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Coral stones in the pelvis. Treatment of staghorn nephrolithiasis

On our site, urate ones that are easy to treat, and not too complex oscalate ones, have already been considered, now it's time to consider the most severe form urolithiasis, namely, staghorn kidney stones.

Already by the size of these stones, it is clear that it will not be easy to cure them, because sometimes they reach the size of the renal pelvis, practically representing its cast. Imagine that plaster is poured into the kidney and you get a fairly accurate representation of the staghorn stone.

Even 30 years ago, this type of stones inevitably led to surgery, and in particular severe cases the case generally ended with the removal of the kidney. The only thing that saves the situation is the rarity of staghorn stones, they occur in every thousandth patient with urolithiasis.

In this article, we will look at modern methods treatment of staghorn kidney stones, surgery to remove them and the rehabilitation period after.

Coral kidney stones should be considered as a special form of urolithiasis. The treatment of staghorn kidney stones is a rather complex task for the urologist, involving risks and specific interventions. Coral kidney stones are quite common. With the ICD, among ordinary stones about a third of the kidneys can be stones of this type.

Women suffer from the formation of kidney staghorn stones 200% more often due to the characteristics of the female body. According to statistics, over half of patients with urolithiasis and those with staghorn stones are people aged 30 years and older.

Varieties of coral-like kidney stones

Staghorn stones are divided into four types of staghorn nephrolithiasis, depending on the size and localization in the kidneys:

Coral nephrolithiasis I - the calculus is localized in the pelvis and in one of the cups;
Coral nephrolithiasis II - the calculus is located in the pelvis of the extrarenal type with processes in two or more cups;
Coral nephrolithiasis III - a stone formed in the pelvis of the intrarenal type with processes in all cups;
Coral nephrolithiasis VI - has processes and performs the entire deformed pelvic-cup system.

Retention changes in staghorn nephrolithiasis have many degrees, ranging from moderate expansion of the renal pelvis to expansion of the calyces. Choosing a method of treatment, the urologist considers violations in the work of the kidneys.

The insufficiency of the secretory ability of the kidneys is classified into four phases, which comprehensively make it possible to assess the nature of the calculus, the characteristics of inflammation and the size of the expansion of the pelvis-calyx system.
I phase - deficiency of tubular secretion 0-20%;
II phase - 20-50%;
III phase - 50-70%;
IV phase - over 70%.

Causes of the formation of staghorn kidney stones

To date, there is no unambiguous explanation for the causes of the appearance of kidney stones, including staghorn calculi. This leads to certain difficulties with the development of accurate treatment regimens for patients with staghorn nephrolithiasis, effective control of KSD and optimal preventive measures. There is intuitive knowledge gained by practical means and temporarily adopted by urologists.

According to these data, the formation of staghorn kidney stones is promoted by congenital and acquired kidney diseases, mainly leading to a characteristic lesion of the glomerular apparatus of the kidneys.

Coral-like kidney stones develop against the background of a significant deterioration in urodynamics and complications in the form of pyelonephritis. This eventually leads to kidney failure.

The development of staghorn nephrolithiasis leads to excessive excretion of oxalic acid salts in the urine (up to 80%), in other cases, tubulopathies are observed, accompanied by renal tubular acidosis, the appearance of galactose and fructose in the urine.

As noted in earlier publications, climate plays a special role in the appearance of staghorn nephrolithiasis, mostly hot, as well as water, food and general regional ecology.

The formation of staghorn calculi during pregnancy is acceptable, which can be explained hormonal changes in a woman's body. Heredity in staghorn nephrolithiasis is also taken into account and accounts for about 20% of all cases.

It is believed that in about a third of cases, the etiological cause of staghorn nephrolithiasis is hyperparathyroidism.

However, it is not possible to prove the dominant role of changes in the function of the parathyroid glands in the occurrence of kidney stones, since not all patients suffering from staghorn nephrolithiasis have hypercalciuria, hypophosphatemia and hypercalcemia. Also, not all patients with Recklinghausen's disease suffer from staghorn calculus.

The origin and development of staghorn kidney stones

The building material for the core of most coral stones is organic matter, although there are exceptions that indicate the possible inorganic nature of stone formation. The stone can be formed on the basis of the components of cystine, phosphate, calcium and salts, seized together by an organic substance, including glycosaminoglycans and glycoproteins.

Immunochemical analysis protein composition urine allows you to detect excretions in the urine of alpha-acid glycoprotein, albumin, transferrin and IgG, which indicates tubular proteinuria.

Thanks to the study, it is possible to identify a clear relationship between the appearance of proteins in the secondary urine and damage to the structure of the glomerular basement membranes. From which we can conclude that the formation of staghorn stones is correlated with tubular disorders and glomerulopathy.

Electron microscopic studies of the renal tissue make it possible to detect disturbances in the areas of the cell membrane responsible for the operation of the mechanisms of obligatory and facultative reabsorption.

So, in the lumen of the loop of Henle and collecting ducts, electron-loose flocculent material is found, and in the nephrocytes of the renal tubules of the proximal and distal sections, changes in the microvilli of the brush border are detected. The cell nuclei of the loop of Henle are always deformed, and the basement membrane is strongly altered.

Also, in the course of the research, evidence was obtained of an unconditional change in the renal parenchyma in all departments with the appearance of staghorn stones.

There have been cases when complaining about completely different symptoms and taking an x-ray, people found coral-like stones in themselves when they were just forming.

Symptoms of the appearance of staghorn kidney stones

Inherent only in staghorn nephrolithiasis, it is difficult to identify. After all, back pain and weakness can indicate a number of kidney diseases - chronic pyelonephritis, various forms urolithiasis, kidney tumor, autosomal dominant polycystic disease, hydronephrosis, etc.

However, there is special moments registering some signs of impaired urodynamics and kidney function. Therefore, based on the data clinical picture, staghorn nephrolithiasis is divided into four stages.

I - incubation period;
II - the onset of the disease;
III - stage of clinical manifestations;
IV - hyperazotemic stage.

During the course of stage I, patients report chills, general weakness, headaches and thirst. kidneys on this stage patients are not worried.

