Renal calculus

　　1, Etiology

　　Renal calculus is a suspension formed by many fine calcium particles with a diameter of 0.2-0.5mm, which are in a suspension state and remain in the renal pelvis diverticulum, renal cyst, or hydronephrotic renal pelvis. Obstruction and inflammation cause dysfunction of secretion and reabsorption of renal units, the urine in the renal pelvis gradually becomes concentrated, making the crystal components such as calcium and phosphates saturated and precipitate, forming calcified particles.

　　2, Pathogenesis

　　The pathogenesis of renal calculus is not yet unified. Due to the weight of the calculus, it can deposit in the lower position when the body position changes. In a few cases, some coarse particles are mixed with calcium particles, which can accumulate into a mass. Most of the time, the calcium milk in the ureter can be excreted spontaneously, but occasionally it may block the ureter, causing symptoms similar to ureteral calculus.

　　It often occurs with upper urinary tract stones. Kidney stones are caused by the imbalance of colloidal and crystal metabolism in the body, and are related to factors such as infection, disordered nutrition metabolism, foreign bodies in the urinary system, urinary stasis, and geographical climate. Men are more prone to this disease than women. People over 30 years old are more prone to this disease than young people. It is relatively rare for children to have this disease. The pain may last for several days, and severe renal colic may occur during the process of stone excretion. The location of the pain is the location of the kidney stone. When there are fewer stones, there are no obvious symptoms, and they can only be found during X-ray imaging. When the stones are larger, they may cause symptoms such as ipsilateral lumbar pain, renal colic, and hematuria. Kidney stones may also occasionally get stuck in the ureter, blocking the urine flow on one side. The complications of kidney stones include acute pyelonephritis, which may lead to chronic renal failure in severe cases. The recurrence rate of kidney stones is relatively high.

　　Patients may have a history of urinary tract infection; some patients have a history of primary hyperparathyroidism, which is similar to the clinical manifestations of kidney stones. Most patients do not have obvious clinical symptoms, and some patients may have symptoms such as lumbar pain, renal colic, hematuria, and so on. When complicated with diverticulitis infection, lumbar pain may worsen, and systemic symptoms such as fever may occur.

　　Pay attention to the prevention and treatment of urinary system infection in daily life; whether it is hydronephrotic or cystic renal calcareous milk, it is a contraindication for extracorporeal shock wave lithotripsy. Because not only can it not achieve the effect of stone removal, but the localized calcareous milk is also prone to spread, increasing the difficulty of the next treatment. Therefore, in clinical diagnosis and treatment, it is necessary to make a clear differential diagnosis first to avoid misdiagnosis as a stone.

　　Firstly, Urinalysis:There may be microscopic hematuria, and when complications such as infection occur, there may be white blood cells or pus cells in the urine.

　　Secondly, Imaging Examination

　　1. Ultrasound:It shows the liquid dark area of renal calyceal diverticulum or renal hydronephrosis, with a circular echo light mass inside.

　　2. KUB Flat Film:Circular, unevenly dense 'sesame seed'-like shadows can be seen in the renal area, and the shadow changes into a crescent shape when a standing film is taken, and a characteristic liquid level formed by the sinking of calcareous milk can be seen. This is a typical manifestation of renal calcareous milk.

　　3. IVU:It can show the relationship between renal calcareous milk and the collecting system. When the neck of the diverticulum is obstructed, the contrast agent cannot enter the diverticulum.

　　4. Retrograde Angiography:When IVU imaging is not satisfactory, retrograde angiography can be performed, and occasionally, a channel between the diverticulum and the collecting system can be seen.

　　5. CT Examination:On the scan films of supine and prone positions, the crescent-shaped shadows formed by the calcareous milk particles can be seen to change with the change of body position.

　　In addition to routine treatment, attention should also be paid to the following aspects of diet for renal calcareous milk patients: patients should pay attention to light diet, try to stay away from spicy and stimulating foods, reduce the intake of greasy foods, and at the same time, pay attention to drinking more water.

　　1. Symptomatic Treatment:Apply antibiotics to control infection when complications such as infection occur.

　　2. Surgical Treatment:For patients with obvious symptoms and frequent complications of infection, surgical treatment should be performed for renal calcareous milk. Open the top of the diverticulum, suck out the calcareous milk inside. Try to find the neck of the diverticulum, electrocauterize the neck with an electrosurgical knife, or suture the neck with absorbable sutures to close it. Large diverticula can be filled with pedicled omentum to prevent the formation of an ineffective cavity locally.