What is urolithiasis or renal lithiasis?
Urolithiasis is the presence of stones (lithiasis, hard masses, “stones”) in the urinary tract (kidneys, ureters and bladder) capable of causing pain, obstruction, bleeding or infection.
One or more stones may occur at the same time, and 4 types are distinguished according to their chemical composition:
- Calcium stones: these are the most common, and are formed by excess calcium or oxalate in the blood. The first can appear by taking certain drugs or by excess of vitamin D, and the second by genetics or a diet with foods rich in oxalate (such as spinach).
- Uric acid stones
- Cystine stones: these are rare, and occur in people with an inherited disease that causes the kidneys to excrete large amounts of certain amino acids.
- Struvite stones: caused by bacteria that infect the urinary tract. It is more frequent in women.
Urolithiasis or renal lithiasis: causes
They are produced inside the urinary tract, usually in the kidney and less frequently in the bladder, and there are multiple causes for their production:
- Diets (excess of calcium, proteins, oxalates, obesity, deficit in fluid intake, etc.).
- Sedentary lifestyle and immobilization
- Endocrinological alterations (hyperuricemia – gout -, hyperthyroidism, hyperparathyroidism, etc).
- Intake of some drugs (vitamin D and C at high doses, calcium antagonists, some diuretics, Indinavir, etc.).
- Diseases (myelomas, inflammatory bowel diseases – ulcerative colitis and Crohn’s disease, sarcoidosis, etc.).
- Repeated urinary tract infections (some bacteria are capable of producing lithiasis).
- Anatomical alterations (congenital such as vesicoureteral refluxes, urinary tract diverticula, horseshoe kidneys, sponge kidneys, ureteral and pyeloureteral junction strictures, etc., or secondary to urological surgeries).
Urolithiasis or renal lithiasis: symptoms
They can occur without producing symptoms in a high percentage of cases. Sometimes, and as a consequence of eroding the interior of the urinary tract, they cause a darker colored and even bloody urine.
Other times they can cause lumbar and abdominal pain, fever -if there is an associated infection-, dysuria (stinging when urinating) or the “dreaded” nephritic colic (very intense pain radiating from the lumbar area towards the abdomen and often accompanied by nausea and vomiting).
Treatments for urolithiasis or renal lithiasis
Treatments are multiple and depend on the size of the lithiasis, its location, age and associated pathology of the patient. As general preventive measures, dietary measures should be considered and in some cases pharmacological or interventional treatments should be used.
1. Dietary measures:
- Abundant fluid intake (urinate more than 2 liters per day).
- Avoidance of excess protein, foods rich in oxalate and uric acid.
- Avoid excess sodium (the common salt we usually use in our meals).
Pharmacological treatment (potassium citrate, allopurinol to reduce uric acid levels, thiazides -diuretic that increases calcium reabsorption-, vitamin B6, antibiotics in lithiasis of infectious origin…).
3. Interventional treatment (minimally invasive treatments are attempted whenever the case permits).
- Extracorporeal shock wave lithotripsy; high energy waves that, when applied on the body surface, focus all their energy on the lithiasis. If the lithiasis is large, they are not as effective.
- Endoscopic surgery; fragmentation of the lithiasis (by means of laser energy, electrohydraulic, etc.) inside the body without the need for external wounds; cystolithotripsy, inside the bladder; ureterorenoscopy, treatment of lithiasis inside the ureter and kidney.
- Percutaneous nephrolithotomy; fragmentation and treatment of lithiasis inside the kidney through a small access in the lumbar area.
- Open surgery (for large lithiasis or associated with anatomical anomalies that prevent less invasive treatments).
For more information consult your urologist.