At stage II of the manifestation of the disease, patients note mild dull pain in the lumbar region.

At stage III, blood impurities may appear in the urine, fragments of stones or independent small calculi begin to move away, renal colic is possible. The lower back hurts constantly, and the body temperature steadfastly keeps at around 37 - 37.5 ° C. Weakness, apathy, fatigue against the background of signs of chronic renal failure.

During stage IV, dysuria and signs of exacerbation of pyelonephritis are added, chronic renal failure passes into an intermittent or terminal stage.

Coral-like kidney stones often lead to increased blood pressure, also with staghorn nephrolithiasis, chronic pyelonephritis may occur at any time.

Diagnosis of staghorn kidney stones

The diagnosis of staghorn nephrolithiasis is based on common signs and data additional research. Therefore, staghorn stones may be detected on examination, for example, when performing an x-ray of the urinary tract or ultrasound.

Thanks to ultrasound and x-rays in the diagnosis, in 100% of cases it is possible to determine the size and contours of the kidney, the projection shadow, the size of the coral stone, and also to establish the expansion of the pelvicalyceal system. Excretory urography makes it possible to more accurately assess the functional activity of the kidneys, revealing the expansion of the pyelocaliceal system.

To detect chronic renal failure different stages, urologist:

studies the lifestyle of patients;
collects information about their living conditions preceding the disease with staghorn nephrolithiasis;
analyzes the current clinical picture of the disease;
evaluates data and indications received from the laboratory.

Thanks to the constant improvement of urologists, the development of new scientific methods and the change in the fleet of diagnostic equipment, the number of patients suffering from staghorn nephrolithiasis in the terminal stage of chronic renal failure is steadily decreasing.

In chronic renal failure in patients with staghorn stones, plasma proteins are detected - albumin, transferrin, acid glycoprotein. Immunoglobulins, beta-lipoproteins and a2-macroglobulins can also get into the urine.

This indicates a violation of the integrity of the glomerular basement membranes, which usually prevents plasma proteins from entering the urine. Changes in the work of the functional activity of the kidneys lead to a violation of carbohydrate metabolism due to an increase in the proportion of insulin in the blood.

Clinical diagnosis of staghorn kidney stones

As staghorn nephrolithiasis develops, patients indicate a number of ailments: a change in the color of urine, elevated temperature, urination disorder, dull back pain and accompanying renal colic. Small stones may pass, skin itching is possible. Patients are thirsty and complain of a parched mouth.

Laboratory diagnosis of staghorn kidney stones

A urologist will help to comprehensively assess the situation, find out the state of kidney function, and assess the size of inflammation. laboratory research.

Already on initial stage studies often manage to detect pyuria, leukocytosis, and notice an increase in the erythrocyte sedimentation rate. Reberg's test shows a marked decrease in kidney function and an increase in the concentration of amino acids in the blood plasma.

Instrumental diagnosis of staghorn kidney stones

It is possible to determine the source of bleeding in macrohematuria using modern instrumental methods examinations such as cystoscopy.

Ultrasound examination shows not only the presence of a staghorn calculus, but also makes it possible to determine its characteristics (shape, size), note changes in the renal parenchyma, for example, identify an expansion of the pelvicalyceal system.

The leading role in the diagnosis of staghorn kidney stones is played by x-ray methods.

Retrograde pyelography is rarely prescribed, only before surgery, if there is a suspicion of a violation of urodynamics.

In the course of excretory urography, it is possible to determine the size of the kidney, its contours, segmental changes on nephrograms, slowing down the release of a contrast agent, its accumulation in dilated cups, and the absence of kidney function.

The method of isotope renography, including the assessment of blood clearance, shows the level of functional renal activity.

Renal scintigraphy allows monitoring of hemodynamic disturbances in various segments of the kidneys.
Renal angiography indicates the location of the origin of the renal artery from the aorta, and also determines the diameter of the renal artery and the number of segmental branches.

Dynamic nephroscintigraphy makes it possible to have accurate information about the functional state of individual sections of the renal parenchyma and upper urinary tract.

Treatment of staghorn kidney stones

There are three treatments for coral kidney stones: conservative treatment, and surgical treatment.

Patient on early stage diseases of staghorn nephrolithiasis (but not having impaired renal function and exacerbations in the form of pyelonephritis) can undergo a conservative course of treatment. The patient will be monitored by a urologist who will prescribe antibiotics and various diuretics.

Conservative treatment of staghorn kidney stones

To maintain the pH of urine in the range of 6.2-6.8. Blemaren is usually recommended. Drinking soda allows you to raise the pH of urine. With oxaluria, treatment with pyridoxine is effective.

To reduce the formation of urea, the urologist may prescribe medications to the patient that speed up the excretion process. uric acid from the body.

With an increased calcium content in the urine, hydrochlorothiazide is indicated at a dose of 0.015-0.025 g 2 times a day, and dairy products are excluded.

Diet for coral stones

Surgical treatment of staghorn kidney stones

The widespread introduction of percutaneous nephrolithotomy and external lithotripsy greatly helps in the treatment of severe patients with staghorn kidney stones. Schemes of surgical interventions are constantly being improved by urologists-practitioners, which makes it possible to preserve the functioning renal parenchyma of the kidneys.

A popular method widely used to remove coral stone on stages I-II staghorn nephrolithiasis can be called percutaneous nephrolithotomy. In the third stage of staghorn nephrolithiasis, PNL is proposed as an alternative choice to surgery.

External lithotripsy is used in stage I of staghorn nephrolithiasis, it is well tolerated by children and adolescents, DLT is optimal for stones in the pelvis of the intrarenal type, with a decrease in kidney function.

The choice of treatment method rests with the urologist. Many operating physicians, highly appreciating the merits of both PCNL and EBRT, use in practice various combinations open intervention and these methods.

Every year, open surgical treatment acquires more and more sparing properties, such as lower pnelolithotomy, posterior subcortical or pyelocalicotomy, which is recommended for many patients with staghorn nephrolithiasis.

Some disadvantage of pyelolithotomy can be considered the impossibility of evacuating stones from the calyces, therefore, PCNL is still preferable for the treatment of staghorn stones at stage III staghorn nephrolithiasis.

