sang e-gurda vo masana (renal and urinary bladder calculi)
Post on 21-Jan-2018
Health & Medicine
Embed Size (px)
A kidney stone is a solid piece of material that forms in the
kidney out of the substances in the urine.
A small stone up to a few millimetres (<5 mm) may pass
easily through the tube and out of the body without causing
any pain or discomfort.
The formation of kidney stones
Kidney stones can form when substances like calcium
oxalate, cysteine or uric acid are at high levels in the
These substances form crystals which then become
anchored in the kidney and then gradually grow in size
forming larger kidney stones.
Certain foods may promote stone formation in people
who are susceptible.
Risk groups Men > women
Peak age (30 to 50)
Overweight and obese
People who do not drink
A family h/o kidney stones
Cystic kidney diseases
Renal tubular acidosis
Blockage of the urinary tract
Chronic inflammation of the
including diuretics, calcium-
based antacids, topiramate
Most common type
Occur in two major forms: calcium oxalate and calcium phosphate
Calcium oxalate stone by high calcium and high oxalate excretion
and a diet heavy in meat, fish, and poultry .
Calcium phosphate stones by the combination of high urine calcium
and alkaline urine
Other diseases cause increased blood levels of calcium (primary
parathyroidism, sarcoidosis, hyperthyroidism, renal tubular
acidosis, multiple myeloma, and some types of cancer.
Uric acid stones
Form when the urine is persistently acidic.
A diet rich in purines: animal protein such as meats, fish, and
Result from kidney infections.
These bacteria produce a substance called urease,
which increases the urine pH and makes the urine more
alkaline and less acidic.
This chemical environment allows struvite to settle out
of the urine, forming stones.
Result from a genetic disorder that causes cystine to leak
through the kidneys and into the urine, forming crystals
that tend to accumulate into stones.
Symptoms of Kidney StonesPain –
ureteropelvic junction: Mild to severe deep flank pain without
radiation to the groin with irritative voiding symptoms
Stones within ureter: Abrupt, severe, colicky pain with intense
nausea with or without vomiting
Stones passed into bladder: Mostly asymptomatic; rarely,
positional urinary retention
If the stone is localised in the bladder neck or urethra - pain
may present at tip of penis pain.
feeling restless and unable to lie still
Cloudy or smelly urine
A high temperature (fever) of 38°C or more
Recurrent urinary tract Infections esp. staghorn stones
Diagnosis Physical exam and take a medical history
Urinary sediment/dipstick test: To demonstrate blood cells,
with a test for bacteriuria (nitrite) and urine culture in case of a
Serum creatinine level
24-Hour urine profile
Plain X-ray (KUB).
Computerised Tomography (CT scan)
Retrograde pyelography: determining the anatomy of the ureter
and renal pelvis; for making definitive diagnosis of any ureteral
Urine and blood tests
Prevention Increase fluid intake
Eating less meat, fish, and chicken may be helpful for
patients with calcium oxalate stones.
Other items in the diet that may encourage calcium
oxalate stone formation include beer, black pepper,
berries, broccoli, chocolate, spinach, and tea.
Juices containing citrates are thought to reduce the risk
of stone formation
Bladder stones are small particles that can form in
In some cases bladder stones do not cause any
symptoms of signs and are discovered as an
incidental finding on a plain radiograph.
Severe lower abdominal and back pain
Difficult, painful and frequent urination at night
Blood in the urine -will appear towards the end of urination.
Nausea, vomiting and chills
If the stone gets stuck at the entrance of the urethra, the jet of
urine will suddenly stop in the middle of urinating.
urine becomes concentrated or when one is dehydrated.
urine pools in the bladder and not completely emptied.
A structural abnormality of the bladder (blind pouch)
an enlarged prostate, urethral stricture, neuropathic bladder
Bladder stones may occur whenever the kidneys, bladder
The use of urinary catheters may cause a bladder stone.
Finally, a kidney stone may travel down the ureter into the
bladder and become a bladder stone.
Increasing fluid intake can facilitate the passage of
small bladder stones.
