• Complaints
• Management of renal colic
• Diagnostics
• Radiation diagnostics
• Kidney ultrasound
• Kidney scintigraphy
• Laboratory research
• Treatment and prevention

• To make an appointment

Urolithiasis is quite common. Its prevalence in developed countries is 1-5%, and the incidence among middle-aged men is 1% per year. The lifetime probability of urinary stones is 20% in men and 5-10% in women. In 50% of patients, a second stone is formed within 5 years. The most common cause of stone formation is insufficient urine volume. Therefore, drinking plenty of fluids is the most important part of preventing recurrence of urolithiasis.

Complaints

The stone can cause acute obstruction (blockage) of the urinary tract with the classic picture of renal colic: cramping pain in the side that radiates to the groin, testicle or labia on the affected side, combined with the appearance of blood in the urine. The stones of the lower third of the ureter can be manifested by painful frequent urination, an urgent urge to urinate. Nausea and vomiting are common. With obstruction, urinary tract infection with high fever and sepsis can develop.

Management of renal colic

If a patient with renal colic has previously had an X-ray-positive stone, then an overview X-ray of the abdomen is performed to clarify the size and location of the stone and select the optimal treatment tactics. Patients with an unclear clinical picture, who have no history of urolithiasis or have X-ray negative urinary stones, undergo spiral computed tomography (CT) without contrast or excretory urography. Ultrasound examination (ultrasound) is informative for kidney stones, but does not always reveal ureteral stones. If the patient has both kidneys, his condition is stable, there are no signs of infection, obstruction of the urinary tract is incomplete and does not threaten renal failure, you can limit yourself to analgesics (often you have to use narcotic analgesics). Otherwise, urgent urine diversion is indicated by placing a stent in the ureter or percutaneous nephrostomy. In case of infection, antibiotics are immediately prescribed. The need for surgical treatment is determined by the size of the stone. Against the background of conservative treatment, stones up to 4 mm in size leave on their own in 90% of cases, and 6 mm or more - only in 10% of cases. If the pain persists or after 3-4 weeks of conservative measures the stone does not move and does not go away, surgical treatment is indicated.

Diagnostics

To find out the causes of urolithiasis, information about the past diseases is very important. A history of fractures and peptic ulcer disease are signs of primary hyperparathyroidism. Chronic diarrhea, ileal disease, and bowel resection predispose to calcium oxalate stones due to oxaluria and hypocitraturia. With gout, urate and oxalate stones are formed. Recurrent urinary tract infections contribute to the development of triple phosphate stones.

Radiation diagnostics

Radiation diagnostics is one of the most important stages of the examination. With its help, it is possible to determine the number, size and localization of stones, to identify anatomical defects of the urinary tract, to assess the function of the kidneys. Research is carried out prior to the appointment of treatment. More than 90% of urinary stones are X-ray positive (that is, visible on X-ray). Calcium phosphate and calcium oxalate stones are best seen. All patients with urolithiasis first undergo a general X-ray of the abdomen (kidneys-ureters-bladder). Studies using radiopaque substances are carried out later, since these substances can mask even a large stone. On the basis of an overview image of the abdomen, it is possible to establish the number, size and localization of stones, to suggest their composition (by X-ray positivity). Sometimes on a plain radiograph, urinary stones are not visible due to bone structures (sacrum, transverse processes of the vertebrae). In such cases, an oblique or posterior frontal projection x-ray is helpful. Small, hard to see stones can be detected with CT.

Kidney ultrasound

This method helps to identify hydronephrosis and calculi-pelvic system stones, to assess the state of the kidney parenchyma against the background of urinary tract obstruction. Ultrasound can detect X-ray stones. The middle and lower third of the ureter are poorly visible due to the accumulation of gas in the intestine and projection onto the pelvic bone. Kidney ultrasound can be used to rule out other causes of acute abdominal pain, as well as to monitor patients with recurrent urolithiasis (in this case, it replaces radiography and avoids unnecessary radiation).

CT scan

The method is especially valuable in the presence of X-ray-negative filling defects in the renal pelvis or ureter. In addition, CT can detect anatomical defects, urinary obstruction, and diseases associated with acute abdominal pain. Spiral CT without contrast is today considered the best method for examining patients with acute flank pain. This method is fast, economical and more sensitive than X-ray and ultrasound, it can detect urinary stones of any composition. It can help detect other signs of urinary tract obstruction with a stone. In addition, spiral CT is useful in diagnosing causes of acute flank and abdominal pain such as appendicitis and diverticulitis.

Kidney scintigraphy

It is a quick and safe method to assess the overall kidney function and the function of each kidney separately. It does not require special preparation of the patient (including bowel cleansing), does not cause allergies, and the radiation dose is minimal.

Laboratory research

The doctor and the patient should decide the question of the scope of the examination for the first time diagnosed with urolithiasis, guided by the risk of the formation of new stones. The high-risk group includes middle-aged white men with chronic diarrhea, pathological fractures, osteoporosis, urinary tract infections, and gout. Such patients, as well as patients with cystine, urate and tripelphosphate stones, are shown additional examination.

Treatment and prevention

There are several general guidelines for the treatment of urolithiasis, regardless of its cause. Increase fluid intake so that diuresis (urine volume) exceeds 2 liters per day. Prescribe a diet low in oxalates and sodium (while the release of oxalates and calcium decreases). After 3-4 months, the patient is examined again. If, with the help of diet and abundant drinking, it was possible to eliminate the factors contributing to the formation of urinary stones, such treatment is continued, every 6 months by examining daily urine. If these measures are unsuccessful, drug treatment is prescribed. Indications for surgical treatment are persistent pain syndrome, urinary tract obstruction, coral stones (even asymptomatic). In addition, such treatment is indicated for patients who cannot be prevented from developing renal colic (for example, pilots) or infection (patients who have undergone transplantation or endoprosthetics). Treatment planning and choice of method depend on the composition, location and size of the stone, on the function of the kidneys and the anatomical features of the urinary tract. Currently, most kidney stones and the upper third of the ureters are removed by extracorporeal lithotripsy. The stones are destroyed by shock waves. These waves are transmitted through water and focused on kidney and ureteral stones under fluoroscopy or ultrasound guidance. Due to the different density of kidney tissue and stone, energy is concentrated on its surface, and the stone is destroyed. As a result of several discharges, sand is usually formed (small fragments with a diameter of 2-3 mm), which passes through the ureter and is excreted in the urine. In the absence of contraindications, extracorporeal lithotripsy is the preferred method of removing small stones from the upper urinary tract because it is non-invasive, cheap, and rarely complications. Other minimally invasive treatments are percutaneous nephrolithotomy, retrograde lithotomy. Open intervention is used in less than 1% of cases when the stones are very large or have a complex shape.