Thanks to percutaneous nephrolithotomy and external lithotripsy, the number of complications is reduced to 1-2%. Open operations with serious preoperative preparation, improvement of anesthesiology and methods of pyelonephrolithotomy with clamping of the renal artery make it possible to perform effective organ-preserving operations. Therefore, the proportion of nephrectomy for staghorn stones is constantly decreasing.

Further actions

Coral kidney stones are prevented by active prevention of the disease under the supervision of a urologist. A urologist, conducting dynamic observations, will be able to identify a dangerous tendency to the appearance of stones, for example, to detect signs of a change in urine pH, hyperoxaluria, hyperkalyshemia, etc., and prescribe a course of corrective infusion therapy.

It is also advisable for the patient to follow simple rules: eat less table salt and fats, give up coffee, chocolate, sweets, fried and spicy foods. Drink plenty of fluids, at least two liters per day.

Information taken from the site http://mchs-uro.ru

Surgery to crush large and staghorn kidney stones

Large and staghorn kidney stones are a common and difficult to treat problem even at the current level of development of urology. In this article, we will not cover the causes and process of stone formation - this is a separate and very extensive topic.

Ultimately, the impact on the formation of kidney stones is a matter of postoperative anti-relapse therapy. In any case, the stone(s) usually need to be removed, as its (their) existence often seriously affects the functioning of the kidney.

Below is an example of how a large calculus that disrupts the outflow of urine from the kidney and causes chronic sluggish inflammation, “quietly” (without bright and noticeable symptoms) led to the complete disappearance of the function of the organ (Fig. 1.).

Percutaneous nephrolithotripsy (percutaneous nephrolithotripsy)

Figure 1 shows that on the right, despite the staghorn stone, the kidney accumulates and secretes a contrast agent (kidney tissue and ureter are stained). On the left, a large pelvis stone is visible, and there is practically no accumulation and highlighting of contrast - the kidney does not work (the thickness of the kidney tissue does not exceed 5 mm at a norm of 15 mm).

If at one time the large stone on the left had been destroyed, the kidney would not have died. And in this situation, if nothing is done, the patient is doomed to the development of chronic renal failure and hemodialysis.

To date, the "gold standard" for the treatment of large and staghorn kidney stones is percutaneous (percutaneous) nephrolithotripsy.

The essence of the method is that under the control of ultrasound / X-ray, a puncture (puncture) is performed on one of the cups of the kidney cavity system, after which a special “working port” is formed with a diameter of 5 mm to 1 cm (depending on the technology).

Through this port, a special endoscopic instrument (nephroscope) with a video camera, lighting and a working channel is passed into the kidney cavity system, through which, using ultrasound, laser, pneumatics, and other types of energy, stone fragments are destroyed and removed.

At the final stage, a drainage (nephrostomy) is usually installed in the kidney through the formed port for several days. Thus, a stone, sometimes reaching a size of 7-8 cm, is removed through a hole of 1 cm or even less (with smaller sizes stone).

With a smooth course of the postoperative period for 3-4 days, the patient can already be at home and return to ordinary life. Previously (and, unfortunately, now in many domestic clinics) in similar situations, a large and traumatic operation was performed, which involved a 20-centimeter incision in the lumbar region with the intersection of muscles, fascia and nerves, the isolation of the kidney and its extensive surgical trauma.

Naturally, after all this, the patient expected a rather painful postoperative period, and the results were usually quite modest. In some cases, urologists prefer not to meddle “where they shouldn’t” at all and recommend “observation” to the patient ... As a rule, this is monitoring the slow (and not so) death of the kidney.

Problems with coral stone removal operations

Percutaneous nephrolithotripsy of the kidney has been around for over 30 years, but it is still available in a few clinics. What is the reason?

Firstly, the fact is that the kidneys are very intensively supplied with blood organs. With their mass not exceeding 0.5% of body weight, they receive 20-25% of the blood from cardiac output. The blood pressure in the large arteries of the kidney corresponds to the pressure in the aorta. This means that mistakes in this area of surgery are quite costly.

Secondly, in order to ensure high level the safety and effectiveness of percutaneous nephrolithotripsy of the kidney, the operating room must be very plentifully and correctly (!) Equipped.

Suffice it to say that in addition to high-quality surgical x-rays and ultrasonic device, at least 50-60 items of endoscopic equipment, consumables and, preferably, all main types of contact lithotripters (ultrasound, pneumatics, laser) should be available in the endourological operating room.

“Poverty” in this area leads to the fact that operations are unsuccessful or even end tragically ... By the way, this also applies to incompetent “wealth”, when all the regiments are forgotten by good, the benefits of which are very doubtful.

Thirdly (and in fact - firstly), deep and comprehensive training of specialists in the field of endourology is necessary. There are enough areas in surgery where at first you can “throw hats” on the problem and, in the end, learn how to perform the operation quite tolerably. In percutaneous kidney surgery, this approach is usually unsuccessful. Colleagues will agree with me.

In the urology department of our Center, more than 600 endourological operations are performed annually. We successfully (“on the fly”) perform, among other things, percutaneous interventions for large and staghorn kidney stones.

To do this, we have everything you need (I already wrote about this above). The most important thing is that we not only perform such operations, but, being in a multidisciplinary hospital, we are ready to effectively deal with complications (although, thank God, they occur extremely rarely).

So, in the last 100 percutaneous operations, we have never had to resort to blood transfusion or embolization of renal vessels due to bleeding.

In conclusion, we can cite several clinical cases in which percutaneous nephrolithotripsy has successfully relieved patients from quite serious problems.

Examples of removal of coral stones from practice

Clinical case #1
The patient M. already known to you (Fig. 1.) was operated on for a coral-like stone of the only functioning right kidney - the picture the next day after the operation is shown in Figure 2.

Clinical case #2
Patient V. had a large stone occupying the entire cavitary system of the left kidney. The complexity of the clinical case was that the density of the stone exceeded 1700 Hounsfield units (twice as dense as bone). Crushing had to be done by combining pneumatic and ultrasonic energy at maximum power (Fig. 3-6).

