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Kidney stone disease: Difference between revisions
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<section begin="urology colic" /><section begin="radiology" />'''Kidney stone disease''', also called '''nephrolithiasis''' or '''urolithiasis''', refers to the presence of symptomatic kidney stones in the urinary tract. When stones are present in the ureter it may be called '''ureterolithiasis''', while stones in the bladder are usually simply called '''bladder stones''' or '''bladder calculi'''. It's a relatively common condition, with a lifetime prevalence of 10 - 20 percent.<section end="radiology" /> | <section begin="urology stone" /><section begin="urology colic" /><section begin="radiology" />'''Kidney stone disease''', also called '''nephrolithiasis''' or '''urolithiasis''', refers to the presence of symptomatic kidney stones in the urinary tract. When stones are present in the ureter it may be called '''ureterolithiasis''', while stones in the bladder are usually simply called '''bladder stones''' or '''bladder calculi'''. It's a relatively common condition, with a lifetime prevalence of 10 - 20 percent.<section end="radiology" /> | ||
Many have asymptomatic kidney stones (which is not considered kidney stone disease), but in some cases stones can cause [[Obstructive uropathy|urinary obstruction (obstructive uropathy)]] and resulting damage to the kidney, as well as episodes of severe pain called renal colic.<section end="urology colic" /> | Many have asymptomatic kidney stones (which is not considered kidney stone disease), but in some cases stones can cause [[Obstructive uropathy|urinary obstruction (obstructive uropathy)]] and resulting damage to the kidney, as well as episodes of severe pain called renal colic.<section end="urology colic" /> | ||
== Epidemiology == | |||
Kidney stone disease more commonly affects males than females, and mostly affect people in the 30 - 60 years age group. | |||
== Etiology == | |||
Certain risk factors are known for certain stone types: | |||
* Any type | |||
** Low fluid intake | |||
** Family history | |||
* Calcium oxalate stone | |||
** Hypercalcuria | |||
** Crohn disease | |||
* Uric acid stone | |||
** Hyperuricaemia and gout | |||
* Struvite stone | |||
** UTI with urease-producing bacteria | |||
== Pathology == | == Pathology == | ||
Kidney stones are usually small (2-3 mm). 80% of kidney stones are formed of calcium oxalate. 10% are so-called struvite stones, which are formed of magnesium ammonium phosphate. The remaining types are formed of uric acid and cysteine. | Kidney stones are usually small (2-3 mm). 80% of kidney stones are formed of calcium oxalate. 10% are so-called struvite stones, which are formed of magnesium ammonium phosphate. The remaining types are formed of uric acid and cysteine. | ||
Stone formation occurs when the urine is supersaturated with the components of the stone. In some cases other factors will contribute to the formation of stones as well, like abnormal pH. | Stone formation occurs when the urine is supersaturated with the components of the stone . In some cases other factors will contribute to the formation of stones as well, like abnormal pH. | ||
Calcium oxalate stones are the most common type. This type of stone is radiopaque. | |||
Struvite stones occur in people with alkaline urine. Alkaline urine is a result of a [[urinary tract infection]], especially one caused by bacteria that produce ''urease'', like [[Proteus]] and [[Staphylococcus]]. Struvite stones can sometimes make a “cast” of the renal pelvis, called staghorn calculi. | Struvite stones occur in people with alkaline urine. Alkaline urine is a result of a [[urinary tract infection]], especially one caused by bacteria that produce ''urease'', like [[Proteus]] and [[Staphylococcus]]. Struvite stones grow quickly and can sometimes make a “cast” of the renal pelvis, called staghorn calculi. | ||
Uric acid stones occur in people with acidic urine and increased excretion of uric acid. The latter can be idiopathic or in combination with [[gout]] or diseases that cause rapid cell turnover, like leukaemia. | Uric acid stones occur in people with acidic urine and increased excretion of uric acid. The latter can be idiopathic or in combination with [[gout]] or diseases that cause rapid cell turnover, like leukaemia. This type of stone is radiolucent. | ||
Cysteine stones occur in people with genetically determined defects in renal transport of cysteine. Acidic urine also increases the risk for cysteine stones. | Cysteine stones occur in people with genetically determined defects in renal transport of cysteine. Acidic urine also increases the risk for cysteine stones. | ||
The pain associated with kidney stones is thought to occur due to distension of the kidney capsule due to urinary obstruction and due to ureteric spasm. | The renal colic pain associated with kidney stones is thought to occur due to distension of the kidney capsule due to urinary obstruction and due to ureteric spasm. | ||
<section begin="urology colic" /> | <section end="urology stone" /><section begin="urology colic" /> | ||
== Clinical features == | == Clinical features == | ||
Kidney stones may be asymptomatic, especially if they are in the renal pelvis. | Kidney stones may be asymptomatic, especially if they are in the renal pelvis. | ||