Complete collection and description: why kidney ultrasound does not show stones? and other information for human treatment.

When detecting kidney stones on ultrasound, priority is given to X-ray research methods - intravenous urography, computed tomography.

On ultrasound, a true kidney stone is represented by a hyperechoic structure, followed by an acoustic path. Compacted fat of the renal sinus, blood clots (due to fibrin) can imitate a stone. But these structures usually do not give an acoustic shadow behind them, as their density is lower than that of stone. But in some cases, the detection of a kidney stone by ultrasound is difficult.
As with any organ, kidney stones can be single or multiple. There are coral stones - these are stones that occupy the entire cup-pelvis system of the kidney.

If a stone blocks the outflow of urine below the upper third of the ureter, then ultrasound is unlikely to detect such a stone. The ultrasound doctor will only describe the signs of a kidney block. Since the ureters are not visible on ultrasound. You can see only its upper part, in case of its expansion. If the ureter is visible on ultrasound, then it is already dilated. Depending on the level of the block in the kidney, you can find:

Calicoectasia or hydrocalicosis - expansion of the calyces by more than 5 mm. More often the calyces are enlarged in groups.

Pyelectasia - enlargement of the pelvis more than 15 mm.

Calicopyelectasia - expansion of the calyx and pelvis.

Ureteropyelocalicoectasia - dilation of the ureter, pelvis and calyces.

Hydronephrosis- persistent progressive expansion of the entire renal calyx-pelvis system.

Stages of hydronephrosis:

Stage 1 - persistent progressive expansion of the pelvis;

Stage 2 - persistent progressive expansion of the pelvis and calyces with initial manifestations of atrophy of the renal parenchyma;

Stage 3 - terminal. Transformation of the kidney into a liquid sac. Hydronephrotic transformation.

The secondary-shriveled kidney is a kidney that has lost its functional activity. Ultrasound reveals a decrease in the size of the kidney, an unevenness of the outer contour, a violation of the differentiation of layers.

Ultrasound examination of the kidneys is of great help to the doctor in the diagnosis of many pathologies of the urinary system. It, as a rule, is used primarily as a screening method for detecting kidney pathology, since it has wide availability, harmlessness, high information content simultaneously with the speed of its conduct.

Why is an ultrasound of the kidneys prescribed?

Ultrasound of the kidneys is prescribed when the doctor suspects the presence of pathology in them in the patient. This can be thought of when there are changes in laboratory analyzes of urine or blood, or complaints from the patient himself.

Kidney structure

Ultrasound examination of the kidneys is indicated for pain in the lumbar region, in the abdomen, with fever with an unknown cause, with trauma of the abdominal cavity, with the appearance of a palpable mass in the abdominal cavity, with urine staining red, with increased or decreased urination, absence of urine, the standard treatment for increased blood pressure, at the first suspicion of cancer or the search for metastases.

In addition, under the control of ultrasound, minimally invasive interventions can be performed, the condition of organs can be assessed after surgical or drug treatment.

Training

No special preparation is required for an ultrasound of the kidneys in adults. Only in case of severe intestinal distension is the patient recommended to follow a diet with restriction of plant fiber, fresh dairy products and bread for three days before the study.

It is not recommended to conduct an ultrasound examination on the same day after a colonoscopy or an X-ray of the intestine with barium contrast, because the temporary changes that have occurred in the intestine after these procedures will prevent the doctor from reliably and freely examining the structure of the renal parenchyma.

What diseases can be detected?

With echography in organs, focal and diffuse changes can be detected. Focal changes are called those changes that capture a small area of ​​the organ, while the rest of the kidney remains unchanged. With diffuse changes, pathology captures the entire structure of the organ.

Of the focal changes, cysts are most often detected in the kidneys. They look like anechoic (completely black) rounded structures with smooth, distinct contours, which amplify the ultrasound signal. Only one cyst may be visible, but more often there are several in one or both kidneys. As a rule, simple cysts do not represent any danger and are found in many people after 40 years.

If all of the kidney tissue is replaced by multiple cysts from birth, this condition is called polycystic. Polycystic kidney disease is often associated with similar changes in the liver and pancreas.

Polycystic kidney disease

An abscess occurs as a result of acute inflammation and, on ultrasound, unlike a cyst, it has fuzzy contours and more echogenic contents, represented by pus. Sometimes the abscess may appear hyperechoic at first.

Among the focal changes, relatively often with ultrasound, you can see a benign formation of angiomyolipoma. It is a formation of a rounded shape of increased echogenicity with smooth, clear contours.

Angiomyolipoma of the kidneys

Among diffuse kidney diseases, glomerulonephritis and pyelonephritis can most often be found. They do not have unambiguous ultrasound criteria, but there are a number of signs that are most typical for these inflammatory diseases on ultrasound.

Acute glomerulonephritis leads to an increase in the size of the kidney with an increase in the parenchyma thickness of more than 20 mm. In this case, an increase in the echogenicity of the parenchyma can be noted.

Glomerulonephritis of the kidney

With long-term chronic glomerulonephritis, the size of the affected organ, on the contrary, becomes less than normal, the cortico-medullary differentiation of the parenchyma decreases, the thickness of the parenchyma becomes less than 12 mm.

Often, with acute pyelonephritis, you cannot see any characteristic changes on ultrasound. The kidney is hypoechoic, edematous, the boundaries between the cortical and medulla are blurred.

Chronic pyelonephritis is a long-term destructive process, therefore it leads to morphological changes in the kidney, which can be seen with ultrasound. In the terminal stage of pyelonephritis, a decrease in the size of the affected kidney, a hyperechoic halo of the renal parenchyma and individual small cysts are revealed. Over time, thinning of the cortical substance with retraction of the surface appears, associated with the formation of scars.

Ultrasound examination helps in the diagnosis of renal tuberculosis. It begins with the defeat of the pyramids, in which cavities with liquid contents are formed. When the cavities break through, a deformed hollow space is formed, which has a characteristic appearance with excretory urography. An ultrasound scan reveals hollow spaces containing fluid and partially calcified. At the same time, there is a gradual destruction of the renal parenchyma and shrinkage of the entire organ.