However, larger stones may require other methods of
Fragmentation of bladder stones by use of a cystoscope
and uses ultrasonic energy or laser lithotripsy
Some stones are too large even for cystoscopic
treatment and may require open cystotomy
Lack of exercise
Common in sedentary habit people
Lack intake of liquids
Mada of Niqras
Excessive intake of meat
Excessive intake of yam varieties
Liver, kidney and bladder disorders
Ilmul AmrazStones form due to two main causes
2. Ghaleez and Lesdar Rutubat
Any other thick and viscid substances
3. Retention of Mada
Flesh (esp. red meat)
Alamath Sediments present in the urine
Colour of the urine is red / yellowish
When calculus in the Gurda heaviness in the lumbar region
Heaviness is increased when patient is in prone position & when the bowels are overloaded
When the stone is in the ureter pain felt in the testicles & lower limb of the same side
Certain degree of numbness also felt
Sometimes Rutubat-e-Baiza present in the urine
Frequency of urination
If there is ulceration due to calculus then there will be Varm.
In such condition pain is severe, Reem present in the urine & fever will develop
As the size of the calculus increased structure of the
kidney get damaged
Pain become intermittent when the calculus is present in
Patient will be restless
Incontinence of urine with burning sensation
Extremities are cold & clammy
Patient feels faintness
Usool-e-Ilaj Give Muqaiyat, Mufatehat and Mudirat
If necessary do Fasd of Basaliq
Do Abzan, Nutool, Takmeed, etc.
Apply Zimad, Roghan
Ilaj Avoid Ghaleez, ghiza such as milk, beef, mutton
Avoid fruit such as Saib, Amrood, Dates
Produce emesis to expel the Ghaleez Mada
Give light Mushil
Joshanda-e-Sapistan, Mulaiti, Khatmi with Thuranjabeen and
Thalmakana, Tukhm-e-Kaddu, T-e-Khiyar, Halyoon, Kaknaj,
If calculus is very small it will expell on its own
When calculus is big it is necessary to give Mufattet-e-Hasat
either as Majoon or Qurs
Gokru, Pudina, Beeh-e-Hilyoon, Habbul Ghar, Sudab, Beeh-
e-Badiyan, Persiaoshan, Tukhm-e-Khiyar
Give light Ghiza
Advice light exercise
For the prevention of further formation of calculus
Prohibit intake of alcohol
Take plenty of water
Management during attack
If there is Qabs give Huqna with oils such as Roghan-e-
Make the patient sit in Abzan made in Gokru, Koknar, Khatmi,
Soya, Kharaf, Karamkalla, Persiaoshan, Maithi, Khurfa,
After coming out of the Abzan apply oils such as R-e-
Banafsha, R-e-Soya according to Mizaj of the patient
In the Abzan Muzliq Dawa also can be added
Make Zimad with above drugs and apply over the renal area
If the above treatment make the calculus to come out but it
lodge in its way then do a Huqna prepared with Luwabat
Luwab-e-Tukhm-e-Khatmi, Alsi and Maithi mixed with R-e-
Badam & Magz-e-Amaltas
If stone get obstructed in urethra
Urethra is kept in hot water
douche with Luwabat & Roghan and frequently massage
from above down wards until the stone evacuated out
Try to suppress the acute pain by all possible means
Plain hot water can be given to drink & Abzan
Application of hot Zimad or fomentation
Application of Zimad-e-Mukhaddir
Internally give compound preparations containing
Afiyun(eg. Barshasha) or Dawaul Fahi, Thriyak
Giving Musakkinat help in 2 ways
It reduce the pain
Relax the ureter which helps the calculus to descend
Arq-e-Ajeeb 2-4-drops with water
Majoon-e-Barshasha 500 mg -1 g
Arq-e-Ajeeb 5 g + Sirka apply and massage
Post-e-Khashkhas + Arq-e-Gulab or Saboos-e-Gundum + Namak + Sand make a potly and heat it and foment frequently
Gul-e-Tesu, Gul-e-Babuna,Tukhm-e-Khiyarain, Tukhm-e-Kharpaza
Gul-e-Tesu, Parsiaoshan, Hilteet, Tukhm-e-Soya, Tukhm-e-Kharpaza, Gul-e-Aak
After subsiding the pain give Hajrul Yahood (1 g) & Sang-e-Sar-e-Mahi (1 g) make fine powder and give with Jawarish-e-Zarooni 5 g
In the morning give the following
Shora Qalmi & Jawakhar fine powder mix with Jawarish-e-Kamoon and give with a diuretic
Sheer-e-Kharpaza with sharbat-e-Buzoori Motadil
Hab-e-Kabid Naushadari 2 Pills
Liquid diet – Arq-e-Badiyan, Dal ka pani, Sagudana