| Kidney stones, also called renal
calculi,
are solid concretions (crystal aggregations) of dissolved minerals in urine; calculi typically form inside the kidneys or bladder. The terms nephrolithiasis
and urolithiasis refer to the presence of calculi in the kidneys
and urinary tract, respectively.
Renal stone or calculus or lithiasis is one of
the most common diseases of the urinary tract. It occurs more frequently
in men than in women and in whites than in blacks. It is rare in
children. It shows a familial predisposition.
Urinary calculus is a stone-like body composed
of urinary salts bound together by a colloid matrix of organic materials.
It consists of a nucleus around which concentric layers of urinary
salts are deposited.
Renal calculi can vary in size from as small as grains
of sand to as large as a golf ball.
Most calculi originate within the kidney and proceed
distally, creating various degrees of urinary obstruction as they
become lodged in narrow areas, including the ureteropelvic junction,
pelvic brim, and ureterovesical junction. Location and quality of
pain are related to position of the stone within the urinary tract.
Severity of pain is related to the degree of obstruction, presence
of ureteral spasm, and presence of any associated infection.
Etiology
- Hyperexcretion
of relatively insoluble rinary constituents
such as oxalates, calcium, uric acid, cystine and certain drugs
(such as magnesium trisilicate in the treatment of peptic ulcer).
- Physiological
changes in urine such as Urinary pH (which
is influenced by diet and medicines), Colloid content, Decreased
concentration of crystalloids, Urinary magnesium/calcium ratio.
- ALTERED URINARY CRYSTALLOIDS AND COLLOIDS.
- Either there is an increase in the crystalloid
level or a fall in the colloid level, urinary stones may be
formed.
- If there is any modification of the colloids
e. g. they lose their solvent action or adhesive property, urinary
stones may develop.
- DECREASED URINARY OUTPUT OF CITRATE.
- VITAMIN A DEFICIENCY.
- The desquamated cells form nidus for stone
formation. This is more applicable to bladder stones.
- URINARY INFECTION.
- Infection disturbs the colloid content of
the urine, also causes abnormality in the colloids (which may
cause the crystalloid to be precipitated).
- Infection also changes urinary pH and also
causes increase in concentration of crystalloids.
- URINARY STASIS.
- It causes a shift of the pH of the urine
to the alkaline side, predisposes urinary infection, and allows
the crystalloids to precipitate.
- HYPERPARATHYROIDISM.
- Due to overproduction of parathormone the
bones become decalcified and calcium concentration in the urine
is increased. This extra calcium may be deposited in the renal
tubules or in the pelvis to form renal calculus.
- Prolonged
immobilisation.
- NIDUS OF STONE FORMATION.
PREDISPOSING
FACTORS
ENVIRONMENTAL
AND DIETARY FACTORS
- Low urine volumes.
- High ambient temperatures.
- Low fluid intake.
- Diet.
- High protein intake.
- High sodium.
- Low calcium.
- High sodium excretion.
- High oxalate excretion.
- High urate excretion.
- Low citrate excretion.
OTHER
MEDICAL CONDITIONS
- Hypercalcemia of any cause
- Ileal disease or resection (leading to increased
oxalate absorption and urinary excretion)
- Renal tubular acidosis type I
CONGENITAL
AND INHERITED CONDITIONS
- Familial hypercalciuria
- Medullary sponge kidney
- Cystinuria
- Renal tubular acidosis type I
- Primary hyperoxaluria
Types
of renal calculi
Basically the renal
stones can be divided into two major groups
- Primary stones
- Secondary stones.
PRIMARY STONES
They appear in apparently healthy urinary tract
without any antecedent inflammation.
·
Calcium oxalate.
- Uric acid calculi.
- Cystine calculi.
- Xanthine calculi.
- Indigo calculi.
SECONDARY STONES
They are usually formed as the result of inflammation.
- Triple phosphate calculus.
- Mixed stones.
Symptoms
·
Colicky
pain: "loin to groin". Often described as "the
worst pain [...] ever experienced".
·
Hematuria:
blood in the urine, due to minor damage to inside wall of kidney,
ureter and/or urethra.
·
Pyuria:
pus (white blood cells) in the urine.
·
Dysuria:
burning on urination when passing stones (rare). More typical of
infection.
·
Oliguria:
reduced urinary volume caused by obstruction of the bladder or urethra
by stone, or extremely rarely, simultaneous obstruction of both
ureters by a stone.
·
Abdominal distension.
·
Nausea/vomiting: embryological link
with intestine – stimulates the vomiting center.
·
Fever and chills.
·
Hydronephrosis.
·
Postrenal
azotemia: when kidney stone blocks ureter.
·
frequency in micturation: Defined as an increase
in number of voids per day (>than 5 times), but not an increase
of total urine output per day (2500 ml). That would be called
polyuria.
·
loss of appetite.
·
loss
of weight.
Investigations
- Blood examination.
- Urinalysis.
- Radiography.
- Straight X-ray.