Very often, a violation of the outflow of urine occurs in the kidneys, which can be indicated by an ultrasound device. There are several stages of hydronephrosis:

1. Expansion of the renal pelvis, the parenchyma of the kidney is not changed.
2. Expansion of the pelvis and calyces, thinning of the parenchyma.
3. Cystic enlargement of the pelvis and a narrow rim of the parenchyma.
4. The parenchyma is not completely visible, it does not function, the kidney is a "bag" with expanded calyces.

Hydronephrosis of the kidney

The reasons for the violation of the outflow can be different: blockage of the ureter by calculus, blood clot, compression by a tumor, a pregnant uterus, and others.

One of the common reasons for referral for ultrasound of the kidneys is renal colic. With the help of echography, in most cases, it is possible to reliably determine the presence of stones with a diameter of more than 2 mm in the kidneys and urinary tract. The stones look like bright hyperechoic structures that reflect ultrasonic rays well from themselves, and then give a clear acoustic shadow.

The diagnosis "Sand in the kidneys", which is widespread in some clinics, is actually not ultrasound, since at present, physically using an ultrasound device, only those structures in the kidneys with a linear dimension of more than 2 mm can be seen. And we all know perfectly well that the diameter of the grains of sand is less than 2 mm.

Spongy kidney with ultrasound

The spongy kidney is a developmental anomaly - a congenital expansion of the structural components - the collecting ducts. For most patients, this anomaly is harmless and proceeds without any clinical manifestations. But in some people, such a pathology contributes to the development of an ascending infection that requires appropriate treatment.

With echography, the kidney pyramids, which are normally hypoechoic (dark gray), become hyperechoic (white) as a result of an increase in the number of reflective interfaces due to the expansion of the tubules.

With age, secondary calcification of the dilated collecting ducts is possible, as well as the formation of cysts in the cortex of the abnormal organ. In this case, the spongy kidney begins to resemble changes in nephrocalcinosis, but without concomitant changes in laboratory tests.

What does cancer look like on an ultrasound machine?

The ultrasound picture of cancer is very diverse. The most common malignant tumor of the kidney is renal cell carcinoma. Tumors of a small size are often hypoechoic, large ones are usually hyperechoic or contain areas of mixed echogenicity due to changes occurring in the tumor. Often kidney cancer is isoechoic, that is, identical in structure to the surrounding tissue and thus very poorly distinguishable from it. Isoechoic cancer less than 1 cm in size is especially difficult to detect with ultrasound. Small tumors usually have a regular rounded shape, relatively even contours.

Kidney cancer

Large cancer is characterized by heterogeneity of the structure with areas of increased echogenicity due to fibrosis and areas of reduced echogenicity. Calcination zones can be detected. In the foci of cancer decay, cystic cavities are formed containing fluid, blood, or jelly-like masses. Areas of decay with echography have the form of an- or hypo-echogenic cavities of irregular shape.

Echographic signs of cancer may include the following changes:

• volumetric formations with a different acoustic density than the parenchyma;
• limited protrusion of the contour of the organ;
• cysts with a very dense or uneven wall, with hemorrhage;
• intermittent echo signals from the central echo complex, detection of parenchymal bridges;
• Doppler ultrasound in cancer reveals a staining defect where the normal architectonics of the renal vessels disappears, the degree of vascularization can be different - from the complete absence of vascular images to high vascularization with multiple amplification of the color signal.

Humpback kidney - what is it?

Sometimes on the surface of the organ, more often on the left, a bulging of its outer contour is revealed. In some cases, it is mistaken for a tumor, but upon a more detailed examination it is established that this is an individual feature of the patient's organ structure and does not pose any danger to the life and normal functioning of the organ. In this case, the doctor introduces the phrase "humpbacked kidney" into the ultrasound description. It arises either from the pressure of the spleen on the kidney, or as a result of disturbances in embryonic development.

What does the darkening in the kidney indicate?

In relation to instrumental diagnostics, the term "darkening" is used in radiology. In the echographic description, structures that appear darker than the surrounding tissue are called "hypoechoic" or "reduced echogenicity". All black structures are called "anechoic".

The following changes can be hypoechoic areas:

• abscess;
• tumor;
• hemorrhage;
• in addition, the pyramids are normal hypoechoic structures in the parenchyma.

Completely black, "anechoic" can be: cysts and dilated pelvis or calyces as a result of urinary retention.

Further actions, analyzes, diagnostics after ultrasound of the kidneys

After the ultrasound diagnostics, the doctor hands out the examination protocol to the patient or hands it over to the attending physician. An ultrasound report is not a definitive diagnosis, but only serves as an aid to the doctor in diagnosing the changes occurring in the patient's body. The doctor, on the basis of not only the ultrasound description and conclusion, but also analyzing the complaints, examination of the patient, laboratory tests of the patient exposes him to the final diagnosis and prescribes the necessary treatment.

If the doctor does not have enough of these data, or during an ultrasound of the kidneys, some unclear abnormalities were found that can occur in various diseases, the attending physician prescribes additional examination methods for the patient. This can be computed tomography, magnetic resonance imaging, excretory urography, radiography, angiography, various laboratory analyzes of urine and blood, or a control ultrasound in dynamics after a while.

Conclusion

In most cases, ultrasound examination allows the doctor to make an accurate diagnosis and prescribe the necessary treatment for the patient. Due to the wide availability, harmlessness and high information content, this method of examination is among the first to be prescribed if almost any diseases of the kidneys and urinary system are suspected.

Diagnosis of kidney stones

Diagnosis of kidney stones begins with a doctor's consultation. The doctor will be interested in questions related to your disease: what symptoms bother you, when they appeared, how pronounced they are, whether relatives suffer from kidney stones, and much more.

To make the consultation as productive as possible, you can prepare for it. What can you do:

• Write down on a piece of paper any symptoms that bother you, even those that you think are not related to kidney stones;
• Make a list of all medications you are taking, including vitamins and dietary supplements;
• Prepare an extract of your diseases, in addition to kidney stones, previous operations, etc. In addition, you can take with you the results of previous examinations;
• Make a list of relatives who also have kidney stones. You can take a family member with you to the consultation, sometimes a loved one can provide important information that you forgot about;
• Write down on the sheet any questions you would like to ask your doctor.

