Kidney Stones Introduction:
Kidney stones or Renal calculi are consist of crystals and small amounts of proteins and glycoproteins.It has been known that familial and hereditary predisposition can cause stone formation. Most of urinary stones originates in kidney or a renal pelvis .Different types of stones occur in different parts of the world.
Epidamology,Incidence,Aetiology of Kidney Stones:
Renal CALICULI are particularly common in the south eastern parts of united states,in south africa ,in parts of india ,and in south east asia.
Fifty percent of patients present between the ages of 30 & 50 years. The male to female ratio is 4:3.
The exact aetiology is unknown, the various predisposing factors may be
1) Dietary Factors – Diet rich in red meat, fish, eggs can give rise to aciduria. Diet rich in calcium – milk, spinach, rhubarb etc produce ) calcium oxalate stones. Diet lacking in vitamin A causes desquamation of renal epithelium and the cells form a nidus around which the stone is deposited. dieteric imbalance is evident for renal caliculus.
2) Altered Urinary Solutes & Colloids – Dehydration leads to an increased concentration of urinary solutes and tends to cause them to precipitate.
3) Decreased Urinary Citrate – The presence of citrate in urine as citric acid, tends to keep otherwise relatively insoluble calcium phosphate in solution. When citrate level decreases, it precipitates the urinary calcium.
the excretion of citrate is under hormonal control .
4)Renal Infection – Organisms such as streptococci, staphylococci, proteus, pseudomonas, kle bsiella & E.coli produce recurrent urinary tract infection, producing urea which causes stasis of urine, precipitates calcium formation.
5) Metabolic Causes –
a) Hyperparathyroidism – increases the calcium levels resulting in hypercalcaemia and hypercalciuria producing calcium stones.
b) GOUT – increases the uric acid levels and cause multiple uric acid stones.
6) Prolonged Immobilisation – from any cause, eg: paraplegia is liable to result in skeletal decalcification with increase in urinary calcium favouring the formation of calcium phosphate calculi.
7) Inadequate Urinary Drainage – as in cases of horse shoe kidney, undescended kidneys are more vulnerable for development of stones due to stasis.
8) Hot Climates – cause increase in concentration of solutes by excessive sweating resulting in precipitation of calcium.
9) Randall’s Plaque – Randall suggested that initially a small erosion or an ulcer develops on the tip of renal papilla on which minute concretions or minor calcium particles or microlith get deposited normally in renal parenchyma .these particles are carried away ,like carbon partucles from bronchi.
Some of the renal lymphatic vessels become bloked by inflammatory exudate and later the endothelium becomes ulcerated leaving the calculus in cotact with urine and give rise to stone formation.
Types Of Renal Calculus:
Nearly 30%- calcium oxalate alone.
nearly 10%- calcium phaspate alone.
Another 15%-magnesium ammonium phospate(struvite)
Less than 5%-uric acid
Less than 2%-cystine
Types Of Kidney stones in detail:
Oxalate Calculus (Calcium Oxalate ):
The commonest type of stone, called as mulberry calculi. Irregular in shape, covered with sharp projections which tends to cause bleeding. Produces haematuria very early, resulting in deposition of blood over the stone giving a dark colour to it. Hard and single, occurs in infected urine. Can be visualized radiologically.
Phosphate calculus (usually calcium phosphate or rarely as magnesium ammonium phosphate or struvite)
Smooth, round, dirty white to yellow in colour. Commonly occurs in renal pelvis & tend to grow in alkaline urine especially when proteus organisms are present. As it enlarges in the pelvis, it grows & fills the major & minor calyces & slowly forms a STAG HORN CALCULUS. This produces recurrent urinary infections & haematuria. As they are large, they are usually easy to see on radiographs.
Multiple, small, hexagonal, multifaceted. Colour varies from yellow to reddish brown. Occur in acidic urine. Pure urate stones are radiolucent, unless contaminated with calcium salts.
