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NEPHROLITHIASIS

The manifestations of renal calculi are extremely variable. In many instances stones are carried in the kidneys for years without producing any symptoms. More commonly, a mild infection develops in the pelvis about the stone and gradually involves the cortex of the kidney until a severe pyelonephritis develops. If the stone is large, or several are present, the infection may progress to pyonephrosis, resulting in the destruction and ultimate loss of the kidney.

The size of a calculus varies from very small gravel to a large stag-horn stone which may fill the renal pelvis. Calcium oxalate stones usually are small, dark, rough and hard, while calcium phosphate stones tend to be soft, white, chalky and frequently stag-horn in shape. Migration of a stone may cause obstruction with resultant stasis, infection and clinical manifestations. Persistent or repeated obstruction leads to pyonephrosis or hydronephrosis. When a stone enters and obstructs the ureter, renal colic occurs. There is excruciating pain which originates in the back of flank and radiates across the abdomen and into the groin, genitals and inner aspect of the thigh. There may be nausea, vomiting, sweating, frequency, urgency of urination, chills and shock. Examination reveals slight soreness over the involved kidney and ureter, spasm of the abdominal muscles, albuminuria and microscopic haematuria.

Intermittent or persistent obstruction to the flow of urine leads to stasis, infection, hydronephrosis and renal destruction if the obstruction is bilateral, anuria and uremia ensue.

Exercise 8. Answer the following questions:

1. How are the stones carried in the kidneys for years?

2. Where does a mild infection develop?

3. In what case may the infection progress to pyonephrosis?

3. Where does the pain radiate across?

4. When does renal colic occur?

5. What may the migration of stone cause?

6.Where does the excruciating pain originate?

7.What does the examination of the kidneys reveal?

8. What symptoms may occur in case of excruciating pain?

9. What does the size of a calculus vary from?

10. What is the difference between calcium oxalate stones and calcium phosphate stones?

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