Physical examination also plays an important role, it allows the doctor to assess the general condition and exclude the presence of other non-urological diseases that can mimic the presence of kidney stones.

Already at the consultation, it is possible to make a preliminary diagnosis and even suggest the type of kidney stone!

What tests to take?

The next stage in the diagnosis of a kidney stone is laboratory tests, first of all, general urine analysis.

An indirect sign of the presence of a kidney stone may be the detection of salt crystals in urine... The type of salt found can provide preliminary information about the chemical composition of the calculus. For example, if the urine contains a lot of oxalates, then there is a high probability of the presence of calcium oxalate calculus in the kidney.

In addition, it is also important acidity index, urine pH. A urine pH of 7 is considered neutral, a solution with a pH below 7 is considered acidic, and above 7 is considered alkaline. In patients with urinary stones acid urine always has a more acidic reaction, and in people whose stones have formed due to infection, urine is alkaline. The acidity of the urine also helps to guess the type and chemical composition of the stone.

If bacteria are found in the urine, it is highly likely that a person has struvite calculus or a concomitant infectious complication of a kidney stone. The appearance of inflammatory cells, leukocytes, in the urine is a common occurrence with any stone in the kidney, therefore, the presence of leukocytes in the absence of bacteria in the urine does not always indicate an infection.

It is also routine for all patients to perform general and biochemical blood test... This is essential for the diagnosis of kidney stones and their complications.

24-hour urine analysis Is a study of urine collected in 24 hours. Analysis of daily urine is necessary to assess the volume of urine separated per day, the level of acidity, the content of salts and crystals in it. Appointed according to indications.

A kidney stone, as well as renal colic, have symptoms that are often similar to many other diseases, including non-urological ones. Although history and physical examination are important in the diagnosis of kidney stones, one of the imaging tests is required to confirm the diagnosis, i.e. such a survey, which will make it possible to see the stone and determine its size, shape and location. Currently, several types of studies are available for the diagnosis of kidney stones, the advantages and disadvantages of which are outlined in the table.

Methods for diagnosing kidney stones and their effectiveness:

Study type	Sensitivity	Specificity	Advantages	Flaws
Kidney ultrasound			Inexpensive; Good for diagnosing kidney stones and hydronephrosis; No radiation exposure;	Low efficiency of diagnosis of stones that have advanced into the ureter;
X-ray of the kidneys			Affordable and inexpensive examination;	Ineffective for the diagnosis of stones located in the middle part of the ureter; The plain X-ray does not show the X-ray non-contrasting stones; Does not make it possible to exclude the presence of other non-urological pathology;
X-ray with contrast			Affordable and relatively inexpensive; Provides data not only on the location of the stone, but also on the anatomy of the urinary system and kidney function;	Requires preliminary preparation; The use of a contrast agent is required; Does not make it possible to exclude the presence of other diseases that mimic kidney stones; A series of shots is required, i.e. higher radiation exposure;
CT scan			The most sensitive and specific radiological examination; Allows you to establish the degree of blockage of the ureter in renal colic; It makes it possible to detect or exclude the presence of other non-urological pathology;	Less affordable and relatively expensive; Does not allow assessment of renal function.

Sensitivity- an indicator reflecting the probability of detecting a calculus. Specificity- this, on the contrary, is an opportunity to exclude the presence of a disease, i.e. reliably confirm its absence.

Now let's take a closer look at each method for diagnosing kidney stones separately.

Ultrasound of kidney stones

Ultrasound of kidney stones (ultrasound)- a widespread method of diagnosing various diseases of internal organs, including kidney stones, using ultrasonic waves.

Ultrasound examination has limitations in the diagnosis of urolithiasis. Ultrasound examination is readily available, quickly feasible, and highly effective for diagnosing a kidney stone, but it rarely detects a calculus trapped in the ureter (sensitivity is 19%). On the other hand, ultrasound can diagnose hydronephrosis, which may be an indirect sign of blockage of the ureter with a stone. Hydronephrosis is an expansion of the ureter and the renal calyceal system above the blockage.

An ultrasound examination helps the doctor to exclude the presence of other diseases that mimic an attack of renal colic, for example, appendicitis, cholecystitis, torsion of the uterine appendages, etc.

Ultrasound is the method of choice for diagnosing kidney stones in pregnant women.

X-ray of kidney stones

Drawing. X-ray shows multiple kidney stones.

Plain X-ray- a method for diagnosing a kidney stone, which allows you to identify an X-ray contrast calculus, to determine its size and location. X-ray contrast stone- This is a calculus that is clearly visible on an X-ray image. Calcium stones are clearly visible on an x-ray. Diagnosis of kidney stones from uric acid, cystine or magnesium ammonium phosphate (infectious calculi) using plain X-ray is difficult or even impossible, since they are poorly visible on the x-ray.

Often, even an X-ray contrasting stone can not be seen in the picture due to gases accumulating in the intestines, or the imposition of a shadow of a calculus on the shadow of the vertebrae. And such non-urological phenomena as calcification of lymph nodes in the abdominal cavity, gallbladder stones, etc., can imitate calculus in the picture.

Thus, it is clear that both the sensitivity and specificity of this method for diagnosing a kidney stone is low.

X-ray with contrast for kidney stones

X-ray of the kidneys with contrast- one of the main methods for diagnosing a kidney stone. X-ray of the kidneys with contrast allows you to obtain valuable information about the calculus (its size, location and contrast X-ray), the state of the urinary system (the structure of the calyx-pelvic system, ureters, etc.) and kidney function. Research is affordable and inexpensive. Unlike a simple X-ray it allows you to distinguish a kidney stone from other X-ray contrast particles (calculi of the gallbladder, calcification of the lymph node, etc.).

Drawing. X-ray taken ten minutes after the injection of contrast medium into the vein.

Compared with ultrasound diagnostics and plain radiography, X-rays kidney with contrast has a higher sensitivity and specificity. During this study, it is necessary injection of contrast agent into a vein... After a while, when the substance enters the urinary system, a series of X-rays are taken.

The disadvantage of this method for diagnosing a kidney stone is the possibility development of an allergic reaction on contrast agent. But, if you have ever applied iodine to your skin and you have not experienced an allergic reaction, then there is nothing to worry about.