Cystine Calculus :
They appear in the urinary tract of patients with a congenital error of metabolism that leads to cystinuria or due to decreased resorption of cystine from renal tubules. They are hexagonal, multiple, pink or yellow. Occur in acidic urine. Seen in young girls at puberty. They are radio opaque due to sulphur content.
Extremely rare. They are smooth and round, brick red in colour and show lamellation on crosssection.
What are Risk Factors for Renal Stones?
- Family history
- Medical conditions causing hyper calcuria
- Medical conditions causing aciduria
Pathology and Pathogenesis of Renal Stones:
If the urine is supersaturated with the ions that form a stone, the ions tend to cluster together. If more than 100 ions form a cluster, it becomes stable and can serve as the nucleus of the stone. Once nucleation has occurred, the stone will continue to grow even if the concentration of the ions in the urine falls.
If the core of the stone and the ions that are subsequently added to it are the same, the process is called homogeneous nucleation. If the ions in the core are different from those subsequently added, the process is called heterogeneous nucleation or epitaxy .
The pyrophosphates present in the urine are the principal inhibitors that prevent the formation of calcium oxalate and calcium phosphate stones and slow their growth. Mucopolysaccharides and perhaps citrates in the urine act in the similar fashion. In most people with calcium stones, the concentration of the inhibitors in the urine is reduced.
Inhibitors that prevent nucleation prevent the formation of calcium stones and slow their growth, but have little part in controlling the formation of other kinds of stone.
Calcium stones: They develop when the urine is supersaturated with the ions forming the stone. Often, the stone begins in a renal papilla. Crystals of calcium oxalate or calcium phosphate are precipitated on some irregularity in the tubular lining or around some fragment of debris that serves as a nidus for crystallization. The stone grows as more crystals of calcium oxalate or phosphate are being added. Eventually the stone escapes, to lie free in the renal pelvis or to pass into the ureter.
Over 50% of the patients with a calcium stone have idiopathic hypercalciuria. The concentration of calcium in the plasma is normal, but excessive amounts of calcium are excreted in the urine. Its cause is unknown. The underlying defect could be in the bowel or in the kidneys.
- Excessive absorption of calcium from the gut would tend to cause hypercalcemia, reducing the paratharmone secretion and so increasing the excretion of calcium in the urine, to maintain homeostasis.
- Alternatively a fault in the renal tubules could cause increased excretion of calcium, tending to cause hypocalcemia, increasing the secretion of parathyroid hormone, increasing the activation of vitamin D in the kidneys and so absorbing the increase of calcium from the gut, again to maintain homeostasis.
Whatever the mechanism, the high concentration of calcium in the urine favors the precipitation of calcium crystals and the formation of calcium stones.
About 15% of people with a calcium stone have hyperuricuria, with a normal concentration of urate in the plasma and with no abnormality of calcium metabolism. These patients are usually men, with a high intake of purines from a diet predominantly of meat. They usually form calcium oxalate stones.
About 10% of people with calcium stones have both hyperuricuria and hypercalciuria, though they are normouricemic and normocalcemic. They tend to develop stones late in life and to form calcium phosphate stones. Some 55 of people with calcium stones have hyperuricemia, with consequent hyperuricuria, from gout or some other cause.
Excess of oxalate in the urine is an common cause of calcium stones. Renal stones are common in oxalosis,. Steatorrhoea, Crohn’s disease and resection of ileum can cause hyperoxaluria . sever disease of the terminal ileum with steatorrea allows calcium in the bowel to be bond to unabsorbed fatty acids., normally the oxalate in the bowel forms insoluble calcium oxalate and is excreted in feces.when insufficient calcium is available in the bowel,the fee oxalate reabsorbed in the colon and excreted by the kidneys favoring the precipitation of oxalate stones.
renal stones develop in 10% of patients with crohns disease.the stones may contsist of uric acid ,calcium oxalate ,calcium phospate.often the urine is acid ,because of loss of bicorbonate into the bowel and cocentrated ,because of loss of water in diarrhea ,factors favoring the precipitation of uric acid stones .