Information taken from gosmed.ru

Video about crushing coral stones

Kidney stones - pathology excretory system, in which neoplasms appear in the cups and pelvis. They are made up of salts.

coral stone in the kidneys - a form of disease of the excretory system, it is the most severe of all diseases of the organ system. Not only is this a serious illness, but the incidence of it is only five percent of all diseases of the genitourinary system.

This disease has a peculiarity. The disease will be independent, unlike others. This name was awarded because of the shape of the stones in the pathological process.

The risk group includes people from thirty to fifty years. Representatives of the “fair” sex often suffer.

The size of the stones reaches eight centimeters. Due to the size of the stones, it is very difficult to cure such a disease.

Because of such neoplasms, a person begins to have problems with the excretion of urine. Moreover, the peculiarity of such stones is prolonged absence any problems with the patient. Therefore, when contacting a doctor, the patient often comes with critical forms of the disease.

Causes of the disease

At the moment, there are several reasons for the appearance of such a disease. They will be given below:

Problems with metabolism.
Abuse of "strong" drinks.
Pathologies of the digestive system.
Genetics plays an important role.
Problems with urinary excretion organs.
A sedentary lifestyle (because of this, disturbances in the metabolism of calcium and phosphorus begin).
Diseases of the circulatory system.
A high content of salts and protein in the urine.

Doctors made up the stages of development:

First. A small stone appears in the cup. It may also appear in the pelvis.
Second. The stone has processes that diverge into two (at least) cups.
Third. Distribution is as follows: a pebble in the pelvis and gives branches to all cups.
Fourth. It spreads to the renal pelvic area, leaving no clear areas. At this stage, damage and deformation of the kidneys begin.

Symptoms

Each disease has its own characteristics or symptoms. Coral kidney stones will be no exception. Most often, those who are affected go to the doctor with renal colic.

But with an ailment, pain is absent or insignificant (this disease is classified as hidden). The first stages are not detected due to the absence of symptoms.

The manifestation is expressed as follows:

In the first stage, the patient will not feel any manifestations. The maximum that can be is: dry mouth, rare headaches, fatigue, lethargy, sometimes there may be chills
Further, completely different manifestations begin. They will be: the appearance of a dull pain in the kidney area (lower back), sometimes there is even blood in the urine (hematuria)
Further, worse. In the third stage, more characteristic conditions for the disease are observed. The pain, which was insignificant, is aggravated (becomes also constant) and renal colic is already beginning. The body temperature rises. Instead of blood clots in the urine, as in the second stage of the disease, more pronounced hematuria appears. If you do not see a doctor on time, then kidney failure may begin.
At the last stage of the symptomatology such. Thirst and dryness increase. Maybe, but not necessarily more urination. Already developed renal failure flows into a chronic form

To summarize and contact a doctor, the symptoms are as follows:

Hematuria.
Pain in the region of the kidneys.
Frequent urination.

A kidney stone is not uniform in structure, composition and origin. There are several types of stones:

Soft. Often the stone is coral, with coral stones consisting of phosphoric acid and calcium salts.
Solid, consisting of salts formed with uric acid.
Dense, derived from oxalic acid.

How to determine the onset of the disease?

This question is asked by people who have suffered from urolithiasis. Methods used for diagnostics:

Ultrasound examination of the abdominal organs.
X-ray method.
Urography.
Tomography.
Analysis of urine and blood.

When collecting urine, follow the doctor's instructions. Wrong collected urine differs from the composition of genuine urine.

Treatment of the disease

There are several treatments for kidney stones:

Therapeutic treatment. It is carried out with the help of drugs that destroy stones and remove them with urine, diets are prescribed. It is used for stones that consist of any urea salts. Baking soda can be used to increase the acidity of the medium. With this type of treatment, it is necessary to exclude dairy products from the diet. And use for good content potassium in the blood is better dried fruits (raisins) and potatoes. Or prescribe drugs containing potassium.
Surgery. Used for ineffective medical treatment. A pyelolithotomy is often indicated. But the procedure is not always effective. Therefore, pyelonephrolithotomy is performed. Any surgical intervention with the disease ends with the installation of a nephrostomy (a tube for diverting urine from the kidney).
Lithotripsy. An effective way of treatment with the help of special laser or ultrasonic devices stones begin to break down and are excreted in the urine.

Surgical treatment is considered more effective. This method is used for certain indications, which are given below:

Loss of blood from its appearance in the urine.
The ineffectiveness of therapeutic treatment.
A neoplasm that interferes with conservative treatment.
Incorrect urine flow.

Diets for coral stones

The diet for coral stones is the high content of calcium in foods. For the treatment of staghorn kidney stones, you can not use products:

milk and its products;
coffee and alcohol;
salt and berries;
carbonated drinks;
vegetables and fruits.

Allowed products:

soups, juice, fruit drink, meat.
fish, pasta, bread.
oil, water (two liters per day).

After treatment, a long visit to the attending physician and compliance with preventive measures are necessary.

Folk remedies

For fans of outpatient treatment there will be good news. For the treatment of coral-like kidney stones, treatment with folk remedies is observed.

Home treatment is used if the size of the stones is small. Such treatment must be discussed with the attending physician. Drinking helps to remove stones from the kidneys.

Juices. Drink only natural juices. Coral-like kidney stones are treated with juices, if there is no allergic reaction. Juices used:

Carrot and birch.
Beetroot and radish juice.

The duration of treatment is on average 4 months. Control is carried out during the passage of ultrasound. If the stones do not get smaller, then the treatment is useless.

Decoctions. Feature: decoctions can not only remove stones, but also dissolve them. Several types of herbs can be used.

Collection number 1. The herbs included are:

cumin;
motherwort;
sweet clover

For manufacturing you need: four tablespoons of herbs per liter of liquid. Drink for three weeks, six times a day. Indication for collection No. 1: the phosphate composition of the stones.

Collection number 2. Herbs:

sage and nettle;
mint and calendula.

To prepare a decoction, you need to mix 2 tablespoons of herbs in two hundred milliliters of boiled water. Next add honey. Drink before meals, as the first collection.