Computed tomography of kidney stones

CT scan- a method widely used all over the world for the diagnosis of kidney stones. This diagnostic method allows you to quickly identify a calculus any kind, size and location. Computed tomography has a high sensitivity and specificity, allowing to exclude the presence of other diseases that mimic a kidney stone or renal colic. In addition, the diagnostic method provides information about the structure of the urinary system, the degree of ureteral obstruction calculus. Flaw- inability to assess kidney function. Another significant disadvantage is high price diagnostics. For example, in the United States, the cost of computed tomography is $ 600, and intravenous pyelography is $ 400. Nevertheless, the speed and high efficiency of computed tomography makes this method indispensable in the diagnosis of kidney stones. Therefore, computed tomography is gradually becoming the gold standard and the method of choice for the diagnosis of calculus in the kidney.

Drawing. CT scan. The picture shows a large stone in the right kidney.

Ultrasound of the ureters is a type of informative ultrasound diagnostics, which is used for suspected urolithiasis and other diseases of the urinary system. It is a painless procedure that allows a diagnosis to be made in a short time. How and when is ultrasound performed for ureteral stones?

Ureters: functions and features

The meaning and role of the ureters

The ureters are tube-shaped and connect the kidney to the bladder. Their main function is to carry urine from the renal pelvis into the bladder, preventing it from moving in the opposite direction. The renal pelvis is a junction of small vessels of the kidney, in which urine accumulates.

The ureters are partly made up of muscle tissue, which allows them to contract without releasing urine from the bladder back to the kidneys. As you know, in a healthy person, the right kidney is located slightly lower than the left, respectively, and the right ureter is a couple of centimeters shorter than the left. The length of the ureters is normally 28-34 cm.

The ureter does not have the same diameter over its entire length. It narrows in three places: at the exit from the renal pelvis, in the middle and at the entrance to the bladder. This is normal and not pathological. However, it is in the places of narrowing that stones can get stuck, which cause pain, impaired urination. Urine enters the bladder through the ureters not in a continuous stream, but in small portions every 20 seconds.

The contracting parts of the ureters are called cystoids (inflammation of the bladder - cystitis).

Their inflammation or pathology can be determined only with the help of:

• Urine test
• Ultrasound of the ureters
• X-ray

Almost all diseases of the ureters are accompanied by severe pain in the lower abdomen, which intensify with urination, but such diseases are few and far between. Pathologies can be congenital, caused by inflammation, trauma, cancer, benign tumors.

Congenital diseases of the ureters begin to develop even in the intrauterine period of life.

Under the influence of negative factors, the fetus begins to develop incorrectly. Acquired diseases are usually associated with ureteral obstruction.

If a patient comes with complaints to the hospital and the doctor suspects a pathology of the ureter, the first test will be a urine test for erythrocytes and leukocytes, which will indicate an inflammatory process in the genitourinary system. Then either cystoscopy or ultrasound, CT, X-ray is prescribed to see the cause of the disease. Cystoscopy is a type of endoscopy, only a tube is inserted into the urethra. However, if there is severe pain or bleeding, this method can be quite painful. Then it is replaced with an ultrasound or X-ray.

Indications for ultrasound of the ureters

Appointment for examination

As mentioned above, a rare ureteral disease does without severe pain. This is most often the indication for ultrasound of the ureters. However, lower abdominal pain can mean anything, so your doctor will palpate and take a history before ordering an ultrasound scan.

The ureters are not palpable when examining the abdomen, but a doctor may suspect a medical condition if pain increases along the ureters.

Pain can be a signal of urolithiasis.

By themselves, stones in the ureter are only a consequence of a more serious disease, metabolic disorders. The pain is very strong, sharp, in the lumbar region. This pain is called renal colic. The pain may advance with the stone, followed by brief periods of relief. Blood in the urine may appear. If the stone is in the lower part of the ureter, the pain will be in the suprapubic area.

With urolithiasis, ultrasound is irreplaceable. It is a fast and safe procedure that allows you to see changes in the ureters and reveal the number of stones, their size and location. It is very important to see in time an immobile stone that blocks the ureter and does not allow urine to move into the bladder.

More information about ultrasound of the ureters can be found in the video.

If this condition is left untreated, the kidney can die. In addition, sharp stones scratch the mucous membrane of the ureter or form a "bedsore", which, even after removing the stone, will interfere with normal urination.

Purpose of ultrasound:

• Indications for ultrasound of the ureters are also frequent urination, blood in the urine.
• When pain, burning sensation can be felt during urination, urine comes out with difficulty and in small portions.
• The doctor may prescribe an ultrasound scan even if there are no pronounced complaints, but urine and blood tests have revealed any pathologies.
• Ultrasound is also performed for prophylaxis, when checking the effectiveness of treatment of diseases of the ureters, for examination before surgery and kidney transplantation.

Ultrasound helps to identify and monitor various congenital and acquired kidney anomalies. They are often inoperable or do not require surgical intervention, but they need constant monitoring. Abnormalities may relate to the number of ureters, their shape, size, position. If the abnormality interferes with normal urination, interferes with the flow of urine and leads to various complications, the only treatment is surgery.

Training

Proper preparation for the ultrasound procedure

There are rules for preparing for an ultrasound of the ureters, they depend on the type of procedure, disease, symptoms:

• For the best view, assessment of the size and structure of the bladder and ureters, it is desirable that the bladder is full. Therefore, 2 hours before the ultrasound, the patient is asked to drink about 2 liters of water and not urinate until the procedure. Instead of water, you can drink weak tea, juice or compote. Water should not be carbonated.
• In some procedures, the patient must not urinate for 6 hours before the ultrasound. This can be difficult, especially for people with frequent urination. If it's hard to control, you need to urinate partially, and then drink a glass or two liquids again. Then, by the time of the procedure, the bladder will be filled again.
• If the procedure is scheduled for the morning, you can not follow a special drinking regimen, but simply not urinate in the morning. If this is too difficult, you can get up at 2 or 3 am on the alarm clock and go to the toilet.
• When examining the ureters of a pregnant woman, it is not necessary to fill the bladder after 1 trimester.
• For patients with urinary incontinence, fluid is injected through a catheter just before the procedure.
• In some cases, ultrasound of the ureters is performed rectally, for example, to simultaneously look at the prostate. In this case, it is recommended to completely cleanse the intestines with an enema.
• A full bladder will make the diagnosis easier, but a full bowel will not. It is desirable that it be emptied. In people prone to flatulence, gases accumulate abundantly and interfere with a reliable diagnosis. Therefore, 2-3 days before the ultrasound, it is advisable to abandon products that increase gas formation, carbonated drinks, and alcohol. If necessary, you can drink drugs that reduce gas production.
• In addition to a diet associated with flatulence, you do not need to adhere to any special nutritional principles. The procedure is performed regardless of the fullness of the stomach.

