What is the symptoms of kidney stone? Is kidney stone dangerous?
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Kidney Stones
Except for the brain, the kidney is man's most sophisticated,
discriminating, and intricately developed organ. At
any time approximately one fifth of the entire blood
supply is flowing through the two kidneys. The kidneys take from the blood passing through them those products
which in their judgment are best removed and retain those
that the body still requires. In this way the kidneys
control the composition of the blood and of man's internal
chemistry.
The components which are not retained in the blood
are passed out of the kidney filter complex as urine. The
urine is formed in the kidney. Each kidney passes its
urine into a long thin muscular channel, the ureter, by
which it is conveyed into the bladder. Urine is temporarily
stored in the bladder before being voluntarily voided to
the outside world. It has been repeatedly demonstrated
that the composition of the blood is determined not by
what the mouth takes in but by what the kidneys retain.
If the blood contains an excessive amount of stonemaking
material, such as calcium or an abnormal amount
of protein, or if there is blockage and infection in the
kidney, then the normally minute, soluble matter in
the urine forms insoluble particles. When enough of
these adhere to each other, a stone forms in the pathway
of the urinary stream. These stones may appear in the
kidney, ureter or bladder. They are never normal and
always indicate disease and carry the potential for
serious disturbances. There is a relatively large margin of
safety in kidney disease because the organs are paired
and the reserve so great that an individual can live with
part of one functioning kidney.
What does a kidney stone consist of?
There are several types of stones. The most common
are composed of minerals containing calcium phosphate
or oxalate or uric acid. The shape of a stone conforms to
that of the area in which it is formed. Those that form in
the kidney can be staghorn, those in the ureter are bulletshaped,
those in the bladder are usually spherical. Uric
acid stones are different from the other two kinds in that
they are not directly visible on an X ray.
What happens with a typical kidney stone attack?
A stone can produce pain, increased frequency of urination,
chills and fever, blood in the urine, or any combination
of these symptoms. The typical attack of kidney
pain, called colic, occurs when a stone blocks the urinary
channel. It often starts with loin pain that goes into the
groin. There is often sweating and retching. Narcotics are
usually required to control the pain. Because this pain is
so severe, the patient seeks help to prevent another such
attack.
I am now seventy years of age. What caused me to get a
bladder stone?
Stones can occur in any instance in which the urine
is retained. Bladder stones are most often due to some
type of prostatic obstruction, which prevents the bladder
from adequately emptying itself.
How can one be sure that stones are present?
There are only two ways to demonstrate that a stone is
present: It is seen on an X ray or the patient passes it.
An intravenous pyelogram is an X ray of the entire
urinary system that is obtained by injecting a contrast
material into a forearm vein and watching its transit
through the urinary tract. By this method obstructions,
tumors and stones are accurately revealed about 90
percent of the time. This technique is actually a photograph
of the entire urinary system.
Must all stones be treated?
No treatment is required if the stone or stones are so
localized that they produce no symptoms and no damage
to the urinary system. However, periodic urine examinations
and X-ray studies are required to follow their progress.
How can I avoid a recurrence of stones?
A large fluid intake is necessary. You may also require regulation of diet and correction of urinary acidity. Specific
obstructions that favor stone formation require corrections.
Various parts of the urinary tract may require
periodic stretching or dilation. Urinary antibiotics are
given liberally, the choice of antibiotics being made on the
basis of its action on the bacteria found in the urine of
the particular individual. A periodic checkup with a
urologic X ray is the only way to be certain about the
true internal situation.
Under what circumstances are stones prone to occur?
We see this in individuals who require prolonged orthopedic
immobilization or who are paraplegic. Stones are
also commonly observed in individuals with gout because
they have excess uric acid; this same excess is seen in
association with certain blood diseases, especially polycythemia.
Stones also form in about 10 percent of individuals
with hyperparathyroid function. Some individuals
have a biochemical abnormality which allows them to
form unusual stones made of xanthine or cystine. This
abnormality cannot be specifically corrected. In many
other instances there is no apparent reason for the formation
of a stone.
If the stone is in my kidney, why do you want to operate
on my neck?
People who are repeated stone formers may have an
abnormality in the amount of calcium they form and
require investigation for this possibility. Your blood tests
consistently show that you have an excess amount of
calcium in both the blood and the urine. This is caused
by an increased activity in one or in each of the four little
glands in the neck that lie alongside the thyroid gland.
The removal of the abnormal parathyroid gland tissue will
correct the condition and prevent further stone formation.
How are kidney stones treated? Can they be dissolved?
Calcium stones cannot be dissolved because there is no medication given by mouth or any other way that will do
this. However, many stones will pass spontaneously with
the liberal use of a high fluid intake and regulated diet.
An effort can be made to remove the stone by manipulation
techniques done through the bladder. This is an
operative procedure, but no incision is necessary. In
some instances a special wire loop can be passed through
the cystoscope into the ureter and the stone can be
manipulated into the bladder, from where it is more easily
extracted. This basketing for the removal of stones is
undertaken in selected instances. In some cases a catheter
can be slipped past the stone, allowing draining of the
area above it, and in this way the stone is encouraged to
pass.
When must the stone be removed surgically?
Surgery is advised if th'ere is persistent infection, obstruction
to the kidney, urinary bleeding or persistent
pain.
Treatment for kidney stones without surgery
What is the nature of the surgery?
Every surgeon treating kidney stone disease tries to do
the minimum operation that is consistent with restoring
the functions of the urinary system. He will attempt to
correct the irregularity that was responsible for stone
formation, extract the stone, drain the infection, and
reestablish proper urinary flow. The magnitude of the
procedure can vary from simple stone removal to the
need to remove a totally destroyed and unsalvageable
kidney. The principle is to be as conservative as is consistent
with getting a good result. In all situations the
surgeon also has to be guided by the function of the other
kidney.
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