FREQUENTLY
ASKED QUESTIONS
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| General
Information |
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Suffering
intense pain when urinating can be due to the existence of a renal calculi?
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Does
some relationship between the urinary tract infection and renal calculi
exist? |
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What
is the less painful form of expelling renal calculi? |
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What
are the risks of suffering renal lithiasis in repeated occasions, without
painful renal colics? |
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What
is choledocholithiasis? |
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| Origin
of the Renal Calculi: etiology |
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Why
does renal lithiasis take place? |
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What
is the cause of the formation of calcium oxalate dihydrate calculi? |
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What
is the cause of the formation of calcium oxalate monohydrate calculi? |
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What
is the cause of the formation of calcium phosphate calculi? |
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What
is the cause of the formation of uric acid calculi? |
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What
is the cause of the formation of ammonium urate calculi? |
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What
is the cause of the formation of ammonium magnesium phosphate calculi? |
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What
is the cause of the formation of cystine calculi? |
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Renal Calculi Treatment |
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Does
an effective treatment for renal lithiasis exist? |
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What
is the most appropriate treatment for the renal lithiasis? |
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What
is the most appropriate diet so that renal calculi is not generated?
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What
can one take to dissolve calculi in kidneys? |
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What
can be done so that renal calculi disappear?
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Which
are the measures to treat or to prevent calcium oxalate dihydrate renal
calculi? |
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What
is the treatment when a kidney has lost its function due to serious coraliforme
lithiasis for the calculi size? |
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Is
water effective to eliminate renal sands? |
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Is
it possible to dissolve calcium renal calculi in the urinary bladder or
in the kidney? |
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Does
some medication or treatment that it substitutes surgery in the renal lithiasis
exist ? |
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Does
some medication or treatment to destroy renal calculi alternative to the
surgical intervention or the shock waves extracorporeal lithotripsy (SWEL)
exist ? |
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What
can one do to avoid the recurrence of calcium oxalate renal lithiasis?
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What
kind of medications to avoid the recurrence of calcium oxalate calculi exist,
besides hidroclorotiazide treatment? |
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What
can one do to prevent the recurrence of renal calculi generated by hipercalciuria,
besides tiazides treatment? |
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What
can one do to avoid the recurrence of renal calculi when the urinary uric
acid and calcium values are high? |
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The
treatment of the renal lithiasis with citrate can present, in some cases,
stomachache after its itakes. Is there any pharmaceutical form of citrate
that avoids that problem? |
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What
is more convenient for osteoporosis treatment when
there is a renal calculi: calcium citrate or calcium carbonate?
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ANSWERS
to the FREQUENTLY ASKED QUESTIONS |
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| What
are renal calculi or renal lithiasis symptoms? |
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| When
renal calculi generates nephritic colics a very intense
typical pain of intermittent character appears generally
in the flank of the affected side. The pain can irradiate
to the back and mainly to the groin, sometimes
with nausea . Other manifestations of
renal calculi, in absence of nephritic colic, can be: |
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1.
Persistent or repeated urinary infections
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2.
Blood in the urine or hematuria
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3. Sand expulsion in the urine
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| Suffering
intense pain when urinating can be due to the existence of a renal calculi? |
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| It
is not for sure that this trouble can be attributed to renal calculi. Other
reasons responsible for those nuisances can exist.
If it were renal calculi, the pain would begin in the lumbar area going
towards the groin, appearing in an intermittent way. On the other hand,
other indications would be the appearance of blood in
urine or very cloudy urine. Evidently, the consumption
of calcium and/or vitamin D complements are factors that can induce the
genesis of renal calculi and, therefore, this consumption should be controled
by urinary calcium test to assure that hypercalciuria not appeared. In fact,
some urinary parameters (oxalate, phosphate, magnesium, citrate, pH,...)
related with the renal calculi generation risc must be studied . |
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| Does
some relationship between the urinary tract infection and renal calculi
exist? |
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| There
are three related aspects between urinary infection and renal lithiasis:
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1.
Urinary infection itself, produces an increase of the urinary pH and the
ammonium concentration. This facts induce crystallization of the ammonium
magnesium phosphate or ammonium urate (when the urinary uric acid concentration
is high) that lead to infectious calculi.
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2.
Microorganisms responsible for infection and their excretion products
can acts asnucleous of crystallization of other types of compounds, such
as hydroxyapatite or calcium oxalate monohydrate.