Struvite stones: Magnesium ammonium phosphate precipitates in the renal pelvis only if the urine is alkaline and the concentrations of phosphate and of ammonium in the urine are high. Normally this does not occur. If the urine is alkaline, the concentration of phosphate is high, but the concentration of ammonium is low. Only if the urine is infected with bacteria that form a urease able to split urea to give ammonia, then struvite stones develop. The ammonia hydrolyzes to ammonium hydroxide, making the urine alkaline and increasing the concentration of phosphate and of ammonium. Bicarbonate is also ionized in the alkaline urine and most struvite stones contain calcium apatite as well as struvite.
Infection with one of the species of Proteus is the usual cause of strvite stones, though occasionally a klebsiella, Psudomonas, or Enterobacterium is responsible. Esch. coli does not for urease.
Uric acid stones: Urates are soluble in urine, but undissociated uric acid is poorly soluble. As the urine grows more acid, the proportion of undissociated uric acid increases and the risk of stone grows. A low urinary volume increases the risk by increasing the concentration of uric acid. If the ph of urine is below 6 and the concentration of undissociated uric acid is above 100 mg/L, precipitation off uric acid crystals is likely. This limit can be transgressed even in normal people.
The risk of uric acid stone becomes great f there is hyperuricemia and hyperuricuria, as in gout, or sometimes in leukemia, especially after chemotherapy.
Xanthinuria is arare congenital anomaly, in which there is a deficiency of the enzyme xanthine oxidase, which catalyzes the oxidation of hypoxanthine to xanthine and xanthine to uric acid. Xanthine stones may form in the kidneys in these people.
Conditions Associated With Hypercalciuria:
High dietary intake of calcium, chronic pyelonephritis, hyperparathyroidism, vitamin D poisoning, sarcoidosis, cushing’s syndrome, myelomatosis, renal tubular acidosis, prolonged immobilization, idiopathic hypercalciuria – a) excessive absorption of calcium from gut. b) reduced renal tubular absorption of filtered calcium.
Conditions Associated With Hyperoxaluria:
High dietary intake of oxalates – fruits, vegetables, strawberries, plums, spinach, rhubarb, asparagus, tomatoes etc. Increased absorption of oxalates from gut – a) ileal diseases b) low calcium diet.
Conditions Associated With Hyperuricosuria:
Metabolic disorders like gout, myeloproliferative disorders, high dietary intake of urates – red meat, fish rich in purines.
Signs and Symptoms of Kidney Stones:
These vary according to the size, shape & position of the stone & the nature of the underlying condition. Renal calculi may be present for years without giving rise to symptoms & may be discovered during radiological examination for another disease. These are called SILENT CALCULI.
1) Renal Pain :located posteriorly in the renal angle or anteriorly in the hypochondrium in costal margin or in both. It may be worse on movement, particularly on climbing stairs. It is described as Fixed Renal Pain Or Costovertebral Pain.
2) Ureteric Colic :When the stone is impacted in the pelviureteric junction or anywhere in the ureter, it results in severe colicky pain radiating from the loin to the groin. It may also extend to the testicles, vulva & medial side of thigh. This may be associated with strangury, the painful passage of a few drops of urine, with pallor, sweating & vomiting & he groans in agony.
3) Haematuria: is common with oxalate stones. The quantity of blood lost is small, but it is freshblood.
4) Urinary Tract Infection :fever with chills & rigors, pyuria, burning micturition & increased frequency of micturition may occur. In severe cases, even septicaemia can quickly develop.
5) Rigidity & Guarding :abdominal examination during an attack reveals rigidity of the lateral abdominal muscles & of the rectus abdominis. Percussion over the kidney produces a stab of pain & there may be tenderness on gentle deep palpation.