- Excretory urogram.
- Ultrasonography.
- Computed tomography.
- Renal Scan.
- Cystoscopy.
- Stone analysis.
The following investigations are appropriate in bilateral and recurrent
stone formers:
·
Serum calcium, measured fasting on
three occasions to exclude hyperparathyroidism
·
Serum uric acid
·
Urinary urate, calcium and phosphate
in a 24 hour collection. The urine should also be screened for cystine.
·
Analysis of any stone passed.
General management
The general measures or advises which should be given to the patient
regardless of the type of stone are:
·
Fluid intake should he high at all
times. Fluids should be taken at bed time so that nocturia will
occur. This will prevent dehydration.
·
Avoidance of milk, cheese and great
deal of calcium should be advised. If renal function is satisfactory,
sodium cellulose phosphate 5 g T.D.S. with meals should be prescribed
to reduce calcium absorption.
·
Urine should be kept acid all the
time. Alkalies should be prohibited or used in lesser quantities
in those patients who are suffering from peptic ulcer.
·
Vitamin D should be stopped or used
in very low quantity.
·
Patients with hyperuricemia should
avoid red meats, offal and fish, which are rich in purines, and
should receive treatment with allopurinol.
·
Eggs, meat and fish are high in sulphur
containing proteins and should be restricted in patients with cystinuria.
Homeopathic Treatment for Kidney Stones or Renal calculi
Homeopathy treats the person as a whole. It means that homeopathic
treatment focuses on the patient as a person, as well as his pathological
condition. The homeopathic medicines are selected after a full individualizing
examination and case-analysis, which includes the medical history
of the patient, physical and mental constitution etc. A miasmatic
tendency (predisposition/susceptibility) is also often taken into
account for the treatment of chronic conditions. The medicines given
below indicate the therapeutic affinity but this is not a complete
and definite guide to the treatment of this condition. The symptoms
listed against each medicine may not be directly related to this
disease because in homeopathy general symptoms and constitutional
indications are also taken into account for selecting a remedy.
To study any of the following remedies in more detail, please visit
our Materia Medica
section. None of these medicines should be taken without professional
advice.
Homeopathic Remedies
Argentum nit.
"Nephralgia from congestion of kidneys or
passage of calculi." Dull aching in small of back and over
bladder. Urine dark, contains blood or deposit of renal epithelium
and uric acid: passed often and little at a time, in drops (Nephritic
colic.) Urine burns while passing and urethra feels swollen. Face
dark: dried-up look. Arg. nit. craves sweets and sugar, which disagree.
Suffers from anticipation: hurry. Flatulent dyspepsia.
Belladonna
Renal calculi with sharp, shooting pains. Come
suddenly, crampy straining along ureter, during passage of calculus.
Feverish and excitable. "Irritation and clutching and spasm
where there are little circular fibres in small canals- as in gall-stones
(which see) or in renal calculi." Bell. is red, and hot, and
dry: hypersensitive, especially to jarring. Bell. pains come and
go suddenly.
Benzoic acid
Nephritic colic with offensive urine.Urine deep-red,
of strong odour:-dark brown; smells cadaverous, putrid. Urine alternately
thick like pea-soup, then clear like water. But
patient feels better when urine is profuse, thick and offensive:
suffers in joints-heart- when it is clear and scanty. Highly intensified
urinous odour.
Berberis
"Excellent remedy for renal calculi."
Pains shoot: radiate from a point . Cannot make the least motion:
sits over to painful side for relief. Sharp, darting pains following
ureter and extending down into legs. Pains run up into kidneys and
down into bladder. Formation of little calculi like pin-heads in
pelvis of Kidney, start to go down to bladder, with great suffering.
"You will be astonished to know how quickly Berberis will relieve
this particular colic." "Anything that is spasmodic can
be relieved instantly.'-Kent. Burning and soreness, lumbar, in region
of kidneys. Cannot bear any jar : has to step down carefully. Urine
dark, turbid, with copious sediment: slow to flow: but constantly
urging. May be associated with biliary calculi.
Calcarea carb.
Gravel: urinary calculi. In a Calc. patient: chilly:
cold sweating feet: sweating face: head
sweats at night. Often fat, flabby and weak. Lethargic. Longs for
eggs.
Cantharis
One of the best remedies during the paroxysms
of renal colic. Pain and excitement found in no other remedy. Pains
lancinating, cutting, stabbing like knives, shoot off in
different directions. Burning pain, with intolerable
urging to urinate. Tenesmus. Sits and strains and gets no relief.
"if he could only pass a few drops more urine (or a little
more bloody stool) he would get relief: but no relief comes. Intolerable
urging, before, with and after urination: violent pain in bladder"
(Cystitis). Thirst, with aversion to all fluids. "The burning
pain and intolerable urging to urinate point to Canth. in all inflammatory
diseases of others parts."
Chimaphila umb.
