Renal Lithiasis: Symptoms, Diagnosis, and Treatment

Renal Lithiasis: Definition and Causes

Renal lithiasis occurs as a process due to the substantial precipitation that contains urine. It can occur in the kidney and bladder.

Clinical Presentation and Diagnosis

If the stones do not block the excretory tract, symptoms do not appear. However, they can move and cause obstruction of the way, so they will produce hydronephrosis and corresponding renal fossa pain. The characteristic pain radiates to the genitals; this happens when making a radiograph of the abdomen, where one can see the route of the excretory tract. The diagnosis of kidney stones is done by clinical evaluation and a simple x-ray of the abdomen. Additionally, ultrasound is used to observe what degree of impact the calculus has on the track and the renal parenchyma.

It may occur that despite the clinical signs, the abdominal x-ray does not see the stone for two reasons: it is too small or it is radiolucent (such as uric acid calculations). When this occurs, we will use ultrasound.

Treatment for Small Calculations

Small stones: Drink plenty of fluids, and use analgesics and anti-inflammatories because the stone provokes an inflammatory reaction and a resulting narrowing of the lumen of the ureter system. These patients need to be controlled to see what happens with the stone. This is very important because the kidney has no pain sensitivity, so it may still produce dilation without pain and reach a situation in which there must be a confirmation of the renal parenchyma. It is essential to ensure the resolution of hydronephrosis. After the expulsion of the calculus, it is necessary to confirm if there is more load in the tract.

Management of Large Calculations

Large size stones: These have a morphology that prevents their mobilization. The treatment depends on the situation where it is found. The mechanics to follow go from less invasive to more invasive and resolutive, depending on the situation:

• Renal pelvis: Lithotripsy is carried out, which is the administration of shock waves to break the stone. A double J catheter is placed, thus avoiding the possibility that fragments of the stone produce renal colic.
• Middle or lower third: This is treated via endoscopic means. Through ureteroscopy and managing the energy, the calculus can be broken. If this fails, surgery will be held: stones in the pelvis (open pyelotomy) or stones in the ureter (open ureterotomy).

Coralliform and Bladder Calculi

Coralliform Calculations

Its morphology resembles a large coral. These are large stones that occupy the entire renal pelvis and combined calyces. Treatment: Lithotripsy for the fragmentation of the calculation and then open surgery or via a percutaneous route.

Bladder Calculi

Bladder stones occur in the context of obstructive cervicourethral pathologies, such as benign prostatic hypertrophy. Until the obstruction is settled, the formation of the stone load will not stop.