Don't let small stones lead to big crises! Beware of the hidden dangers of urinary stones

In life, many people often don't pay enough attention to some minor illnesses, thinking that they will go away if they endure it. But sometimes, minor illnesses left untreated for a long time can cause big problems. Just like the patient Ms. Cheng, she had been found to have kidney stones before, but she didn't take it seriously. As a result, she suddenly developed abdominal distension, vomiting and other discomfort symptoms recently, and rushed to the hospital emergency room for treatment.

After a series of examinations, he was diagnosed with acute renal failure, with a creatinine level as high as 1693.2umol/L. Abdominal CT showed multiple small stones in both kidneys, an overfilled bladder, and dilatation and accumulation of water in the right kidney and ureter. His condition was extremely critical. Fortunately, the emergency doctor immediately contacted the urology department for an emergency consultation, quickly took catheterization measures, and then performed holmium laser lithotomy, which relieved the symptoms of urinary tract obstruction. During the follow-up examination, it was shown that his renal function had returned to normal.

Ms. Cheng's experience has sounded the alarm for us. In this regard, Zhou Qibing, director of the Emergency Medicine Department of Hunan Provincial Second People's Hospital (Provincial Brain Hospital), is here to talk to you about urinary stones, a disease that seems common but is actually full of dangers.

1. Current status and hazards of urinary stones

Urinary stones are very common among inpatients in urology departments. my country is one of the three most common areas in the world. In recent years, the incidence rate has been on the rise, and the prevalence rate in southern China is as high as 5% - 10%. Don't underestimate these stones. They not only cause pain, but can also lead to urinary tract obstruction, just like what happened to Ms. Cheng, which can lead to hydronephrosis and renal damage. In severe cases, it can even develop into acute renal failure, which is life-threatening.

2. Causes

Metabolic abnormalities: Changes in urine pH, hypercalcemia, hypercalciuria, hyperoxaluria, hyperuricemia, cystinuria, hypocitraturia, hypomagnesemia and other metabolic problems may promote stone formation. For example, consuming too much oxalic acid-rich food, such as spinach and chocolate, may increase the risk of calcium oxalate stone formation.

Local causes: Urinary tract obstruction, infection, and foreign bodies in the urinary tract provide a breeding ground for the growth of stones. Holding urine for a long time will increase the concentration of harmful substances in the urine, which is easy to form crystals and may turn into stones over time.

Drug-related factors: The use of certain drugs may also be related to stone formation, such as sulfonamides, acetazolamide, etc.

3. Diagnostic Methods

Imaging tests

- Ultrasound: It is simple, economical, and non-invasive. It can detect stones larger than 2 mm and understand the degree of dilation of the urinary tract above the stones. It can be used as a routine examination method and is the first choice when renal colic occurs.

- Urinary tract X-ray (KUB plain film): It can detect about 90% of positive stones, determine the approximate location, shape, size and number of stones, and preliminarily indicate the chemical properties of the stones.

- Intravenous urography (IVU): It is performed on the basis of urinary tract plain film. It helps to understand the anatomy of the urinary tract, determine the location of stones, find negative stones, identify suspicious calcification foci, and understand the renal function on each side and the degree of hydronephrosis.

- CT scan: It is not affected by the composition of the stones, renal function and respiratory function. It can detect small stones that are easily missed by conventional imaging examinations and is very helpful in the diagnosis of patients with acute renal colic.

Laboratory tests: including blood analysis, urine analysis and stone analysis, are critical for understanding the patient's physical condition and stone composition.

IV. Treatment

Conservative treatment: Conservative treatment can be used for smaller stones (less than 0.6 cm in diameter) with smooth surfaces and no obstruction of the urinary tract below the stones, without causing complete urinary tract obstruction, staying in the local area for less than 2 weeks, and stones with special components (such as uric acid stones and cystine stones).

The main measures include drinking plenty of water (keeping urine volume > 2000 ml/day), moderate exercise, oral stone-removing drugs, lithotripsy, etc. Uric acid stones can be treated with allopurinol, supplemented with potassium sodium citrate or sodium bicarbonate tablets to alkalinize the urine; cystine stones are mainly treated by oral potassium sodium citrate or sodium bicarbonate tablets to alkalinize the urine.

Surgical treatment

- Extracorporeal shock wave lithotripsy (ESWL): Suitable for most patients with urinary stones, but there are some contraindications, such as uncorrectable bleeding disorders, pregnancy, urinary tract obstruction below the stone, severe obesity or skeletal deformity.

- Percutaneous nephrolithotomy (PNL): It has a wide range of indications and is often used for large renal stones that are difficult to crush or fail to be treated with ESWL, are ≥ 2 cm, or most of them originally require open surgery, including stones with obstructed excretion tracts such as ureteral stenosis.

- Ureteroscopy: mainly using a soft endoscope. For patients with particularly hard and X-ray negative kidney stones (<2cm) and difficulty in establishing a PNL channel, it can be combined with holmium laser lithotripsy, which is a useful supplement to ESWL and PNL.

Just like the holmium laser lithotripsy that Ms. Cheng received, it uses the natural cavity of the human urinary system, does not require surgery or stitches, has little trauma, and has a quick recovery. Holmium laser can crush stones of various compositions, and the crushed stones are small and easy to expel, and have little damage to surrounding tissues, making them highly safe.

- Open surgery: Its use has decreased significantly in recent years, but it still has important value in certain situations, such as when other options are contraindicated or complications require open surgery.

V. Preventive measures

Drink more water: This is the simplest and most effective way to prevent stones. Make sure to drink enough water every day to dilute the urine and reduce the deposition of stone components.

Reasonable diet: Eat a balanced diet and avoid excessive intake of high-calcium, high-oxalate, and high-purine foods. For example, reduce the intake of animal offal, seafood, and beer, and eat more vegetables and fruits.

Appropriate exercise: helps promote stone excretion and reduce the risk of stone formation.

Regular physical examinations: Especially for people with a family history of stones or high-risk factors, regular urinary system examinations should be performed to facilitate early detection and treatment.

Director Zhou Qibing reminded that Ms. Cheng's experience tells us that we must not delay treatment when we have health problems. Even seemingly insignificant small stones may cause serious consequences. I hope everyone can pay attention to their health, take preventive measures, and stay away from the troubles of urinary stones. If you find related symptoms, you must seek medical attention in time and follow the doctor's advice for treatment.

Hunan Medical Chat Special Author: Li Zhaohui, Department of Emergency Medicine, Hunan Second People's Hospital (Provincial Brain Hospital)

Follow @湖南医聊 to get more health science information!

(Edited by Wx)