Kidney and Ureteral Calculi

　　There are many causes, including genetic factors, metabolic factors, infectious factors, environmental factors, dietary factors, anatomical factors, and drug factors, etc. The pathogenesis is also very complex. We can simply introduce the formation of kidney stones by understanding the composition of urine. The main function of urination is to excrete various waste products produced by metabolism. People excrete about 1500ml of urine every day, carrying away about 30 to 50 grams of waste. These wastes include: urea, uric acid, creatinine, various acidic substances (hydrogen ions, lactic acid, glucuronic acid, β-hydroxybutyric acid, oxalic acid, citric acid, etc.), and various salts (calcium, phosphorus, magnesium, potassium, sodium, ammonia, chlorine, etc.). These substances have a high concentration in urine, but the human kidneys can maintain a balance of these substances to excrete them from the body in a dissolved state. If there is too little urine, substances with lower solubility such as calcium oxalate, calcium phosphate, uric acid, and ammonium phosphate will form crystals - which are tiny stones. Usually, people excrete these tiny stones without realizing it. The cause of the above stone formation is that some components in the urine have changed, and the balance of urine has been broken, forming tiny stones first. Under the long-term action of pathogenic factors, the crystals continue to grow and eventually develop into kidney stones with clinical significance.

　　Complications may include hydronephrosis, renal insufficiency, gastrointestinal symptoms, anemia, infection, and others.

　　1. Lumbar colic:Renal colic is a typical symptom of kidney stones, usually occurring suddenly on one side of the lumbar and back pain after exercise or at night, often described as 'like a knife cut' due to the severe pain. At the same time, pain in the lower abdomen and inner side of the thigh, nausea and vomiting, pale complexion, etc. may occur. Patients are restless and very painful. The cause of renal colic is that kidney stones block the pelvis or ureter during the excretion process. Many patients have hidden or bloating pain in the waist. After the pain, some patients may find stones excreted with urine.

　　2. Hematuria:About 80% of kidney stone patients have hematuria, among whom only a part can find the urine red with the naked eye, and most can only be found through urine testing.

　　3. Asymptomatic:Many patients discover kidney stones by accident during physical examination, without any symptoms.

　　4. Hydronephrosis:Kidney stones can block the pelvis and ureter, causing poor excretion of urine and leading to hydronephrosis. Some hydronephrosis may have no symptoms. Long-term hydronephrosis can cause renal insufficiency on the affected side. Severe hydronephrosis on both sides can lead to uremia.

　　5. Fever:Kidney stones can be caused by bacterial infection (infectious stones) and can also induce bacterial infection, leading to fever. Because the stones block the excretion of urine, bacteria cannot be excreted in time, and in severe cases, it can lead to sepsis, which is life-threatening.

　　The main symptoms are pain and hematuria, and a very few patients may have no自觉 symptoms for a long time.

　　1. Pain:Most patients experience lumbar pain or abdominal pain. Larger stones often cause dull or hidden pain on the affected side of the waist, which often worsens after activity; smaller stones often cause smooth muscle spasm and result in colic pain, which often occurs suddenly, is severe, like a knife cut, and radiates to the lower abdomen, perineum, and inner side of the thigh. Sometimes, patients may also have pale complexion, cold sweat, nausea, vomiting, and in severe cases, symptoms such as weak and rapid pulse and blood pressure drop may occur. The pain often occurs in paroxysms, or may suddenly stop or relieve due to some action, leaving hidden pain in the waist and abdomen.

　　2. Hematuria:Due to the direct injury to the mucosa of the kidney and ureter by the stones, hematuria often appears after severe pain, which can be microscopic or gross hematuria, and the severity of hematuria is related to the degree of injury.

　　3. Pyuria:When kidney and ureteral stones are complicated with infection, pus cells may appear in the urine, and clinical symptoms such as high fever and lumbar pain may occur.

　　4. Other:Obstruction of kidney stones can cause hydronephrosis, renal insufficiency, and some patients may also experience gastrointestinal symptoms, anemia, etc.

　　Changing lifestyle habits can prevent and reduce the growth and occurrence of kidney stones. There are several types of kidney stones, and once your doctor confirms the type of your kidney stone, the following methods can help reduce the chance of recurrence.