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3. Urinary tract microorganisms can produce injuries in the uroepithelium
that could also act as crystallization nucleus
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| What
is the less painful form of expelling renal calculi? |
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| When
renal calculi elimination doesn't take place spontaneously, non invasive
techniquescan be used, as shock
waves extracorporeal lithotripsy (SWEL),
percutaneous nephrolithotomy, etc. avoiding open surgery. However in some
cases the classic surgery is unavailable. Yet, despite evident importance
of calculi elimination processes, the affected patient should be more interested
avoiding the episode repetition. When renal calculi is generated, once eliminated,
the danger of new calculi generation persists within 50-70%. It is advisable
to follow measures to avoid their repetition. |
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| What
are the risks of suffering renal lithiasis in repeated occasions, without
painful renal colics? |
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| The
presence of calculi in kidney can produce injuries in the uroepithelium,
although the extension of these injuries will depend on, to certain extend,
the location in the renal cavities. Those injuries could induce new crystallization
focuses, generating more calculi in this way. |
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| What
is choledocholithiasis? |
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| Choledocholithiasis
is the formation of a calculi in the biliary vesicle. The causes that generate
this pathology don't keep any relationship with renal calculi. |
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| Why
does renal lithiasis take place? |
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There
are many types of renal calculi and each one has different formation causes.
However, in general there is an unfortunate combination of several factors.
These factors can be classified in two groups:
I)
Factors related to the composition of the urine (high concentration
of certain substances (calcium, oxalate, phosphate, uric acid), altered
urinary pH , small urinary volume and deficit of inhibitors of crystallization
(citrate, phytate, pyrophosphate, magnesium))
II)
Factors related with the renal morphoanatomy (renal cavities
with low urodynamic efficacy that, therefore, retain urine during lingering
times, and alterations of the epithelium that line the renal papilla).
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| What
is the cause of calcium
oxalate dihydrate calculi
formation? |
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etiologic factors related with calculi formation are the existence of renal
cavities of low urodynamic efficacy, high calciuria possibly within the
range of the hipercalciuria and deficit of inhibitors of the calcium salts
crystallization. |
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| What
is the cause of calcium
oxalate monohydrate calculi formation?
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| The
etiologic factors generally related to formation of this type of calculi
are: the existence of some epithelium lesions in the renal papilla, presence
of organic matter in urine, alterations of urinary pH and deficit of inhibitors
of the calcium oxalate crystallization. |
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| What
is the cause of calcium
phosphate calculi
formation? |
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The
possible etiologic factors related with the formation of this type of calculi
are:
1. Renal cavities of low urodynamic efficacy
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2.
Urinary pH values higher than 6.5 with a possible renal tubular
acidosis
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3.
Hipomagnesiuria
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4.
High urinary calcium values not necessarily within the range of
the hypercalciuria
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5.
Deficit of inhibitors of the calcium phosphate crystallization
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| What
is the cause of uric acid calculi
formation? |
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The
possible etiologic factors related with the formation of this type of
calculi are:
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1.
Renal cavities of low urodynamic efficacy
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2.
Urinay pH values lower than 5.5
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3.
Hyperuricuria
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| What
is the cause of ammonium
urate calculi formation?
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| The
possible etiologic factors related with the formation of this type of calculi
are: |
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1. The existence of renal cavities of low urodynamic efficacy
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2.
High uricuria
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3.
The existence of urinary infection by ureolithic microrganisms that
generate:
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a. An increase of the pH value
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b.
An increase of urinary ammonium concentration
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| What
is the cause of ammonium
magnesium phosphate
calculi formation?
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| The
possible etiologic factors related with the formation of this type of calculi
are: |
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1. Renal cavities of low urodynamic efficacy
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2.
Urinary pH values higher than 6,5
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3.
Urinary infection.
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| What
is the cause of cystine calculi formation?
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possible etiologic factors of the formation of this type of calculus are:
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1. High
cistinuria values
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2. Urinary pH values lower than 6.0 were cystine is insoluble and precipitates.
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| Renal
Calculi Treatment |
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| Does
an effective treatment for renal lithiasis exist? |
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| Yes,
but it should be considered that there are different types of renal
calculi and each one has
different etiologic factors
(causes). Therefore, the preventive therapeutic measures
should be conducted to the treatment of each causes.
Otherwise, other lithiasic episodes
of repetition
could take place. |
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| What
is the most appropriate treatment for the renal lithiasis? |
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| Due
to the existence of different types of renal calculi, the most appropriate
treatment depends on the type of calculus
generated, because
for each one there are different causes. |
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| What
is the most appropriate diet so that renal calculi is not generated?