Disease prevention is cheaper and safer treatment. That's why main advice, which can be given, is that no one starts the body and, if a disease is suspected (no matter what), consult a doctor.

with nephrolithiasis or nephrolithiasis in 5-20% of cases, patients are diagnosed with staghorn kidney stones. Often, the growth of calculi occurs rapidly. Within a few weeks after the onset of the stone formation process, coral-like stones reach an impressive size, grow into the kidney tissue, so the treatment of the disease often comes down to the need for surgical intervention.

Coral kidney stones are most often detected in women aged 30-50 years. The mechanism of their formation is not reliably known to this day. As a result of the research, it was found that the core of the stones is predominantly of an organic nature. In general, they consist of cysteine, phosphates, oxalates, carbonates, calcium, the particles of which are bound by colloidal substances of protein origin. Externally, the calculus resembles the shape of a deer antler or coral ranging in size from a few mm to 10 cm.

There are 4 types of staghorn nephrolithiasis. The criterion for differentiation is the size and location of the formation in the kidney:

1 - the calculus is in the pelvis and 1 cup;
2 - the calculus is located in the extrarenal pelvis and has processes in 1 or more cups;
3 - the calculus is located in the intrarenal pelvis and has processes in 1 or more cups;
4 - the calculus and its processes spread in the pelvic-cup system, causing its deformation.

Regardless of the type of disease, there are changes in the parenchyma of all parts of the kidneys.

Coral kidney stone

Factors predisposing to the development of the disease

Coral kidney stones occur for the following reasons:

Urolithiasis in relatives and other hereditary factors. For example, with tubulopathies, which are inherited in 20% of cases, there is a violation of the transport of substances in the tubules. Accumulating, they form a coral stone.
The presence of congenital or acquired kidney disease.
Metabolic disorders in the body.
Living in regions with a hot climate. At high temperatures, sweating increases, dehydration occurs. As a result, salts that form stones are concentrated in the urine.
Flaw physical activity. Hypodynamia affects the decrease in blood circulation, which negatively affects the work of the kidneys.
Long-term medication.
Abuse of alcoholic beverages and food harmful to the body.

Important! The growth of coral stones can be triggered by a change hormonal background therefore, it is necessary to monitor urine tests in pregnant women and, in case of deviation from the norm, immediately conduct an ultrasound of the kidneys.

You can suspect the development of the disease by a number of symptoms.

Symptoms of the disease

With coral stones, the patient has symptoms similar to those of other kidney diseases. Their intensity depends on the stage of the stone formation process:

The first stage is the incubation period. At this stage, a person feels weak, suffers from headaches, chills, and thirst. There is no pain in the kidneys.
The onset of the disease is characterized by the fact that dull, non-intense pain in the lumbar spine joins the existing symptoms.
The symptoms of the third stage of the development of the disease are:

the appearance of blood impurities in the urine;
discharge of small particles of stones, causing renal colic;
severe back pain requiring the use of painkillers;
increase in body temperature up to 37.5˚С;
apathy, fatigue, fatigue.

If you do not take measures to remove the conglomerate, 4 - hypoazotemic stage occurs. At this stage, the final development occurs, and an excess of nitrogenous substances is found in the blood.

The period of growth of stones is individual, it is impossible to predict their size. The interval between stages 1 and 4 in patients takes from several months to several years.

Diagnostic methods

Coral-like conglomerates can be identified using ultrasound and radiography methods. They allow with a high degree of accuracy to describe the size and contours of the kidney, determine the size of the stone, and assess the degree of deformation of the pyelocaliceal system of the organ.

Cystoscopy is an invasive method for examining the urinary system. Using an optical device inserted through the urethra, the doctor assesses the condition of the bladder.

To obtain additional data on the work of the kidneys, the patient takes tests:

Blood analysis. With exacerbation of pyelonephritis or renal colic caused by staghorn stones, there is an increase in leukocytes and ESR, the presence of large granules of neutrophils, or "toxic granularity".
Analysis of urine. With inflammation, an increase in erythrocytes, salts is observed, impurities of pus (pyuria), blood (hematuria), proteins (albumin, glycoprotein, transferrin, IgG, in rare cases - IgA and 2 - macroglobulin) are detected. This indicates the development of tubular (tubular) proteinuria, damage to the glomerular apparatus, or glomerulopathy.

To avoid development bacterial infection urine culture is performed. With its help, the presence of bacteria is determined, the effect of antibiotics on the infectious focus is examined.

Important! If in preparation for surgery there is a need to obtain 3D image coral stone, use the MRI method.

Treatment methods for coral stones

What to do if a coral stone is found, will tell qualified specialist- Nephrologist. There are 3 ways to solve the problem.

First, therapeutic treatment. Its effectiveness is low, since the size of conglomerates often does not allow them to come out on their own. However, the method is effective for kidney stones, consisting of uric acid salts. Under the influence of drugs, they are able to gradually dissolve. If the size of the formations does not exceed 0.04 cm, Prolit is used. To relieve spasm and pain, drugs are used: No-Shpa, Spazmalgon, Papaverine, Analgin, Pentalgin. Effective anti-inflammatory and analgesic drugs are Urolesan, Kanefron, Cyston.

The second method, more effective, is nephrolithotripsy. More often it is performed percutaneously, since remote crushing of the stone by shock waves is effective only in relation to small formations. With percutaneous nephrolithotripsy, a puncture is made in the lumbar region, and under the control of an ultrasound or X-ray machine, doctors crush the stone with a laser or ultrasonic lithotripter, removing it by particles to the outside.

The third treatment is surgical intervention. In this case, the crushed stone is removed through a small incision, in especially severe cases - together with the kidney.

Non-traditional methods of treatment

It is impossible to cure a coral-like stone with folk remedies, but it is possible to stabilize the work of the kidneys and raise immunity. The following tools will help with this:

Infusion based on bean inflorescences. Pour raw materials with 200 g of boiling water, leave for ½ hour. Drink three times a day before meals.
Raisin compote. In the evening, 2 tbsp. l. raw materials pour 0.6 liters of water. In the morning, divide the raisins and drink into 3 parts, take 3 times a day. The course of treatment is 1-1.5 months.
Carrot seeds must be consumed raw for two weeks, 1 g each.

