Nephrolithiasis (Kidney Stones)
Introduction and Facts
Nephrolithiasis (kidney stones) is a condition in which there are one or more stones in the pelvis or calyces of the kidneys. Intrinsic and extrinsic factors influence the formation of kidney stones. Intrinsic factors are age, gender, and heredity, while outside factors are geographical conditions, climate, eating habits, substances in the urine, work, etc. In Indonesia, the most common kidney diseases are kidney failure and nephrolithiasis. The highest prevalence of nephrolithiasis was in DI Yogyakarta (1.2%), followed by Aceh (0.9%), West Java, Central Java, and Central Sulawesi (0.8%).
Pathophysiology
Based on its composition, nephrolithiasis is divided into calcium stones, struvite stones, uric acid stones, cystine stones, xanthine stones, triamterene stones, and silicate stones. Stone formation in the kidney generally requires a state of supersaturation. However, in normal urine, stone-forming inhibitors were found. Under certain conditions, some reactants can induce stone formation. The presence of an obstruction to the flow of urine, congenital abnormalities in the pelvis, benign prostatic hyperplasia, strictures, and buli neurogenic bladder is thought to play a role in the stone formation process.
Stones consist of crystals composed of organic or inorganic materials dissolved in the urine. These crystals will remain in a metastable position (remain dissolved) in the urine if no conditions cause crystal precipitation. If the crystals experience precipitation, they form a rock core, aggregating and attracting other materials to form larger crystals. Crystals will settle on the epithelium of the urinary tract and form stones large enough to block the urinary tract to cause clinical symptoms later.
Clinical Symptoms and Complications
Patients with nephrolithiasis often get complaints of pain in the lower back and front. Pain can be colic or non-colic. The pain can persist and be very intense. Nausea and vomiting are often present, but fever is rare in patients. There may also be gross or microhematuria.
Diagnosis
Apart from the typical complaints found in patients with nephrolithiasis, several things must be evaluated to make a diagnosis, namely:
1. A screening evaluation consisting of a detailed medical and dietary history, blood chemistry, and urine of the patient.
2. Abdomen X-ray, which is used to see the possibility of radio-opaque stones.
3. Intravenous pyelography, which aims to see the anatomy and function of the kidney. This examination may reveal radiolucent stones.
4. Ultrasound (USG) can see all types of stones.
5. CT Urography without contrast is the standard to see stones in the urinary tract.
Medication and Treatment
The main treatment goals in patients with nephrolithiasis are to relieve pain, remove existing stones, and prevent recurrent stone formation.
1. ESWL (Extracorporeal Shockwave Lithotripsy). It works by using shock waves generated outside the body to crush stones inside the body. Stones will be broken into small pieces so that they are easily removed through the urinary tract.
2. PCNL (Percutaneous Nephro Litholapaxy) is an endourological procedure to remove stones in the kidney tract by inserting an endoscope into the calyces through an incision in the skin. The stone is then removed or broken first into small fragments.
3. Open surgery for health services that do not yet have PNL and ESWL facilities, actions that can be performed through open surgery.
4. Conservative Therapy or Medical Expulsive Therapy (TEM). Therapy using this medication is aimed at cases with stones whose size is still less than 5 mm; it can also be given to patients who do not indicate active stone removal.
Reference:
Fauzi A, son of MMA. Nephrolithiasis. Majority 2016:5(2):69-73