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| Due
to the existence of different types
of renal calculi, the most appropriate diet depends on the type of
calculi formed,
because for each different type there are different generation causes. However,
in general, diets should be balanced, not excessively vegetarian
nor meat rich. A high consumption of liquids
is always advisable (preferably
not carbonic drinks), although in some cases, such as uric acid lithiasis,)
their consumption is recomendable. |
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| What
can one take to dissolve calculi in kidneys? |
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For
calcium oxalate, hydroxyapatite, brushite or mixed calculi,
there are no medication that dissolves them in vivo exist.
However, in these cases it is important to know the causes of calculi,
to be able to avoid that formation and to prevent the appearance
of new episodes.
Prevention
depends on calculus type and on the urinary parameters alterated.
Preventive measures can include an increase of liquid consumption (not
carbonic drinks), dietary modifications and specific pharmacologic treatment
in the most severe cases.
On
the other hand, dissolution of uric acid calculi in vivo
can be performed, through ingestion of urinary alkalinizants
such as citrate or bicarbonate. Although it is very recommended that your
specialists control the urinary pH to avoid an excessive alkalinization,
which would generate other problems such as calcium phosphate lithiasis.
However, when the calculus has a considerable size or it is located
in cavities of very low urodynamic efficacy, the dissolution
through urinary alkalinization is very difficult, if not impossible.
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| What
can be done so that renal calculi disappear?
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Except
in the case of the uric acid calculi that can be dissolved in
vivo (inside the organism) by means of urine alkalinization,
no medication to dissolve them in vivo exists. However fragmentation
inside the organism can be done facilitating the
expulsion of smaller size fragments.
On
the other hand, it is important to discover the causes that have induced
the calculi formation, in order to correct and to prevent the appearance
of new episodes.
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| Which
are the measures to treat or to prevent calcium oxalate dihydrate renal
calculi? |
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| In
this case it is recommended to increase diuresis (by increasing liquid
ingestion). Hypercalciuria, if present, must be evaluated to know
the type and treat them specifically. When calciuria is present above normal
calciuria range it is advisable to establish measures leading to its reduction
such as reducing solar exhibition, limiting salt consumption
and avoiding vitamin D supplements... After diuresis and calciuria
normalization, in the case of deficit of inhibitors a treatment
with inhibitors of the crystallization of calcium salts such as phytate,
phosphate syrup or citrate must be followed. However when administering
citrates the urinary pH should be controlled in order not to reach pH
values of 6.0, due to the increase of the urinary pH by citrate. |
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| What
is the treatment when a kidney has lost its function due to serious coraliforme
lithiasis for the calculi size? |
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| The
main cause of the formation of those calculi is an infection by ureolithic
microorganisms. Treatment consists in the eradication of the infection by
antibiotic treatment, being very important to completely eliminate all calculi
fragment infection, since otherwise the microorganisms situated outside
those fragments would become resistant to antibiotics. It is also very important
to select the most effective antibiotic. For this reason we recommend you
to contact an urologist with experience in infectious renal lithiasis treatment
(pharmacological and surgical).. |
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| Is
water effective to eliminate renal sands? |
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| Higher
consumption of water implies higher diuresis (that is a higher urinary volume
than normal) which induces a higher flow and it allows haulage of renal
sands, by diluting the urine (diminishing the salts concentration). However,
in the case of a considerable size renal calculi that can not be expelled
spontaneously, the increase of diuresis will not contribute to its elimination.
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| Is
it possible to dissolve calcium renal calculi in the urinary bladder or
in the kidney? |
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| For
calcium calculi such as calcium oxalate (in monohydrate or dihydrate form),
hydroxyapatite, brushite or mix, unfortunately there is no medication that
dissolves them in vivo, inside the organism. However fragmentation inside
the organism can be done (there are diverse techniques) facilitating the
expulsion of smaller size fragments. On the other hand, it is important
to discover the causes that have induced the calculus formation, in order
to correct and to prevent the appearance of new episodes. |
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| Does
some medication or treatment that it substitutes surgery in the renal lithiasis
exist ? |
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Alternative
treatments are preventive and they depend on the calculus type and urinary
parameters alterations. Preventive measures can include an increase of liquid
consumption (not carbonic drinks), dietary modifications and specific pharmacologic
treatment in the most severe cases.
On
the other hand, dissolution of uric acid calculi in vivo can be performed,
through ingestion of urinary alkalinizants such as citrate or bicarbonate.