Complications of Kidney Stones:
occurs due to back pressure producing renal enlargement. Due to the stretching of the renal capsule, it results in pain in the loin & an associated palpable kidney mass suggests hydronephrosis.
The kidney is converted into a bag of pus when hydronephrosis becomes infected.
Bilateral staghorn calculi may be asymptomatic until they present with uraemia.
How to Diagnose Kidney Stones?
1) Radiography – plain x-ray (KUB) helps to diagnose 90% of renal stones.
2)Intravenouspyelography Or Excretory Urography –
This helps to locate the stone exactly in relation to kidney & ureter & to assess renal function. A radiolucent stone can be seen as a filling defect. Hydronephrosis can also be made out.
3) Ultrasonography –
is the most valuable to diagnose the stone, its size & exact location. It also confirms the enlarged kidney.
4) Urine Culture & Sensitivity – Examination of urine for protein, R.B.C, W.B.C, micro organisms reveals abnormalities of urinary tract, infection etc.
5) Investigation Of Renal Function –
Blood examination for urea, creatinine, creatinine clearance etc to rule out renal failure.
Treatment and General management of Kidney Stones:
Kidney stone dietary management:
Non Surgical treatment for kidney stones:
Small stones less than 5 mm in size pass off with intake of copious amount of fluids & at times forced diuresis. Intravenous hydration may help pass the stones spontaneously.
Extracorporeal Shock Wave Lithotripsy:
Here the calculus is bombarded with shock waves of sufficient energy so that it will disintegrate into fragments using lithotriptors. The fragments then pass down the ureter & are cleared out.
Homeopathic Kidney Stones Remedies:
Homeopathic Remedies for Kidney stones work excellent in removing the stones from kidney. Homeopathic remedies cure the kidney stone forming tendency. Homeopathic treatment prevent the formation of renal stones in future. Remedy must be selected based on individual symptoms of the patient. Below are the symptoms more specific to Homeopathic remedy and Kidney stones.
Berberis Vulgaris Mother tincture Kidney stones remedy symptoms are as follows:
Berberies Renal is best Homeopathic Remedy for Kidney stone colic if pain is on left side. Stitching, cutting pain from left kidney following course of ureter into bladder & urethra.Kidney stone patient if experience Burning & soreness in region of kidneys then this remedy is the best option to cure the pain. Pain in small of back, very sensitive to touch in renal region relieved when sitting and lying, from jar, fatigue. Numbness, stiffness & lameness with painful pressure in renal and lumbar regions. Bubbling sensation in kidneys. Berberies kidney stone patient has Urine greenish, blood red, with thick, slimy mucus, transparent, reddish or jelly like sediment. Kindney stones in this case are associated with Rheumatic & gouty complaints with urinary diseases. Berberis is very good Homeopathic remedy for kidney stones when Back pain increased with motion, any sudden jarring movement, walking, carriage riding.
Cantharis is also one of great Homeopathic Remedy for Kidney stones with Constant urging to urinate, passing but a few drops at a time:
Cantharis Homeopathic remedy for kidney stone patient has Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Patients suffer from Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in whole renal region. Violent tenesmus & strangury. Cantharis Homeopathic remedy for kidney stone patient Urine scalds him and is passed drop by drop. Membranous scales looking like bran in water. Urine jelly like, shredy. Pain raw, sore, burning in every part, internally and externally. Over sensitiveness of all parts. Cantharis kidney stone patient feel pain in bladder even on drinking small quantities of water .
Lycopodium is one of top most Homeopathic Remedies for Kidney stone with right sided back pain:
Kidney stone patient has Pain shooting across lower abdomen from right to left. Pain in back relieved by urinating. Urine slow in coming, must strain. Retensio and Polyuria during night. Most prominent symptom in this patient is Red sand in urine. Uric acid diathesis. Child cries before urinating. Lycopodium works in kidney patients when Pains drawing, aching aggravation at 4-8 pm. This kidney stone Patient can be identified by Upper part of the body emaciated, lower part semidropsical. Lycopodium kidney stone patient has sufferings from fright, anger, mortification, reserved displeasure. The mentality of patient is Avaricious, greedy, miserly, malicious, pussilanimous. Lycopodium is used in Homeopathic treatment for kidney stone in patients usually suffer from Excessive accumulation of flatulence in lower abdomen. These people desires warm food and drinks.