Ultrasound of the ureters can be done in conjunction with other procedures. For example, an ultrasound of the kidneys and ureters is done with a kidney biopsy. A biopsy involves taking a small piece of tissue for a more detailed examination. Most often, a biopsy is taken in a closed way through a puncture.

Preparing for an ultrasound biopsy requires a special approach. Most often, you need to donate urine and blood for analysis, with elevated pressure, a short course of treatment is carried out to reduce it, a preparatory ultrasound. It is also necessary to minimize the intake of any medications.

Procedure and transcript

Ultrasound of the ureters

An ultrasound of the ureters is usually performed in conjunction with an ultrasound of the kidneys. This procedure is performed through the peritoneal wall or through the vagina or anus. Most often, it is the external method of research that is used. But if a person is obese or has a difficult diagnosis, other methods are used.

The patient lies on his back, a special gel is applied to his stomach and a diagnosis is carried out. In the transvaginal method, the woman is asked to bend her knees. With a transrectal ultrasound, the patient lies on his side and pulls the knees up to the stomach. A special sensor is inserted directly into the vagina or anus. To facilitate the procedure, a special nozzle and gel are used.

In some cases, several research methods are recommended at once or all three, for example, if the diagnosis is controversial and more detailed consideration is required. The ultrasound procedure is painless and safe, it only takes 10 minutes. Only a urologist can decipher the result.

During the ultrasound procedure, a specialist evaluates the shape and size of the bladder, its contours, the presence of tumors in the ureters and bladder, the presence of stones, blood clots, ureteral anomalies, their size and expansion.

With urolithiasis, the specialist will be able to consider the size of the stones, their location, number, shape.

The ureters are not always visualized well on ultrasound, so the doctor may prescribe other methods of examination. For example, the middle part of the ureters is always poorly visible.

There are various signs of kidney and ureter pathology on ultrasound:

1. Education with increased or decreased echogenicity. Such formations appear as dark spots. The specialist describes the dimensions and contours of the formation. It could be a tumor or cyst.
2. Education that has both increased and decreased echogenicity. If the formation has a heterogeneous structure, this means that it has liquid inclusions. Usually, in this case, they speak of a benign or malignant tumor.
3. Rough edges of the kidney and ureters. This can be the cause of congenital abnormalities or inflammation.

Kidney stone disease (Urolithiasis) sometimes asymptomatic, especially at the initial stage, although often the presence of stones and sand in the kidneys can be detected with the help general and daily urine analysis, as well as, clinical and biochemical blood tests and a number of other diagnostic methods.

Each patient with kidney stones if possible, the chemical composition of the stone should be examined. In addition, a blood test and urine tests are required. With kidney stones, as a rule, there are salt crystals in the urine that make up kidney stones, this helps to determine the chemical composition of kidney stones and prescribe adequate treatment.

However, to determine the size and position of a stone in the kidney or ureter, as well as the presence of structural changes caused by the stone, more sophisticated research methods are used.

Methods for the diagnosis of kidney urolithiasis

The following modern diagnostic methods help to detect kidney stones:

• general and chemical analyzes of urine (monitoring the level of acidity and excreted salts);
• plain x-ray of the kidneys (plain x-ray of the abdominal organs and kidneys);
• ultrasound examination (ultrasound) of the kidneys (with regular examination, the dynamics of the growth of kidney stones can be monitored);
• excretory urography (EU) using a contrast agent (not all stones are visible on x-ray);
• multislice computed tomography (native MSCT without contrast enhancement);
• screening coagulogram (when planning surgery).

To find out exactly what kind of kidney stones you have, you need to contact a urologist or nephrologist, who will prescribe a comprehensive examination.

Timely consultations and involvement of an appropriate specialist (endocrinologist, nutritionist, gastroenterologist) in the ICD treatment are extremely important.

Tests for kidney stones

All patients with suspected nephrolithiasis and urolithiasis appoint general urine analysis to detect inflammatory processes in the kidneys and urinary tract, to determine the pH level of urine and other changes, as well as, culture of urine for bacteria to detect the presence of a bacterial agent.

Morning urine analysis with sediment examination

The study is carried out using test strips, determine: urine pH; the number of leukocytes and bacteria; concentration of cystine.

Study of daily urine analysis

• calcium;
• oxalates;
• citrate;
• urates (in samples that do not contain an oxidizing agent);
• creatinine;
• urine volume (urine output);
• magnesium (additional analysis is necessary to determine the ionic activity in CaOx products);
• phosphates (additional analysis, necessary to determine the ionic activity in CaP products, depends on the patient's dietary preferences);
• urea (additional analysis, depending on the patient's dietary preferences);
• potassium (additional analysis, depending on the patient's dietary preferences);
• chlorides (additional analysis, depending on the patient's dietary preferences);
• sodium (additional analysis, depending on the patient's dietary preferences).

Urolithiasis is the formation of sand and kidney stones, a consequence of a disturbed water-salt balance. According to statistics, more than 15% of the world's population suffers from kidney disease. But according to the same statistics, urolithiasis can be successfully treated. Modern medicine is developing rapidly and today there are several methods for diagnosing the disease.

X-ray of kidney stones will give the necessary information about the state of human health. This is one of the least costly, but quite effective methods to identify disorders of the body even at the initial stages of the disease. In the overwhelming majority of public medical institutions, two methods of detecting stones are used: using an overview X-ray and an X-ray with contrast.

Plain X-ray

This is an abdominal x-ray that detects the presence of stones without the use of a special contrast agent. The method is successfully used to detect radiopaque calculus. Kidney stones are a pathological condition that develops due to violations of the properties of urine. Sometimes they are not even visible on a general X-ray.

The superposition of the shadow of the calculus on the shadow of the vertebrae interferes with the diagnosis. Also, the formation of gases in the intestinal cavity can make it difficult to view, which will not allow the medical officer to see the presence of pathology. There are a number of urological phenomena that mimic the presence of calculus. These include calcification of the lymph nodes or the presence of stones in the gallbladder. Among the positive aspects of this diagnostic method are:

• the ability to establish in the patient's body the presence of stones consisting of calcium;
• low cost of research;
• availability, an X-ray can be taken at any medical facility.