　　1. Drink more water

　　No matter what type of kidney stone you have, the most important preventive measure is to increase your water intake. Water can dilute urine and prevent the accumulation of high concentrations of salts and minerals into stones. A suitable amount of water is to produce 2 liters of urine per day, which is enough. If you work all day under the hot sun, you need to drink 2 gallons of water.

　　2. Supplement fiber

　　Adding bran to your diet can prevent the occurrence of stones.

　　3. Control the intake of calcium

　　About 80% of stones are formed by calcium or calcium-containing products. If your last stone was mainly composed of calcium, you should pay attention to the intake of calcium. If you are taking nutritional supplements, you first need to consult your doctor to determine whether it is necessary. Next, check your daily intake of high-calcium foods, including milk, cheese, butter, and other dairy products. Milk and antacids may cause kidney stones.

　　4. Check your stomach medicine

　　Some common antacids contain high levels of calcium. If you have calcium stones and are also taking antacids, you should check the ingredient list of this medicine to determine whether it contains high calcium. If it does, you should switch to another medicine.

　　5. Do not eat foods rich in oxalates

　　About 60% of stones are calcium oxalate stones. Therefore, limit the intake of foods rich in oxalates, including beans, beets, celery, chocolate, grapes, bell peppers, coriander, spinach, strawberries, and cruciferous vegetables. Also avoid alcohol, caffeine, tea, chocolate, dried figs, lamb, nuts, bell peppers, black tea, opium poppies, etc.

　　6. Be more active

　　People who do not like to be active are prone to accumulate calcium in the blood. Exercise helps calcium flow to its respective bones. Do not sit around all day waiting for stones to form, and should go out for a walk or exercise.

　　7. Heat compress

　　Applying heat compresses, cupping, and electrotherapy in the kidney area can relieve pain. Taking frequent hot baths is also beneficial for the excretion of stones.

　　8. Eat foods rich in vitamin A

　　Vitamin A is a necessary substance to maintain the health of the urinary tract lining, and it also helps prevent the recurrence of stones. Healthy adults need to consume 5,000 units (Iu) of vitamin A per day. A cup of carrots can provide 10,055 Iu of vitamin A. Other foods rich in vitamin A include broccoli, apricots, melons, pumpkins, beef liver. (Vitamin A is toxic in high doses. Therefore, before supplementing vitamin A, you should first obtain your doctor's consent.)

　　9. Pay attention to protein intake

　　Kidney stones have a direct relationship with the intake of protein. Protein is prone to cause uric acid, calcium, and phosphorus in urine, leading to the formation of stones. If you have had calcium stones, you should pay special attention to whether you are consuming an excessive amount of protein, especially if you have a history of hyperuricemia or cystine stones. Limit your intake of high-protein foods to 180 grams per day, including meats, cheese, chicken, and fish.

　　10. Eat less salt

　　If you have calcium stones, you should reduce the intake of salt. You should reduce your daily salt intake to 2-3 grams.

　　11. Supplement nutrients

　　Magnesium oxide or magnesium chloride, vitamin B6, proteinase, vitamin A emulsion or capsules.

　　12. Avoid L-cysteine

　　If you have a history of kidney stones or are currently suffering from kidney stones, avoid L-cysteine. The accumulation of this amino acid can crystallize in the kidneys, forming large stones that block the internal kidney.

　　13. Eat more watermelons

　　Watermelon is a natural diuretic. It should be eaten regularly, and it should be eaten alone without mixing with other foods. Watermelon has the effect of purifying the body, but it should not be eaten at the same time as other foods.

　　14. Limit the intake of vitamin C

　　If you are prone to forming calcium oxalate stones, you should limit the intake of vitamin C. More than 3-4 grams per day may increase the production of oxalic acid, thereby increasing the risk of stones. Do not take high-potency vitamin C supplements.

　　15. Do not take too much vitamin D

　　Excessive vitamin D can lead to the accumulation of calcium in various parts of the body. It is best not to exceed the recommended daily allowance (RDA) of 400 IU of vitamin D per day.

　　1. Laboratory tests:Urine routine examination can show red blood cells, white blood cells, or crystals. The urine pH is often acidic in patients with oxalate and urate stones; phosphorus stones are often alkaline. When infection is present, there are more pus cells in the urine. In severe infection, blood routine examination can show an increase in the total white blood cell count and neutrophils.

