Renal Calculus

Renal stone or calculus or lithiasis is one of the most common diseases of the urinary tract. It occurs more frequently in men than in women.. It shows a familial predisposition.

Urinary calculus is a stone-like body composed of urinary salts bound together by a colloid matrix of organic materials. It consists of a nucleus around which concentric layers of urinary salts are deposited.

Clinical Features

Symptoms

• Quiescent calculus
• Pain
  • Fixed renal pain
  • Ureteric colic
  • Referred pain
• Hydronephrosis (a lump in the loin and a dull ache)
• Haematuria(blood in urine)
• Pyuria (pus in urine)

Physical Signs

• Tenderness at the ‘renal angle’ posteriorly.
• Muscle rigidity over the kidney
• Swelling in the flank when there is hydronephrosis or pyonephrosis associated with renal calculus.
• Abdominal distension and diminished peristalsis may accompany ureteric colic.

When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs or opioids.

More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require more invasive forms of surgery.

Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.