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a disease of man and animals characterized by the formation in the renal pelves or their calyxes of stones (calculi) consisting of substances from the urine. Disturbance of the biochemical state of the urine causes sedimentation of crystals and amorphous salts, which combine with an organic base consisting of blood clot, fibrin, cellular detritus, and bacteria to form stones. Stones may occur in one or both kidneys, and may be multiple or solitary; they may be small in size or in the form of a large coralline mass.
Nephrolithiasis occurs in men and women with equal frequency and is less common in children. The incidence of the disease varies considerably from country to country and within a country. In the USSR, it is more prevalent in Middle Asia, the Northern Caucasus, and Transcaucasia and in the basins of the Volga, Kama, Don, and other rivers. One cause of nephrolithiasis is suppurative inflammation, especially in the form of pyelonephritis. Less commonly, it is caused by diseases of the internal secretions of the glands, particularly hyperfunction of the parathyroid glands. Life-style, diet, soil, and drinking water are major factors.
Nephrolithiasis is manifested by dull pain in the lumbar region or by renal colic, which results from obstruction of a pelvis or ureter by a stone. Blood may appear in the urine at the end of an attack or soon after. If the disease is complicated by an infection of the urinary tract, the urine becomes cloudy and purulent. Between attacks of colic the patient may feel dull pain in the region of the corresponding kidney. The pain usually intensifies when the patient moves and subsides during rest.
The disease is asymptomatic in 15 percent of patients. Roent-genographic examination, for example, survey radiography or urography, is important for diagnosis. In the case of uric acid stones and urate stones, the characteristic shadow on the film may be absent, and such stones are diagnosed by more complex methods. Small stones entering the ureter from a pelvis often pass spontaneously either after the ingestion of a large quantity of fluid or as a result of drugs prescribed by a physician. Large stones cannot pass from the kidney. Stones that cause frequent attacks of renal colic or secondary pyelonephritis with frequent exacerbation must be surgically removed, as well as large stones accompanied by stenosis of the ureter or by hydronephrosis. Special preparations, called dissolvents, have some effect on urate stones.
Nephrolithiasis is prevented by a diet that takes into account the patient’s susceptibility to the disease, by the use of diuretics, and by control of urinary infection.
REFERENCESVorobtsov, V. I. “Kamni pochek i mochetochnikov.” In Rukovodstvopo klinicheskoi urologii. Edited by A. Ia. Pytel’. Moscow, 1969.
Pytel’, A. Ia. “Pochechnokamennaia bolezn’: Geograficheskaia patologiia.” In Ezhegodnik BME. vol. 2. Moscow, 1969. Pages 777–83.
Hienzsch, E., and H.-J. Schneider, eds. Der Harustein. Jena, 1973.
A. IA. PYTEL’