　　2. X-ray examination:X-ray examination is an important method for diagnosing kidney and ureteral stones. About 95% of urinary tract stones can be visualized on X-ray flat films. With excretory or retrograde pyeloureteral造影, the location of the stones, whether there is obstruction and the degree of obstruction, the function of the contralateral kidney, and distinguishing calcium shadows from outside the urinary tract, excluding other diseases in the upper urinary tract, determining the treatment plan, and comparing the location, size, and number of stones after treatment are all of great value.

　　3. Other examinations:Ultrasound can detect dense light spots or clusters at the stone location, and can detect a liquid level segment when combined with renal积水. Isotope renal imaging can show obstructive patterns of the affected urinary tract. CT scanning is not as直观 as X-ray flat films and urinary tract imaging films, and it is expensive, so it is generally not used as a routine examination.

　　Firstly, dietary therapy formula

　　1. Notoginseng and glutinous rice porridge:3 grams of notoginseng powder, 30 grams of fried glutinous rice, a little bit of rock sugar. Cook the glutinous rice into porridge, add a little rock sugar, and swallow the notoginseng powder.

　　2. White root porridge:30 grams of white root, 30 grams of fried glutinous rice, a little bit of rock sugar. Boil the white root in water to make a decoction, add glutinous rice to cook it into porridge, add a spoon of rock sugar, and eat warm.

　　3. Chicken gizzards and Job's tears porridge:9 grams of chicken gizzards, 60 grams of Job's tears, 2 spoons of brown sugar. Grind the chicken gizzards into powder and cook it with Job's tears to make porridge, add brown sugar, mix well, and eat at will.

　　4. Stone leaved rush and Job's tears porridge:30 grams of stone leaved rush, 90 grams of Job's tears, an appropriate amount of brown sugar. Boil the stone leaved rush in water to make a decoction, mix it with 3 bowls of Job's tears porridge, add brown sugar, and serve.

　　5. Yam porridge:Huangshan Mountain yam 60-100 grams, Poria cocos 30 grams, Herba epimedii 10-15 grams, rice 100 grams. First, cook the Huangshan Mountain yam, Poria cocos, and Herba epimedii, then take the juice and cook it with rice to make porridge.

　　6. Sea cucumber porridge:Sea cucumber 50 grams, rice 100 grams. Soak the sea cucumber until it is fully absorbed, wash and slice it, then cook until it is soft, and finally cook it with rice to make porridge.

　　Secondly, what can patients eat more of?

　　1. The daily water intake should be between 2000-3000 milliliters, and it can increase to 4000-5000 milliliters during hot summer, and even more after heavy sweating. It is essential to maintain a daily urine output of at least 2000 milliliters.

　　2. Magnetic water can be used for drinking, which is easy to dissolve stones.

　　3. Eat more foods rich in vitamin A, such as pork liver, eggs, and fresh cabbage and fruit.

　　4. Suitable foods: walnuts, corn silk, kiwi, astragalus, yellow fish brain, red bean, chicken stew, pickled vegetables, cabbage, winter melon, watermelon seeds, watermelon, luffa, pear, cucumber, kelp, lotus root, carrot, eggplant, asparagus, sweet potato, pumpkin, mung bean,螺蛳,螺肉, frog meat, etc.

　　Third, what patients should not eat

　　1. Eat less food rich in calcium, such as kelp, black fungus, beans, amaranth, milk, celery, purple kelp, eel, pickled radish, pumpkin seeds, dried red dates, etc.

　　2. Eat less food rich in oxalates, such as spinach, celery, cocoa, coffee, beets, strawberries, oranges, sweet potatoes, black tea, etc.

　　3. Eat less food that can easily cause an increase in uric acid, cystine, and xanthine, such as animal internal organs, seafood, beans, peanuts, etc.

　　Fourth, food therapy precautions

　　1. Drink plenty of fluids, and it is best to be able to excrete about 1.14 liters of urine per day.

　　2. Control the intake of calcium to avoid excessive calcium intake, but not to ban it.

　　3. Medications for stomach problems often contain a high amount of calcium. If you have calcium stones, choose brands with less calcium when taking stomach medications.

　　4. Do not eat too much food rich in oxalates, including beans, beets, celery, chocolate, grapes, green peppers, coriander, spinach, strawberries, and tea.

