Renal Calculi

Renal Calculi

1. Definition
   Renal calculi (kidney stones) are hard, crystalline deposits that form in the renal pelvis, calyces or any part of the urinary tract.

2. Causes / Etiology
   Supersaturation of urine with stone‑forming substances → crystallisation. Common pre‑disposing factors are: high urinary calcium, oxalate or uric acid; low urine volume; dietary excess of animal protein, salt or oxalate‑rich foods; metabolic disorders (hyperparathyroidism, gout, cystinuria); recurrent urinary infections.

3. Types or Classification
   ‑ Calcium stones – mainly calcium oxalate, sometimes calcium phosphate; most frequent.
   ‑ Uric acid stones – form in acidic urine; seen in gout or after chemotherapy.
   ‑ Struvite stones – magnesium‑ammonium‑phosphate; usually a sequel of chronic urinary‑tract infection.
   ‑ Cystine stones – rare, due to inherited cystinuria (excess cystine in urine).

4. Pathology (stepwise)
   step 1 → supersaturation of urine with stone‑forming ions (Ca²⁺, oxalate, urate, etc.)
   step 2 → nucleation: tiny crystal nuclei appear in the urine.
   step 3 → aggregation: crystals stick together and grow into a macroscopic stone.
   step 4 → retention: stone remains in the kidney or moves down the ureter, causing obstruction and pain.

5. Clinical Features

General – sudden, severe flank pain (renal colic), nausea, vomiting, hematuria (blood in urine), restlessness, sweating.

Specific – pain may radiate from flank to groin or inner thigh; urinary frequency, urgency or dysuria (painful urination); passage of tiny stone fragments (sand‑like); occasional fever if infection supervenes.

6. Complications

Acute – intense colic, obstruction → hydronephrosis, infection → pyelonephritis, possible sepsis.

Chronic – recurrent stone formation, renal scarring, loss of renal function leading to chronic kidney disease.

7. Diagnosis / Investigations

Routine – urinalysis (blood, crystals, infection), serum electrolytes and creatinine, calcium, uric acid levels.

Special – plain X‑ray KUB (shows radiopaque stones), non‑contrast CT scan (gold standard, shows size & location), renal ultrasound (useful in pregnancy or children), 24‑hour urine collection (quantifies calcium, oxalate, citrate, uric acid, volume).

Short notes: CT gives exact size; ultrasound avoids radiation; 24‑hour urine guides metabolic therapy.

8. Management

General – liberal fluid intake (≈3 L/day) to dilute urine, analgesics (NSAIDs or opioids), anti‑emetics.

Modern treatment – medical expulsive therapy (alpha‑blockers such as tamsulosin) for stones ≤10 mm; extracorporeal shock‑wave lithotripsy (ESWL) for moderate stones; ureteroscopy with laser lithotripsy or percutaneous nephrolithotomy for large or impacted stones.

Dietary advice – increase water, limit salt, moderate animal protein, avoid excessive oxalate foods (spinach, nuts) in calcium‑oxalate stones; alkalinise urine (citrate drinks) for uric acid stones; low‑purine diet for gout patients.

9. Homeopathic Therapeutics (key remedies, 6‑7 points each)

Lycopodium
‑ Pain in right kidney radiating to groin.
‑ Urine scanty, dark, feels hot.
‑ Burning on urination, especially after cold drinks.
‑ Frequent urge to pass urine but only little comes out.
‑ Restlessness, worse at night.
‑ Relief with warmth, heat packs.

Berberis vulgaris
‑ Dull, dragging pain in lumbar region spreading to thighs.
‑ Burning, stinging sensation while urinating.
‑ Hematuria (blood in urine).
‑ Stone sensation, feeling of a hard body in kidney.
‑ Pain aggravated by movement, relieved by lying still.
‑ Often associated with a history of urinary infection.

Sarsaparilla
‑ Sharp kidney pain, worse on the left side.
‑ Urine hot, scanty, may contain sand‑like particles.
‑ Burning on urination, relief after passing a small fragment.
‑ Worse in cold weather, better in warm rooms.
‑ Patient feels weak, wants to lie down.

Uva Ursi (bearberry)
‑ Burning and soreness in urethra during micturition.
‑ Frequent, urgent urination of small amounts.
‑ Deep, aching pain in the flank.
‑ Symptoms improve with warm drinks, worsen with cold.
‑ Useful when urine is dark and foul‑smelling.

Cantharis
‑ Excruciating, tearing pain in kidney region, radiating to thighs.
‑ Urine scanty, may be suppressed; burning sensation intense.
‑ Burning worsens on passing urine, feels like a hot iron.
‑ Patient restless, cannot stay still.
‑ Relief only after the stone passes or after applying cool compresses.