UROLITHIASIS @ Renal Stone @ Batu Karang

Lets read some facts regarding renal stone --a post as requested by a friend of mine.

Our kidney has thousands of important function; which one of those are the excretion of urine. We have tracts which transport these urine from kidney to outside our body. Once the tract is interrupted and blocked by crystal precipitate a.k.a stone, symptoms of urolthiasis will develop. Lets first see basics of our urinary tract:

It starts from the 2 kidneys, followed by 2 ureters into the bladder, and lastly to urethra, connecting to outside our body. (as the photo show)

Urolithiasis is the most common disease occurring in our urinary tract. It occurs more in males in their 20-30's. It seldomly occur in female, because we have more crystal inhibitors; preventing stone formation in our body compared to men. Furthermore, men's testosterone predispose more to stone formation. Thank you Allah! hehe

Things like these can predispose to renal stone:
-low water intake
-low urine output volume
-high protein intake, high sodium intake (salt), low calcium intake (milk)
-recurrent urinary tract infection
-other causes needless to discuss (related to other diseases understandable to meds students only :P)
-to those having gout; be more cautious as the disease itself can lead to this urolithiasis

Patients could have symptoms like pain in urinating, red urine, loin pain, or absolute absence of urine.

In treating the disease, we aim to reduce the growth of existed stones and prevent its recurrence. Of course, first of all, prevention is better than cure. Drink lots of water of at least 2 liters per day, distributed equally throughout the day, drink more milk, reduce salt intake, take moderate amount of protein, reduce food high in oxalate for example; spinach, star fruits, black pepper, berries, mangoes, black tea, cocoa, strawberry, cabbage.. also--avoid Vitamin D supplement!

Once you already develop stone, steps of management will be done beginning with;
1. medical treatment
2. non invasive extra-corporeal shockwave therapy (ESWL)
3. endoscopic treatment and
4. surgical intervention.

It is important to know that 30% patients develop stones and it pass spontaneously without any symptoms, but the remaining will be seeking medical attention.

Medical treatment includes giving patients drugs according to the nature of the stone ( the stone can be acidic, alkaline ).

Patients will be subjected to ESWL if medical treatment fails. This therapy uses shock wave from outside the body exactly at the site where the stone resides. It will break the stone into small pieces to let it pass naturally through urine. This therapy is useless if stone diameter exceeds 2 cm.

Moving to the next step, we might interfere using endoscope if drugs and ESWL is to no avail.

It will enter through u-know-where down there.. I've seen doctors doing this procedure couple of times before. Though they put some lubricants before introducing; it still looks pretty painful. Looking at the stone from inside, doctors may take the stone as it is, or produce mechanical compression to break it, or emit laser wave to disintegrate it.--as long as it relieves the blockage.

The last intervention is to do open surgery to remove the blockage. (we will not proceed to surgery unless all other management steps fails as opens surgery carry higher risk of complications)

thats me in the OT (berbincang dgn doc la konon :P)

So, readers, take note of those foods leading to stones-- eat more citrate fruits (oranges, lime, pineapples), and drink karkadeh as recommended by my doctor. (karkadeh is hibiscus drink- ever drink them? it taste like ribena)

this is the normal view (notes the urine passing from kidney to the bladder)

this is a stone obstructing the flow (the large oval white mass)

So.. till then!