　　5. Taking magnesium and vitamin B6 can reduce the recurrence rate by 90%.

　　6. Eat foods rich in vitamin A, which can maintain the health of the urinary tract mucosa and also help prevent recurrence of stones. These foods include: carrots, broccoli, cantaloupe, pumpkin, beef liver, but high doses of vitamin A are toxic, and it is best to consult a doctor before taking it.

　　7. Maintain vitality to prevent calcium deposition in the blood.

　　8. Reduce the intake of protein, including meat, cheese, fish, and chicken.

　　9. Reduce the intake of salt, eat less food with high salt content.

　　10. Limit the intake of vitamin C, especially for patients with calcium oxalate stones.

　　11. Do not take too much vitamin D.

　　12. If you have been a patient and then feel any severe pain or blood in the urine, please seek medical attention as soon as possible.

　　13. Patients should understand the type of their stones.

　　The treatment of renal and ureteral calculi should be analyzed specifically according to the size, location, number, shape, unilaterality or bilaterality, whether there is urinary tract obstruction, accompanying infection, degree of renal function damage, general condition, and treatment conditions, etc., and fully considered. However, when colic attacks occur, the first step should be to relieve the symptoms, and then choose a treatment plan.

　　First, the treatment of renal colic

　　1. Antispasmodic analgesia.

　　2. Acupressure for pain relief.

　　3. Local closure of the allergic skin area.

　　4. Acupuncture therapy.

　　Second, non-surgical treatment

　　Non-surgical treatment is generally suitable for stones with a diameter less than 1 centimeter, smooth edges, no obvious urinary tract obstruction, and no infection. For some large horn-shaped kidney stones that do not cause symptoms clinically, non-surgical treatment can also be considered temporarily.

　　1. Drinking plenty of water:Increase urine volume to flush the urinary tract, promote the downward movement of stones, dilute urine to reduce crystal precipitation.

　　2. Traditional Chinese medicine treatment.

　　3. Acupuncture method:Increase the peristalsis of the renal pelvis and ureter, which is conducive to stone excretion.

　　4. Regularly perform jumping exercises, or perform inverted position and striking exercises for renal calyx stones, which is also beneficial for stone excretion.

　　5. Other:For patients with bacterial infections in urine culture, sensitive drugs (Augmentin, Metronidazole) should be used to actively control infection. For patients with metabolic disorders, active treatment of the primary disease and adjustment of the acid-base balance of urine should be considered.

　　3. Extracorporeal shock wave lithotripsy

　　4. Surgical treatment

　　If urinary obstruction caused by stones affects renal function, or if non-surgical therapy is ineffective, and there are no conditions for extracorporeal shock wave lithotripsy, surgical treatment should be considered.

　　Preoperative preparation: It is necessary to understand the renal function of both sides before surgery, and to control infection with antibiotics if there is an infection. For patients with ureteral stones, preoperative urinary tract plain films should be taken before entering the operating room or on the operating table to locate the final position of the stones.

　　Surgical methods: Depending on the size, shape, and location of the stones, the following common surgical methods are usually used:

　　1. Renal pelvis or renal sinus nephrolithotomy:Incision of the renal pelvis, removal of stones, cornual stones or renal calyx stones, and sometimes incision of the renal sinus renal pelvis renal calyx for stone removal is required.

　　2. Parenchymal nephrolithotomy:For large kidney stones that cannot be removed through renal sinus incision, stone removal requires incision into the renal parenchyma.

　　3. Partial nephrectomy:Applicable to multiple renal pole stones (usually in the lower pole of the kidney), or located in dilated and poorly drained renal calyces, the renal pole or renal calyx with stones can be resected together.

　　4. Nephrectomy:For patients with one-sided kidney stones and severe hydronephrosis or pyonephrosis, which has seriously damaged or lost renal function, while the contralateral renal function is good, nephrectomy can be performed on the affected kidney.

　　5. Ureteral Lithotomy:For ureteral stones larger than 1 cm or stones that cause urinary obstruction or infection due to impaction, and for those who are ineffective with non-surgical therapy, ureteral lithotomy can be performed.

　　6. Stone Extraction:For ureteral stones less than 0.6 cm in diameter in the middle and lower segments, it is possible to try to retrieve them using a customized basket or catheter through cystoscopy.