X-ray of the kidneys with contrast

Kidney X-ray with contrast is the most demanded diagnostic method today. The medical officer has the opportunity to obtain not only information about the content of calculus in the organ. The nephrologist can establish the size of the calculus and its exact location (this can be seen in the photo), get information about the state of the urinary system.

Kidney stones on X-rays with contrast are easy to determine, it is necessary to properly prepare for the study. An iodine-containing substance is injected into the human body through a vein. After the contrast composition enters the urinary system, the medical officer takes several pictures of the damaged organ. The advantages of this method are obvious:

• high X-ray sensitivity with contrast;
• will make it possible to determine the exact size of the calculus;
• Kidney stones are different from other X-ray contrast particles.

Attention! The main disadvantage of the X-ray of the kidneys with contrast is the appearance of an allergic reaction to the iodine-containing composition. It is recommended to first apply a little iodine to the skin at the elbow. If itching and irritation are not observed, you can safely use contrast.

What stones can be seen on x-ray

Doctors note that not all kidney stones are visible on x-rays. Calcium-containing compounds lend themselves to diagnosis. Among them are oxalates and phosphates. Oxalates have a fairly dense structure, ranging in color from dark gray to black. The stones are almost impossible to dissolve and the use of magnesium preparations is more of a prevention than a therapeutic measure. Formed as a result of an excess of ascorbic acid, vitamin B6 deficiency and diseases of the small intestine.

Phosphates are characterized by a homogeneous structure, smooth and have a white or slightly gray color, consist of calcium salts of phosphoric acid. It is easy to find them in the picture, they have an impressive size and grow rather quickly. Phosphates appear in the kidneys of a person with a sedentary lifestyle, deficiency of vitamins A, E and D, with metabolic disorders.

Unfortunately, not all types of stones can be detected with an X-ray. Uric acid or cystine stones are not visible in the images. In such cases, the nephrologist will prescribe a different diagnostic method. This can be ultrasound, computed tomography, angiographic examination of the kidneys, retrograde pyelography, or magnetic resonance imaging.

- This is a manifestation of urolithiasis, characterized by the formation of salt calculi (stones) in the kidneys. Accompanied by aching back pain, attacks of renal colic, hematuria, pyuria. Diagnostics requires CT and ultrasound of the kidneys, excretory urography, radioisotope nephroscintigraphy, and studies of the biochemical parameters of urine and blood. Treatment of kidney stones may include conservative therapy aimed at dissolving calculi, or their surgical removal (nephrolithotripsy, pyelolithotomy, nephrolithotomy,).

General information

Kidney stones (kidney stones, nephrolithiasis) are a common pathology. Specialists in the field of practical urology are often faced with kidney stones, and stones can form in both children and adults. The majority of patients are men; stones are more often detected in the right kidney, in 15% of cases there is bilateral localization of calculi.

Acquired disorders of salt metabolism can be caused by external (exogenous) and internal (endogenous) causes. Among the external factors, the greatest importance is given to climatic conditions and the drinking regime and diet. It is known that in hot climates with increased sweating and a certain degree of dehydration of the body, the concentration of salts in the urine increases, which leads to the formation of kidney stones. Dehydration of the body can be caused by poisoning or an infectious disease that occurs with vomiting and diarrhea.

In the northern regions, the factors of stone formation can be a deficiency of vitamins A and D, a lack of ultraviolet radiation, the predominance of fish and meat in the diet. Drinking drinking water with a high content of lime salts, food addiction to spicy, sour, salty also leads to alkalization or acidification of urine and precipitation of salts.

Among the internal factors, hyperfunction of the parathyroid glands is distinguished - hyperparathyroidism. The increased work of the parathyroid glands increases the content of phosphates in the urine and the leaching of calcium from the bone tissue. Similar disorders of mineral metabolism can occur with osteoporosis, osteomyelitis, bone fractures, spinal injuries, spinal cord injuries. Endogenous factors also include gastrointestinal diseases - gastritis, peptic ulcer, colitis, leading to a violation of acid-base balance, increased excretion of calcium salts, weakening of the barrier functions of the liver and changes in the composition of urine.

Pathogenesis

The formation of kidney stones occurs as a result of a complex physicochemical process with violations of the colloidal balance and changes in the renal parenchyma. A known role belongs to unfavorable local conditions in the urinary tract - infections (pyelonephritis, nephrotuberculosis, cystitis, urethritis), prostatitis, kidney anomalies, hydronephrosis, prostate adenoma, diverticulitis and other pathological processes that disrupt the passage of urine.

Slowing down the outflow of urine from the kidney causes stagnation in the calyx-pelvic system, oversaturation of urine with various salts and their precipitation, delay in the passage of sand and microliths with urine. In turn, the infectious process developing against the background of urostasis leads to the ingress of inflammatory substrates into the urine - bacteria, mucus, pus, protein. These substances are involved in the formation of the primary nucleus of the future calculus, around which salts crystallize, which are present in excess in the urine.

From a group of molecules, the so-called elementary cell is formed - a micelle, which serves as the initial nucleus of the stone. The "building" material for the nucleus can be amorphous sediments, fibrin filaments, bacteria, cell detritus, foreign bodies present in the urine. Further development of the stone formation process depends on the concentration and ratio of salts in urine, urine pH, qualitative and quantitative composition of urinary colloids.

Most often, stone formation begins in the renal papillae. Initially, microliths are formed inside the collecting tubules, most of which are not retained in the kidneys and are freely washed out in urine. When the chemical properties of urine (high concentration, pH shift, etc.) change, crystallization processes occur, leading to a delay in microliths in the tubules and incrustation of papillae. In the future, the stone can continue to "grow" in the kidney or descend into the urinary tract.