Dieting

Diet plays an important role in the treatment of coral stones and the prevention of their occurrence. With excessive use of salt, carbonated water, sour, fried foods, the acidity of urine increases, and kidney function worsens. Diet restrictions are subject to dairy products, fatty meats, spices.

It is useful to use:

cereals,
lean meats,
juices and fruit drinks from non-acidic berries and fruits,
soups,
bread.

It is important to observe drinking regimen, using 1.5-2 liters of water per day.

Proper nutrition and active image life will help to avoid the disease, and regular preventive examinations will identify stones at an early stage and cope with the disease as quickly as possible.

Urolithiasis requires urgent treatment to avoid complications. Is there a cure for kidney stones that would allow you to get rid of stones without surgery? Yes, the treatment of nephrolithiasis with medicines is widespread in the practice of traditional medicine. Urologists recommend that patients take drugs to crush hard formations and remove them from the body in a natural way.

Remedies for dissolving kidney stones

Treatment medicines unlike the fight against stones, folk remedies are more convenient. It is enough to drink tablets according to the prescription drawn up by the doctor at a certain time. With infusions, decoctions and tinctures, everything is more difficult: you need to prepare fees, brew them yourself, strictly following the recipe. If the remedy is not properly prepared, then no effect from it should be expected. However drug treatment implies sufficient financial costs.

Tablets that dissolve stones

Treatment of nephrolithiasis is effective with the following pills:

Madder extract. Used to dissolve phosphate stones. Pills stain urine red - it's not blood. Cannot be combined with Cyston;
Asparkam (expensive analogue - Panangin). Effective in the fight against oxalates and urates. These are heart pills, so they should be taken with caution. But this is one of the most effective drugs that fight oxalates;
Blemarin. Means for dissolving oxalates and urates. These are effervescent tablets. white color, contributing to the alkalization of urine;
Allopurinol, like Blemaren, is designed to fight urate and oxalate stones. Helps to reduce the concentration of uric acid in the urine;
Purinol. Copes well with urates;
Cystone is a drug designed to dissolve oxalate stones. Tablets can be used for urolithiasis with solid formations of a different composition, so it does not change acid-base balance urine;
Prolit is similar in action to Cyston.

Solid deposits in the kidneys are formed due to the deviation of the acid-base balance from the norm and the characteristics of the metabolism in the body. Therefore, individual preparations designed to dissolve calculi should only be used to combat a certain type of stone. If you do not follow this rule, or take pills in larger or smaller quantities than prescribed by the doctor, then deviations of the acid-base balance from the norm will remain in one direction or another. This will lead to the growth of already existing stones or to the formation of new ones.

Other medicines

Not all drugs are sold in tablet form. Treatment of nephrolithiasis is also carried out with the help of:

Ksidifon - solution for oral administration. Used to dissolve phosphate and oxalate stones;
Urolesan - solution in drops. Promotes the removal of stones from the kidneys in a natural way due to diuretic and antispasmodic effects;
Phytolysin is a paste that flushes out sediment from kidney stones.

When removing stones, one should take not only drugs that promote their crushing, but also means that help remove them through urinary tract. Therefore, treatment must be comprehensive. You don't have to assign it to yourself. You need to visit a urologist to determine which medicines for kidney stones should be taken and in what quantities.

Mineral water

Mineral water can help you dissolve stones. It can be neutral, acidic or alkaline. Water should be selected depending on the types of stones deposited in the kidneys:

Therapeutic alkaline water - with oxalates and urates (Dilijan, Polyana Kvasova, Borjomi, Essentuki 17);
Acidic mineral water - with phosphates. These include Narzan, Smirnovskaya or Mirgorodskaya.

Mineral water may have its own number. If number 4 comes after the name, then it is slightly alkaline. If the water in the name has the number 17, then it is considered alkaline. So, a mineral water with the same name may have a different acid-base balance, depending on the number that stands next to it.

Prognosis for the treatment of kidney stones with medication

Treatment of kidney stones with drugs and medicinal waters is very effective if you follow a number of rules:

Before taking the funds, it is necessary to undergo a urological examination in order to identify the nature of the stones, their size and the possibility of dissolution with the help of medicines;
Consult your doctor for prescription medications. The urologist determines which drugs are needed and in what quantity for each patient individually;
You do not need to self-medicate and take funds for which you have not consulted a doctor. They can reduce the effect of the main drug;
Take the tablets at the same time, following all the doctor's recommendations.

Stones usually begin to dissolve 2 weeks after starting medication. But improvements may not be achieved if treatment is interrupted in the middle of the course or is not followed. special diet. In the case of a small efficiency of crushing stones with medicines, the doctor may prescribe lithotripsy. In some cases, an operation to remove stones.

Causes of staghorn kidney stones and their treatment

Coral-like kidney stones are one of the most severe manifestations of urolithiasis. According to statistics, pathology occurs in 5% of all cases. Mostly women aged 20-50 are affected.

Reasons for the formation

Provoke the development of coral stones can various factors. In modern medicine, it is customary to single out several main reasons:

hereditary predisposition.
Increased content in the urine of protein and salts.
Violation of phosphorus-calcium metabolism in the body.
Infectious diseases urinary system.
Cardiovascular diseases.

Coral stone is formed in accordance with the theory of the matrix. First, a "skeleton" of protein compounds (bacteria, blood cells) appears. Further, mineral salts are gradually deposited on this basis.

Coral kidney stones can have a layered, heterogeneous chemical composition. In most cases, there are no more than 3–4 stone-forming minerals, but there are also monomineral stones. According to the chemical composition, coral stones are:

dense and strong oxalates, which consist of calcium compounds of oxalic acid;
solid urates formed from salts of uric acid;
soft phosphates arising on the basis of calcium salts of phosphoric acid;
mixed stones.

Carbonate, cystine, cholesterol and protein stones are much less common.

