LITIASIS RENAL (CA'LCULOS RENALES)

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	LITIASIS RENAL (CA'LCULOS RENALES)
	*LITIASIS RENAL (CA'LCULOS RENALES)*

LITIASIS RENAL (CA'LCULOS RENALES)

Renal Litiasis (renales Calculations)

It tinkles it is a liquid produced by the kidney in that multiple substances like calcium are dissolved, úrico acid, phosphates... If his conditions of concentration, the balance is broken in which they are and they are combined with other substances, forming added whose size is growing, giving rise to the renales cáculos.

Causes of the renal litiasis

Four types of renales calculations exist according to their composition: calcic (70-80%), of úrico acid (15%), cistina (1%) and of (5%). The calcic calculations are most frequent. They appear less frequently like calcic oxalato or like calcic phosphate.

There are many diseases that produce increase of calcium in tinkles it, like the primary hiperparatiroidismo, malignant hipertiroidismo, tumors, metástasis óseas... but the most frequent cause of formation of calcic calculations is hipercalciuria idiopática, that is characterized by increase of urinary calcium with normal sanguineous calcium.

Hiperuricosuria is another frequent cause, since the úrico acid crystal formation favors the precipitation of calcic oxalato, acting like aggregation nucleus. More infrequent causes are the primary hiperparatiroidismo and tubular acidosis renal distal that increases calcium in tinkles.

The úrico acid calculations on the contrary characterize because they do not see in the simple x-rays, that the rest. They must to an increase of the úrico acid elimination in it tinkles it and it exists a familiar tendency.

The estruvita crystals are the result of chronic infections by bacteria that produce a called substance ureasa. Usually they grow in pelvis renal, forming the calls "coraliformes calculations".

Clinical manifestations

The manifestation most characteristic of the renales calculations is the nefrítico cólico. The renales cáculos form in pelvis renal where they grow without producing symptoms In this phase can cause the appearance of blood in tinkles it (hematuria).

The nefrítico cólico takes place when a renal calculation moves through uréter, that is the conduit that communicates rinón with vejiga urinary. Then an obstruction to the passage takes place of tinkles it, which distiende uréter over the obstruction. This takes place an intense pain that characteristically begins in the back and it is radiated towards the genitals.

Frequently nauseas and vomits appear. Also they can appear annoyances when tinkling and difficulty for the micción. The fever is exceptional.

With smaller frequency other medical problems can be produced: nefrocalcinosis or depóstios of calcium in weave of kidney, cáculos coraliformes (calcium molds that fills up pelvis renal), renal insufficiency...

Mechanisms of formation of renales calculations

The production of calculations must to the alteration of delicate situations of balance physical-chemistry that allow that very insoluble substances appear dissolved in tinkles it. When some of the components of the dissolution increases its concentration, it appears a tendency to crystallize and to form aggregates who grow progressively until reaching the solid state and forming the calculations.

Treatment of renales calculations

PREVENTION OF THE FORMATION OF CALCULATIONS

General measures

Independently of the type of calculations, its formation must to an excess of concentration of the implied substances. For that reason it is fundamental to maintain a suitable hidratación that produces one tinkles very diluted and for it it is recommended to drink two liters of water at least daily.

The diet also must be adapted. The patients with úrico acid calculations must follow a protein diet poor, abstain to take alcohol and diminish the ingestion of some vegetables like the spinach and the tomato. If the calculations are of calcium is due to diminish the salt ingestion, since the rich sodium diets increase the excreción of calcium in tinkles it, increasing the risk of suffering litiasis.

Also one is due to control proteins of the diet since its metabolism modifies the conditions of tinkles it favoring the formation of calculations. Nevertheless, it is not necessary to diminish calcium of the diet since paradoxicalally it increases the formation of calculations. Medical treatment

If they are continued forming calculations in spite of the dietetic modifications, farmacológico treatment is due to restore. This it varies function of the type of calculations.

1. Calcic calculations: The most frequent cause is hipercalciuria idiopática. The treatment consists of trying to diminish the excreción of calcium in tinkles it. This is obtained associating a tiazídico diurético (AmerideÒ) and diet without salt. If this measurement is not sufficient it must use potassium bicarbonate.

2. Cáculos of úrico acid: These calculations require pH urinary stop, reason why it is due to alcalinizar tinkles it.

The suitable substance is the potassium citrato, since the sódico bicarbonate increases the risk of calcic acids. If pH urinary does not diminish the sufficient thing is due to add acetazolamida, a diurético. A low diet in purinas is due to use and if with it the excreción of úrico acid is not controlled, alopurinol is due to add.

3. Calculations of estruvita: The leading urinary infection of the formation of the calculation is due to extract the calculation and to deal with antibiotics.

TREATMENT OF CÓLICO NEFRÍTICO

Preservative treatment

Most of the renales calculations that are obstructing uréter they are able to be eliminated by the urinary flow with two simple measures:

a) To increase the urinary flow with hidratación, that can be oral or intravenous (serum) if the patient has many nauseas or vomits.

b) Espasmolíticos (relajantes muscular), that contributes to alleviate the contractura of the muscle of uréter increasing their caliber and allowing the passage of most of the calculations.

If with the preservative treatment the pain is not alleviated or the obstruction is not solved is due to try to extract the calculation by more aggressive methods, than they are exposed next.

Noninvasive treatment (litotricia extracorporéa)

The objective of the litotricia is to fragment the calculations in smaller pieces so that they are able to cross uréter.

The litotricia consists of applying to the organism shock waves generated by an electrical current of high voltage. The waves are transmitted to the patient through an average liquid (interposed full water bathtub or cushions with the generator of the waves).

After multiple unloadings, most of stones they are reduced to dust, with which it can happen with facility until vejiga and to be expelled with tinkles it.

Surgical treatment

At the moment he is in favor almost obsolete of the effectiveness of the noninvasive techniques.

An invasive surgery exists minimumly that is the percutánea ultrasonic litrotricia that consists of introducing a catheter until the kidney with a small incision in the back.

Through the catheter a ultrasonic trasductor is introduced that applies ultrasound waves directly to the calculation, fragmenting it with application of less energy. The fragments are extracted through the catheter.

The litotricia with laser through ureteroscopia has the same foundation, but the generating source of energy is the laser. With these techniques the open surgery (pielolitotomía or ureterolitotomía), consisting of the opening of rinón or uréter to extract the calculation has practically been in disuse.

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