Although it is very recommended that your specialists control the urinary
pH to avoid an excessive alkalinization, which would generate other problems
such as calcium phosphate lithiasis. However, when the calculus has a considerable
size or t is located in cavities of very low urodynamic efficacy, the dissolution
through urinary alkalinization is very difficult, if not impossible. |
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| Does
some medication or treatment to destroy renal calculi alternative to the
surgical intervention or the shock waves extracorporeal lithotripsy (SWEL)
exist ? |
|
For
calcium calculi such as calcium oxalate (in monohydrate or dihydrate form),
hydroxyapatite, brushite or mix, unfortunately there is no medication that
dissolves them in vivo, inside the organism. However, in these cases it
is important to discover the causes that have induced the calculus formation,
in order to correct and to prevent the appearance of new episodes.
Prevention depends on calculus type and on the urinary parameters altered.
Preventive measures can include an increase of liquid consumption (not carbonic
drinks), dietary modifications and specific pharmacologic treatment in the
most severe cases.
On the other hand, dissolution of uric acid calculi in vivo can be performed,
through ingestion of urinary alkalinizants such as citrate or bicarbonate.
Although it is very recommended that your specialists control the urinary
pH to avoid an excessive alkalinization, which would generate other problems
such as calcium phosphate lithiasis. However, when the calculus has a considerable
size or is located in cavities of very low urodynamic efficacy, the dissolution
through urinary alkalinization is very difficult, if not impossible. |
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| What
can one do to avoid the recurrence of calcium oxalate renal lithiasis?
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| The
calcium oxalate calculi can belong to two groups: |
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a. - Calcium oxalate monohydrate (rounded and darkish calculi): COM
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b. - Calcium oxalate dihydrate (sharp-pointed and yellowish calculi):
COD
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COM
calculi (a) are usually associated to a deficit of inhibitors of the crystallization,
to some alterations of renal epithelium, to alterations of urinay pH and
the presence of organic matter in urine.
COD calculi (b) are usually associated to an excess of urinary calcium excretion
(hypercalciuria) that gives place to high urinary calcium concentrations.
Prevention depends on calculus type and on the urinary parameters
alterated.
Preventive measures can include an increase of liquid consumption (not carbonic
drinks), dietary modifications and specific pharmacologic treatment in the
most severe cases.
Therefore, we recommend to contact an expert physician in the topic
to study your case to establish the best treatment. |
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| What
kind of medications to avoid the recurrence of calcium oxalate calculi exist,
besides hidroclorotiazide treatment? |
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| Hydrochlorothiazides
(a diuretic), and other drugs of thiazides pharmacological group, are drugs
to hypercalciuria treatment unrelated with hyperparatiroidism. Therefore,
it is very important to study urinary calcium, if there is hypercalciuria
(a hypercalciuria corresponds to a daily urinary excretion highest to 250
mg of calcium) also a correct classification of them is necessary. On the
other hand, the administration of thiazides is advisable to combine with
citrates consumption; in our opinion the combination of these two drugs
are appropriate and convenient. Therefore, we recommend contacting an expert
physician in the topic to study your case to establish the best treatment.
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| What
can one do to prevent the recurrence of renal calculi generated by hipercalciuria,
besides tiazides treatment? |
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| Thiazides
(a diuretic) treatment is correct. However in spite of this treatment the
patient generates renal calculi continuously, this will indicate that there
are other altered factors such as a urinary pH higher than 6.0 and/or a
deficit of inhibitors of the crystallization. If the urinary pH is higher
than 6.0 then carbonic and citric drinks consumption, antacid treatment
and excessively vegetarian diets should be avoided. In the case of a deficit
of inhibitors is advisable to treat with phosphate syrup or phytate.
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| What
can one do to avoid the recurrence of renal calculi when the urinary uric
acid and calcium values are high? |
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| First,
it is very important to know the calculus composition to select the most
appropriate therapeutic measures. On the other hand, in accordance with
the alterations detected, the potassium citrate treatment could contribute
to diminish the recurrence or to eliminate the formation of new renal calculi.
Therefore, we recommend contacting an expert physician in the topic to study
your case to establish the best treatment; moreover it is very important
to study the renal calculus composition and the urine composition, since
they can indicate the most suitable treatment. |
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| The
treatment of the renal lithiasis with citrate can present, in some cases,
stomachache after its itakes. Is there any pharmaceutical form of citrate
that avoids that problem? |
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| There
is a pharmaceutical formulation where citrate is included in a wax matrix
that gives place to a slow release of citrate. Depending on dosage, the
tablets intake could expatiate to two a day. However, this formulation can
also originate gastric problems, although it depends on the person and therefore,
it would be necessary try the treatment. |
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| What
is more convenient for osteoporosis treatment when there are a renal
calculi: calcium citrate or calcium carbonate?
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| Calcium
citrate is the most convenient. Taking it you can increase the urinary citrate
levels that presents positive effects on the inhibition of calculi formation
of calcium |
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