Constant pain in region of kidneys. Fluttering
sensation in kidneys. Catarrh of bladder caused by stones. Smarting
pain from neck of bladder to end of urethra. Great quantities of
thick, ropy, bloody mucus in urine. Urine colour of green tea. Queer
symptom: feels as if sitting on a ball. Worse damp weather: washing
in cold water.
Hydrangea
Has been used for the intense pain of gravel and
calculus. Relieves distress from renal calculus, with soreness kidney
region and bloody urine. "The thirstiest plant known (diabetes).
Hydrastis
Dull aching in kidney region. Intense pain in
left ureter. Frequent, scanty urination, with burning at the end
of it. Thick, ropy, mucous sediment in urine.
Ipomea nil.
For the passage of stone from kidney to bladder:
with severe cutting in either renal region, extending down ureter.
Pains excite nausea.
Lachesis
Stitches in kidneys, extends down through ureters.
Pain in left lumbar region. Pain and tenderness left iliac region,
intolerance of pressure. Lifts clothing from abdomen. Extremely
sensitive to touch: especially about throat and abdomen. Left side
ailments. Worse for sleep: worse on waking: sleeps into an aggravation.
Lithium carb.
Kent's Repertory gives Lith. in black type for
renal calculi. Curious symptom, "Pains in heart when urinating:
when bending over." Heavy deposits, urine; dark, reddish brown.
Soreness and sharp sticking pain right side of bladder.
Lycopodium
Usually right-sided. Pain extends along ureter
and ends in bladder: not down leg. Back-ache, > by urination.
Lithic acid in urine. Red sand in clear urine. Characteristics
of Lyc. Desire for sweets and hot drinks. All symptoms < 4-8
p.m. Hunger: but fullness after a little food. Distension, must
loosen clothing.
Nitric acid.
Urinary calculi when the urine contains oxalic
acid: and for oxalic acid calculi. Fetid urine of intolerable odour:
or smells like horse's urine. May feel cold as passed. Typical Nit.
ac. craves salt and fats. Has "splinters" pains: <
touch.
Nux vomica
Indicated in renal colic when one kidney (especially
the right is the seat of the disease. Pains extend to genitalia
and down leg, with nausea and vomiting. Renal colic, especially
when each pain shoots to the rectum and urges to stool. "Must
strain to urinate: bladder is full and urine dribbles away; yet
when he strains it ceases to dribble." "Renal colic is
caused by a stone in the ureter, which by its irritation causes
a spasmodic clutching of the little circular fibres of that canal;
the proper medicine relaxes these fibres, and the pressure from
behind forces these calculi out at once."-
Kent. The Nux patient
is hypersensitive, mentally and physically: choleric; irascible:
quick and active: generally lean. Chilly.
Ocimum can
Renal colic where there is considerable haemorrhage.
Urine has brick-dust sediment and considerable blood. Clarke says,
"Used in Brazil as a specific for diseases of kidneys, bladder,
and urethra." "Renal colic with violent vomiting every
fifteen minutes: wrings the hands and moans all the time."
Urine "saffron colour; or thick purulent, with an intolerable
smell of musk."
Pareira brava
Renal colic. Excruciating pain radiates from left
kidney to groin: follows course of ureter. Excessive pain in Kidneys,
shoots down left ureter; urine passes drop by drop with violent
tenesmus, nausea, vomiting of bile. Constant urging to urinate:
pain extorts screams. Must go down on all fours to urinate. Almost
touches floor with forehead in order to be able to pass urine. With
tearing, burning pains at point of penis. Copious sediment of uric
acid and blood. Thick, stringy, white mucus, or red sand.
Phosphorus
Dull pain in renal region. Renal calculi: congestive
and inflammatory symptoms, with purulent,
chalky or sandy sediment. Phos. craves cold food: ices: salt. Can't
lie on left side. Fear of thunder. darkness.
Sarsaparilla
Excruciating neuralgia of the kidneys. Renal colic.
Passes gravel: vesical calculi. Tenesmus: extreme pain at conclusion
of urination: yells with pain :-or urine passes without sensation.
"White sand in scanty, slimy or flaky urine, or red sand in
clear urine"-Nash. Renal and vesical calculi.Kent says, "This
medicine has many times dissolved a stone in the bladder; it so
changes the character of the urine that it is no longer possible
for the stone to build up, and it grows smaller by continually dissolving
off from the surface." Curious symptom, "Urine only passes
freely when standing." Hot food and drink aggravate all the
complaints; but wants heat applied externally. After the remedy
has been given there is a deposit of sand in the urine, which should
not be stopped.
Silicea
Renal and vesical calculus. Involuntary discharge
of urine after urination. Constant urging. Nightly incontinence.
Sil. is a weakling mind and body: "lacks grit." Worse
cold feet: damp feet: checked sweat. Often, offensive foot-sweat:
or (?) suppressed.
Tabacum
Pains down the ureter, with deathly sickness and
cold sweat. Nausea with burning heat in abdomen the rest of the
body being cold. Patient persists in uncovering the abdomen. Such
sickness suggests Tab. in renal colic.
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