Sarsaparilla is the right Homeopathic remedy for Kidney stone in case if excruciating pains from right kidney moving downwards.
Sarsaprilla kidney stone patients Pass small calculi or gravel with renal colic. This is good remedy for bladder stones and for Severe almost unbearable pain at conclusion of urination. Urine of sarsaprilla patients is bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Patient usually feel Painful distension and tenderness in bladder, urine dribbles while sitting, passes freely when standing. Sarsaprilla is particularly a very good Homeopathic remedy for kidney stone when Air passes from urethra, child screams before and while passing urine.
Tabacum is also a great Homeopathic remedy for kidney stones when patient has violent vomiting s with cold sweat on least motion:
Tabacum kidney stone patients often faint and they require cold open air. Nausea incessant as if seasick relievieed in fresh cold air. These kidney stone patients has Vertigo, death like pallor, on opening the eyes. Face of tabacum patient is pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of stomach. the skin of this kidney stone patient very Icy cold.
Nuxvomica is also a Homeopathic remedy for right sided kidney stones:
In this case of kidney stones Pain extends to the right thigh and to the genitals. Nux Vomica kidney stone patients has Frequent ineffectual urge for urination with dribbling of urine. Haematuria, strangury. While urinating, itching in urethra & pain in neck of bladder. Backache, must sit up or turn over in bed. Adapted to thin, irritable, zealous, nervous, literary, studious, responsible persons. Bad effects of coffee, tobacco, alcohol, highly spiced food, overeating, long continued mental exertion. Nux Vomical is used in Homeopathic treatment for kidney stones in patients Over sensitiveness to all external impressions. Frequent ineffectual urging for stool.
Ocimum Canum is an excellent Homeopathic remedy for kidney stone treatment.
Ocimum is particularly useful in mother tincture form for right sided Renal colic. Uric acid diathesis. Red sand in urine is seen these patients. More over the urine of these patient is High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody, brick dust red or yellow sediment. Odour of musk. Pain in ureters, cramps in kidneys with renal stones.
Belladonna is also an excellent remedy for Kidney stone disease where there is Violent spasmodic pains in kidney region especially of the right side.
Belladona Kidney stone patent feels Pain in back that comes suddenly, last indefinitely and cease suddenly. Pains usually in short attacks. Redness of eyes and face, throbbing of brain and carotids.Belladone kidney stone symptoms usually related with Abdomen tenderness, distended, increased by least jar, even of the bed, slight noise, light, lying down. Pain in back relieved with pressure, tight bandaging, wrapping up. Belladona is of Bilious lymphatic plethoric constitution.
Chamomilla is Homeopathic Remedy for Kidney stone when pain in back and hip are not separable:
These patients usually suffer from Insupportable pains in loins and hips. Pains in Chamomilla kidney stone cases are seem unendurable, drives to despair and increased by heat, evening before midnight, with heat, thirst and fainting with numbness of affected parts, eructation’s increase the pain in back. Violent pains, drive him out of bed, compels to walk about. Chamomilla kidney stone patients are Over sensitive to pain, to open air. Cannot tolerate anyone near him, is cross, irritable, easily angered.
Colocynth is particularly useful as Homeopathic remedy in Kidney stone treatment with Urine infection and discharge like fresh white of egg:
Colocynth kidney stone patients experience back pains on urinating spread all over whole abdomen. Vesical catarrh, Red hard crystals. Renal colic increased on left side. Agonising pain in abdomen causing kidney stone patient to bend double, with restlessness, twisting and turning to obtain relief. Back pain ameliorated by hard pressure. Pains increased by eating and drinking relieved by warm application. Shooting pains like electric shocks. Colocynth is more specifically kindney stone remedy when Complaints appeared from anger, indignation, mortification.