Classification

According to their chemical composition, there are several types of stones found in the kidneys:

• Oxalates... Consist of calcium oxalic acid salts. They have a dense structure, black-gray color, prickly uneven surface. They can form with both acidic and alkaline urine.
• Phosphates... Concretions, consisting of calcium salts of phosphoric acid. In consistency, they are soft, crumbly, with a smooth or slightly rough surface, whitish-grayish in color. Formed with alkaline urine, grow rather quickly, especially in the presence of infection (pyelonephritis).
• Urata... Presented by crystals of uric acid salts. Their structure is dense, the color is from light yellow to brick-red, the surface is smooth or small-dotted. Occur with acidic urine.
• Carbonates... Concretions are formed during the precipitation of calcium salts of carbonic (carbonate) acid. They are soft, light, smooth, and can have various shapes.
• Cystine stones... The composition contains sulfur compounds of the amino acid cystine. The calculi have a softish consistency, smooth surface, rounded shape, yellowish-white color.
• Protein stones... Formed mainly by fibrin with an admixture of bacteria and salts. The structure is soft, flat, small in size, white.
• Cholesterol stones... Rarely encountered; are formed from cholesterol, have a soft crumbling consistency, black in color.

Sometimes stones are formed in the kidneys, not of a uniform, but of a mixed composition. One of the most difficult options is coral stones, which make up 3-5% of all calculi. Coral calculi grow in the pelvis and in appearance represent its cast, almost completely repeating the size and shape of the organ.

Nephrolithiasis symptoms

Depending on their size, quantity and composition, kidney stones can produce symptoms of varying severity. A typical clinic includes back pain, the development of renal colic, hematuria, pyuria, and sometimes - spontaneous passage of a kidney stone with urine. Lower back pain develops as a result of a violation of the outflow of urine, can be aching, dull, and with a sharp urostasis, with blockage of the kidney pelvis or ureter with a stone, it can progress to renal colic. Coral stones are usually accompanied by a mild, dull pain, and small and dense ones give a sharp paroxysmal pain.

A typical attack of renal colic is accompanied by sudden sharp pains in the lumbar region, spreading along the ureter into the perineum and genitals. Reflexively, against the background of renal colic, frequent painful urination, nausea and vomiting, flatulence occur. The patient is agitated, restless, unable to find a position to alleviate the condition. A painful attack with renal colic is so pronounced that it is often stopped only by the introduction of narcotic drugs. With obstruction by stones of both ureters, postrenal anuria and fever develop.

At the end of the attack, kidney stones often pass with urine, post-pain hematuria is possible. The intensity of hematuria can be different - from minor erythrocyturia to severe gross hematuria. Discharge of pus in the urine (pyuria) develops with inflammation in the kidneys and urinary tract. The presence of kidney stones does not manifest itself symptomatically in 13-15% of patients.

Diagnostics

Recognition of kidney stones is based on history, a typical picture of renal colic, laboratory and instrumental imaging studies. At the height of renal colic, a sharp pain is determined on the side of the affected kidney, a positive Pasternatsky symptom, painful palpation of the corresponding kidney and ureter. To confirm nephrolithiasis, the following is performed:

• Laboratory diagnostics... The study of urine after an attack reveals the presence of fresh erythrocytes, leukocytes, protein, salts, bacteria. Biochemical examination of urine and blood, to a certain extent, makes it possible to judge the composition and causes of the formation of stones.
• Ultrasound... With the help of ultrasound of the kidneys, anatomical changes in the organ, the presence, localization and movement of stones are assessed. Right-sided renal colic must be differentiated from appendicitis, acute cholecystitis, and therefore may require an abdominal ultrasound.
• X-ray diagnostics... Most of the stones are determined already with plain urography. However, proteinaceous and uric acid (urate) stones do not reflect X-rays and do not give shadows on plain urograms. They must be identified using excretory urography and pyelography. In addition, excretory urography provides information about morpho-functional changes in the kidneys and urinary tract, the localization of calculi (pelvis, calyx, ureter), the shape and size of stones.
• CT of the kidneys. Computed tomography is the "gold standard" of diagnostics, as it allows you to see stones of any size and density. If necessary, urological examination is supplemented with radioisotope nephroscintigraphy.

Kidney stones treatment

Conservative treatment

Treatment of nephrolithiasis can be conservative or operative and in all cases is aimed at removing stones from the kidneys, eliminating infection and preventing the recurrence of calculi. With small kidney stones (up to 3 mm), which can be removed independently, an abundant water load and a diet that excludes meat and offal is prescribed.

For urate stones, a dairy-plant diet is recommended that alkalizes urine, alkaline mineral waters (Borjomi, Essentuki); with phosphate calculi - taking acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets), etc. Additionally, under the supervision of a urologist, medications that dissolve kidney stones can be used (for example, citrate therapy for urate calculi).

First aid for renal colic

With the development of renal colic, therapeutic measures are aimed at relieving obstruction and pain attack. For this purpose, injections of platifillin, metamizole sodium, morphine or combined analgesics in combination with a solution of atropine are used; a warm sitz bath is carried out, a heating pad is applied to the lumbar region. With intractable renal colic, novocaine blockade of the spermatic cord (in men) or the round ligament of the uterus (in women) is required, as well as ureteral catheterization.

Surgery

Surgical removal of stones is indicated for frequent renal colic, secondary pyelonephritis, large stones, ureteral strictures, hydronephrosis, kidney blockade, threatening hematuria, stones of a single kidney, coral stones. With nephrolithiasis, distance lithotripsy is used to avoid any interference in the body and to remove fragments of calculi through the urinary tract. For stones up to 2 cm in diameter, you can use the method of "flexible retrograde nephrolithotripsy", as well as percutaneous nephrolitholapaxy, which allows you to remove the stone through a puncture in the kidney.

Open or laparoscopic procedures for the extraction of stones - pyelolithotomy (dissection of the pelvis) and nephrolithotomy (dissection of the parenchyma) are rarely used, mainly when minimally invasive surgery is ineffective. With a complicated course of kidney stones and loss of kidney function, nephrectomy is indicated. After the removal of calculi, patients are advised to resort to spa treatment, to follow a lifelong diet, and to eliminate associated risk factors.

Forecast and prevention

In most cases, the course of nephrolithiasis is prognostically favorable. After removing the stones, subject to the instructions of the urologist, the disease may not recur. In unfavorable cases, calculous pyelonephritis, symptomatic hypertension, chronic renal failure, hydropionephrosis can develop.

For any types of kidney stones, it is recommended to increase the volume of drinking to 2 liters per day; the use of special herbal preparations; exclusion of spicy, smoked and fatty foods, alcohol; exclusion of hypothermia; improving urodynamics through moderate physical activity and exercise. Prevention of complications of nephrolithiasis is reduced to early removal of kidney stones, mandatory treatment of concomitant infections.