Clinical signs

Unlike small stones, which can move towards the ureters and cause an attack of renal colic, staghorn kidney stones are inactive. Acute pain practically does not happen.

The following symptoms will appear:

pain in the side or lower back of a dull or aching nature;
gain discomfort against the background of active movement (playing sports, riding a horse or in a car on a rough road);
difficulty urinating (decreased amount of urine and frequent unreasonable urges);
external changes in urine associated with the ingress of blood and inflammatory exudate into the excreted fluid (hematuria, pyuria);
temperature reaction (inflammation in the kidney).

Diagnostic methods

For accurate detection of coral stone in the kidney, and the choice of treatment tactics, 2 diagnostic methods are quite enough:

Ultrasound scanning (ultrasound).
X-ray examination (general view or urography with contrast).

In some cases, if the doctor is in doubt or to choose a treatment, a CT scan will be required. To determine the chemical composition of stones, laboratory tests of urine and blood are carried out.

Main types of treatment

The main and most effective way The treatment for staghorn kidney stones is surgery. The variant of nephrolithotomy is most often used, when, after dissection of the kidney, the staghorn calculus is removed. Indications for surgical removal will:

A large shapeless formation that occupies the inner space of the kidney, in which it is impossible to carry out conservative treatment.
Expressed pathological condition urinary system due to obstruction of the outflow of urine.
Identification of severe complications in the form of hydronephrosis, wrinkling of the organ, suppuration and renal failure.
Frequent episodes of exacerbation chronic pyelonephritis with a severe course of the disease and ineffective treatment.
Severe hematuria with loss of blood through the urinary tract.

The doctor may also suggest a non-surgical technique - remote or percutaneous nephrolithotripsy using shock wave therapy. Crushing coral stone is not always successful, especially if it is oxalate or urate stones. However, with mixed and phosphate stones, the technique is applied quite successfully.

Therapeutic diet

The main task of the diet for coral calculi in the kidneys is the organization of special nutrition and reducing the consumption of foods with high content calcium. Diet is one of the main conditions successful treatment diseases.

It is necessary to limit the use of the following products:

dairy products, including cottage cheese;
all vegetables and fruits;
berries - currants, lingonberries and cranberries.
drinks with gas;
hot spices and salt;
alcohol;
coffee.

Permitted products for coral stones include:

bread;
cereals and pasta;
meat and fish dishes;
vegetable oil and butter;
sour juices and fruit drinks;
any kind of soup.

Coral stones formed in the kidneys can disrupt all the main functions of the urinary system. Identification of this problem is an indication for surgical treatment. In some cases, the doctor may apply a non-surgical treatment option.

Coral kidney stones are side effects that occur during the flow different kind urological diseases. In medicine, this phenomenon is called "coral nephrolithiasis". In the risk zone, as a rule, people 20-50 years old. Women get sick more often than men three times.

The formations that appear in the kidneys grow into the organ and often lead to the fact that the patient loses it. However, in last years, thanks to advances in the field of medicine, specialists managed to reach new level in the treatment of coral nephrolithiasis.

How do coral stones appear and affect the patient's well-being?

A coral-like stone is formed different reasons. It can be the result of failures in phosphorus-calcium metabolism, which occur due to physical inactivity. Stone formation is often caused by accumulations of salts and protein in the urine, which harden into staghorn kidney stones. Infectious diseases, heredity and vascular disease are another number of factors that affect the appearance of unpleasant deposits.

The big minus of the disease is that staghorn kidney stones are growing rapidly. Sometimes some seven days are enough for the formation to fill the entire kidney and the “branches” extending from it. The disease does not appear immediately, and therefore it is difficult to recognize it in the early stages. At a certain moment, the patient feels pain in the lower back, he sharply begins to pound from chills, the thermometer shows high temperature. If these signs are found, you should immediately go to the hospital for further treatment.

How to diagnose the disease and how to avoid it?

In order for the doctor to diagnose the formation in the kidney, he needs to conduct an ultrasound and x-ray radioisotope study. To do this, the patient must pass blood and urine tests for biochemistry. You should also visit a urologist periodically. This will help to avoid a recurrence of the disease, or at least reduce the risk of their frequent occurrence. When staghorn kidney stones have just begun to form, they can still be removed quite easily.

To prevent the development of the disease, it is necessary to normalize the metabolic flows in the body. This is easy to achieve if you engage in herbal treatment, maintain a reasonable and effective diet prescribed by a doctor, exercise, swim in the pool. You need to drink at least one and a half liters of fluid per day. It is desirable to give preference to fruit drinks and mineral water.

In order to avoid the recurrence of coral deposits of the kidneys, alcohol-containing drinks, coffee, sausages, especially liver sausage, should be abandoned. You can not even milk and black tea. You will have to forget about products such as legumes, nuts, cocoa.

It is better to replace blackcurrant with red. Watermelon, grapes, sauerkraut are good for preventive purposes. If you turn to folk remedies, you can include pumpkin juice in the diet, a decoction of bean inflorescences, and another half-palu - this is a herb that grows in Sri Lanka, amazing stories go about it. The patients themselves, treated by her, claim that she remarkably dissolves even the most complex stones of the coral structure, and their removal by surgery is no longer required.

How to get rid of coral stones?

Coral stones can be removed from the kidney in several ways. If the formations consist of uric acid salts, they can be dissolved with medicines. What exactly, only a urologist can say, moreover, after diagnosing and studying the structure of the staghorn formation. The manifestation of initiative threatens the most sad consequences Therefore, it is strictly forbidden to prescribe a course of taking medicines on your own. Treatment in this case It will take a long time, up to three months.

If surgery is indicated, percutaneous nephrolithotripsy is usually used, which consists in a puncture in the lumbar region and the removal of stones after their preliminary grinding with a laser / ultrasound.

After the removal of formations in this way has passed, the patient must be observed by a doctor for at least five years.

Coral kidney stones are diagnosed in only 5-10% of people with urolithiasis.

They appear as salt deposits in the pyelocaliceal region of the kidneys.

Able to grow to considerable size. They can lead to organ death if treatment is not started on time.

