors for pathological factors caused by urinary tract stones, should also actively treat the original disease. The cause of the stone formation is actively treated to prevent the formation and recurrence of the stone. 2. Symptomatic treatment (1) antispasmodic pain M-type choline receptor blockers, can relax the ureteral smooth muscle, relieve spasm,. Intramuscular injection of progesterone can inhibit the contraction of smooth muscle and relieve spasm, pain relief and lithotripsy has a certain efficacy; calcium ion blocker nifedipine, on the relief of renal colic has a certain effect; alpha-blocker in the relief of ureteral smooth muscle spasm, the treatment of renal colic has a certain effect. (2) control infection stone-induced urinary tract obstruction is prone to infection, infected urine often form magnesium ammonium phosphate stones, this vicious circle makes the condition worse. In addition to actively removing stones to relieve obstruction, antibiotics should be used to control or prevent urinary tract infections. (3) elimination of hematuria obvious hematuria can be hydroxybenzylamine or tranexamic acid. 3. Treatment according to different components and etiology (1) Hypercalciuria ① Primary hypercalciuria can be treated with thiazides and potassium citrate, and absorptive hypercalciuria is removed. Thiazides, potassium citrate, can not tolerate the drugs need to use sodium cellulose phosphate, there is a decrease in blood phosphorus need to be changed to orthophosphate. ② hypercalcemia active treatment of concomitant diseases, when the occurrence of hypercalcemia crisis, need urgent treatment. First of all, the use of saline as soon as possible to expand the volume, the use of tab diuretics such as furosemide to increase urinary calcium excretion; diphosphate is the main treatment of hypercalcemia drugs, can effectively inhibit the activity of osteoclasts, reduce bone resorption. Surgical removal of the parathyroid glands is preferred when patients have primary hyperparathyroidism with symptomatic hypercalcemia or asymptomatic kidney stones. When the patient has symptomatic or obstructive renal stones, the stones are treated first in the absence of a hypercalcemic crisis. (2) Renal tubular acidosis The main use of alkaline drugs to slow down the growth of stones and the formation of new stones, and to correct the metabolic imbalance. (3) high oxaluria primary high oxaluria treatment is more difficult, can try vitamin B 6, starting from a small dose, with the effect of decreasing and increasing the amount, at the same time, a large number of drinking water, restriction of oxalic acid-rich foods, the urine oxalic acid level can be reduced to normal. (4) hyperuricosuria low purine food, drink a lot of water can reduce the concentration of uric acid in the urine. (5) Hypercystinuria is treated with an appropriate protein-restricted diet and with cystine-lowering thiol drugs. (6) infected stones According to the patient's condition to remove the stone, choose the appropriate antibiotics to control the urinary tract infection. 4. Surgical treatment Surgical measures should be considered if the pain cannot be relieved by medication or if the stone diameter is large. These include: ① extracorporeal shock wave lithotripsy (ESWL). ①Extracorporeal shock wave lithotripsy (ESWL) treatment. ②Extracorporeal ureteral stenting can also be used with ESWL treatment. ③Transureteroscopic lithotripsy and lithotripsy. ④ Percutaneous nephrolithotomy. ⑤Laparoscopic incision lithotripsy. 5. Emergency management Renal colic and infection should be treated immediately. The infection should be promptly treated with antibiotics and, if necessary, drainage by nephron puncture. Renal colic can be set with anticholinergic, progesterone, calcium channel blocking drugs. Pethidine can be injected for analgesia if necessary. Bilateral ureteral stones combined with obstruction of anuria patients, can consider immediate surgical stone removal.