Dioscorea is Homeopathic remedy for kidney stone with pains radiating to the extremities and while lying.
Back pain in case of Dioscorea patients relieve on standing erect or bending backwards. Violent twisting colic, occurring in regular paroxysms as if abdomen were grasped and twisted by a powerful hand. Kidney stone Pain suddenly shift to different parts, appear in remote localities as fingers and toes.
Hydrangea in mother tincture form works excellent as Homeopathic remedy for Kidney stones treatment:
Hydrangea patients suffer from renal calculi, gravel, profuse deposit of white amorphous salts in urine. Renal colic, sharp pain in loins, especially left. Burning in urethra and frequent desire. Urine in this patients is hard to start. Bloody urine with heavy deposit of mucus is also a prominent symptom. Renal stone symptoms are related with great thirst with abdominal symptoms and enlarged prostate.
Pareira Brava is another most Homeopathic remedy for kidney stones in which renal colic going down the thighs:
Neuralgic pain in the anterior crural region is very important symptom in this remedy . Patient suffer from Constant urging, great straining. Very very specific symptom in this kidney stone patient is, he Can emit urine only when he goes on his knees, pressing head firmly against floor. Urine in this case is of Black, bloody, thick mucus urine. Dribbling of urine after micturition. Urethritis, prostatitis are related with Kidney stones in these patients.
Eryngium Aquaticum is Homeopathic remedy for kidney stones when pain in back comes along with pain in pubis:
Erugium is useful in kidney stone cases when there is congestion of kidneys with dull pain in back, running down the ureters and limbs. Difficult and frequent micturition. Strangury with nervous erethism. Tenesmus of bladder and urethra. Thick yellow mucus discharges.
Eupatorium Purpureum is also a Homeopathic remedy for Kidney stones with Deep dull pain in kidneys. Dysuria, haematuria, strangury. Boring in bladder and urethra on urinating. Vesical irritability in women. Insufficient flow, milky. Albuminuria, dropsy, diabetes, enlarged prostate
Benzoic Acid is particularly useful in kindney stone cases when excess of uric acid present in urine. Urine high coloured, urinous odour highly intensified. Dark brown, highly offensive. Gonorrheal and syphilitic patients. Pain suddenly change their locality. Rheumatism and gout.
Nitric Acid is a kidney stone Homeopathic remedy when there is cloudy phosphatic urine. Scanty, dark, offensive, smells like horse’s urine. Urine bloody, albuminous, turbid, looks like remains of cider barrel, cold on passing. Pricking splinter like pains. Complaints of kindey stones after continued loss of sleep, over exertion of mind and body.
Medorrhinum is particularly helpful in kidney stone when any of the above consiturional remedy fails to produce cure:
The Medorrhinum patient suffer from renal colic with painful tenesmus when urinating. Severe pain in renal region relieved by profuse urination. Intense pain in ureters, with sensation of passing of calculus. Urine flows very slowly. Kidney stones formed after suppressed gonorrhea. Women with chronic pelvic disorders. increased thinking of ailments, day time. Kidney stone pain relieved after lying on abdomen.
Sepia is great Homeopathic Remedy for kidney stone we should not forget. This remedy works in case of women suffering from kidney stones:
Sepia patients show red adhesive sand in urine. Another important symptom in these patients is Chronic cystitis, slow micturition with bearing down sensation above pubes. Pain in renal region relieved by violent exercise, warm application. Renal pain with involuntary urination during first sleep. Urine in these patients is highly offensive, must be removed from the room. Pains comes from other parts to back, attended with shuddering. Sensation of ball in inner parts with kidney stones.Homeopathic Treatment for kidney stones in sepia is successful when patients Weep easily and women are indifference to those loved best.
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