The exact reason why such a formation appears in the kidneys is unknown today, but possible reasons are noted:

heredity (if mom or dad had stones, the child will have them too);
work disruptions;
increased use of drugs;
alcoholism or drug addiction;
pathology of the stomach or digestive tract;
the patient has chronic calculous;
violations of metabolic processes in the body.

In addition, to possible reasons can be attributed cardinal change climate, poor ecology, consumption of polluted water, parahyperthyroidism, pathologies of the heart and blood vessels, prolonged bed rest.

A sedentary image can also contribute to the formation of coral stone. To prevent this, try to move more.

Features and symptoms

Coral stone is a mineral with a special structure. In its appearance, it resembles a piece of coral with sharp corners. Its dimensions can be different - from a couple of millimeters to tens of centimeters (at an advanced stage of the disease).

Coral stones extracted from kidneys

Its chemical composition is heterogeneous. Contains oxalates ( oxalic acid with calcium), urates (salts of uric acid), phosphates and carbonates (salts of carbonic acid). Also, it may include proteins, cystine and cholesterol.

A coral-like stone manifests itself only when it grows and fills a significant part of the cups and pelvis. Up to this point, its climatic signs are similar to those of other urolithiasis.

The course of the disease is accompanied by the following symptoms:

frequent headache;
constant dryness in the oral cavity;
chills (in the absence of temperature and draft);
severely increased fatigue;
frequent weakness (difficulty even walking);
frequent and severe dizziness;
dull pain in the lower back;
poor urine tests;
burning sensation when urinating (but not necessarily).

All these symptoms indicate a chronic inflammatory process, increasing intoxication and stagnation of metabolic products. When stones grow up to large sizes pain in the left or right side of the lower back becomes almost constant and unbearable. Sometimes colic occurs and small parts of the stones move away.

At the chronic stage of the disease, renal failure begins, the outflow of urine is disturbed, exacerbations of pyelonephritis manifest themselves. Later, the kidney simply dies. The duration of the illness varies. In some patients, it develops over many years, in others - in a few months or even weeks.

Classification of coral stones

Based on the overall clinical picture, doctors distinguish 4 stages of coral development:

I - hidden period(the disease does not manifest itself in any way);
II - the beginning of the disease(lower back pain, chills, increased fatigue, frequent headache chill by for some unknown reason, persistent dry mouth);
III - stage of clinical manifestations(all the symptoms described are intensified, the outflow of urine is disturbed, small stones begin to move away, often there is renal colic);
IV - hyperazotemic stage(patients have a strong thirst, complete absence forces and even the terminal stage of chronic renal failure).

It should be noted that the last stage is the most dangerous. If the disease is not treated, the kidney may die.

If you notice any symptoms of the disease, contact your doctor immediately. Do not start the disease, otherwise the case may end fatally.

Treatment

Having discovered, coral stones in the kidneys, treatment by a urologist immediately after the patient undergoes a number of examinations, including:

(helps to identify the stone, its shape and size);
radiography (does all the same, but more clearly);
cystoscopy (helps to check the functioning of the bladder and ureters);
MRI or CT with contrast enhancement (allows you to assess the volume, tactics and need for surgery);
urinalysis (shows the presence of inflammatory processes, the number of erythrocytes and salts);
blood tests (show the number of leukocytes and creatinine).

Treatment can be done in three ways:

therapeutic(appointed various drugs- diuretics, vitamins, antibiotics, non-steroid drugs for severe pain, treatment time - 3-4 months);
surgical intervention(stones are removed through a small incision, the treatment time is 3-4 days, followed by restorative therapeutic treatment);
(coral kidney stones are crushed with the help of special equipment, the treatment time is from several days to several weeks).

The doctor prescribes the most effective method for removing stones on the basis of all the data obtained after the patient has passed all or individual examinations.

Indications for surgery may be:

availability is very large stone, which cannot be removed in any other way;
acute violation of the outflow of urine;
development of renal failure;
detection of kidney deformities, inflammation or decreased function;
lack of effect from taking prescribed drugs or pills;
recurring macrohematuria;
pain that cannot be controlled with medication
the presence of a carbuncle of the kidney (a place of purulent necrosis);
the patient's desire for surgery.

Depending on the severity of the disease, surgery is divided into 2 methods:

unilateral urolithiasis(the stone is localized in one kidney, in case of an unsuccessful operation, surgeons manage to preserve the functions of the genitourinary system);
bilateral urolithiasis(the stone is localized in two kidneys, the operation is performed either immediately on both of them, or with a break of 1-3 months).

By type of operation to remove coral stones from the kidneys are divided into:

lithotropsy(stone crushing is performed using ultrasound, after which it is removed through a catheter or ureter);
endoscopy(a special instrument is introduced to the location of the calculus through the ureter or urethra);
open operation(the kidney is cut, salt deposits are removed directly by the surgeon);
resection (a small part of the organ is removed).

It should be noted that the use of ultrasound is possible even with large coral deposits. But in this case, the patient must be constantly under the supervision of the attending physician and be ready to carry out, if necessary, endoscopic surgery.

ineffective if unsafe. Therefore, try to either completely abandon them, or use only with the permission of your doctor.

Diet

When identifying such stones in the kidneys, it is important to abandon the use of caffeine, alcoholic beverages, soy, beans, spicy and salty foods, black currants and fresh milk, any semi-finished products, spicy dishes.

For coral kidney stones, the diet includes plentiful drink. You can drink natural fruit juices, pumpkin drinks, a decoction of bean flowers or bearberry, weak tea. Also, doctors recommend drinking at least 2 liters of purified water per day.

To relieve pain in the kidneys and relieve inflammation, you can use an infusion of barberry, oregano and celandine. To prepare it, simply pour 1 tbsp. a spoonful of their mixture with a glass of boiling water and let it brew for half an hour. Drink right away. Repeat this for 21 days in a row.

Prevention

Preventive measures should be aimed at properly balancing the metabolism in the patient's body.

As a preventive measure, water therapy, herbal treatment, special exercises prescribed by a doctor are used. Be sure to eat right.

With a timely appeal to the doctor and compliance with all his recommendations, the forecasts are quite favorable. After treatment, the pathology does not recur.