Renal Calculi

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

urine.

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

enough fluids

A family h/o kidney stones

hyperparathyroidism

Cystic kidney diseases

Renal tubular acidosis

Hypercalciuria

Cystinuria

Hyperoxaluria

Hyperuricosuria

Blockage of the urinary tract

Chronic inflammation of the

bowel

Certain medications

including diuretics, calcium-

based antacids, topiramate

Calcium stones

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

shellfish

Struvite stones

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.

Cystine 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

Haematuria

Cloudy or smelly urine

A high temperature (fever) of 38°C or more

frequency

Dysuria

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

positive reaction

Serum creatinine level

Microscopic urinalysis

24-Hour urine profile

Imaging studies

Plain X-ray (KUB).

Computerised Tomography (CT scan)

Ultrasound scan.

Retrograde pyelography: determining the anatomy of the ureter

and renal pelvis; for making definitive diagnosis of any ureteral

calculus

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

Bladder stones are small particles that can form in

the bladder.

In some cases bladder stones do not cause any

symptoms of signs and are discovered as an

incidental finding on a plain radiograph.

Symptoms

Severe lower abdominal and back pain

Difficult, painful and frequent urination at night

Blood in the urine -will appear towards the end of urination.

Fever

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.

Cause

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

Infection

Bladder stones may occur whenever the kidneys, bladder

become inflamed.

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.

Management

Increasing fluid intake can facilitate the passage of

small bladder stones.

However, larger stones may require other methods of

treatment

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

Asbab

Poor digestion

Lack of exercise

Common in sedentary habit people

Lack intake of liquids

Hard water

Mada of Niqras

Excessive intake of meat

Excessive intake of yam varieties

Excessive exertion

Liver, kidney and bladder disorders

Ilmul AmrazStones form due to two main causes

1. Hararat

2. Ghaleez and Lesdar Rutubat

Bulhgam

Ghaleez Khoon

Any other thick and viscid substances

3. Retention of Mada

Ghaleez Ghiza

Thick milk

Paneer

Flesh (esp. red meat)

Roasted meat

Uncooked food

Big fishes

Rice pudding

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

the ureter

Patient will be restless

Incontinence of urine with burning sensation

Vomiting

Extremities are cold & clammy

Patient feels faintness

Usool-e-Ilaj Give Muqaiyat, Mufatehat and Mudirat

Use Mufattet-e-Hasat

Do Huqna

If necessary do Fasd of Basaliq

Do Abzan, Nutool, Takmeed, etc.

Use Musakkinat

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

Magz-e-Amaltas

Give Mudirat

Thalmakana, Tukhm-e-Kaddu, T-e-Khiyar, Halyoon, Kaknaj,

Gokru, Persiaoshan

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 Sirkanjabeen-e-Unsali

Give light Ghiza

Advice light exercise

For the prevention of further formation of calculus

Avoid constipation

Prohibit intake of alcohol

Take plenty of water

Management during attack

If there is Qabs give Huqna with oils such as Roghan-e-

Zaitoon, R-e-Bedanjeer

Make the patient sit in Abzan made in Gokru, Koknar, Khatmi,

Soya, Kharaf, Karamkalla, Persiaoshan, Maithi, Khurfa,

Banafsha, Barg-e-Isapgoal

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

Give Abzan

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

Mamulat-e-Matab

Musakkin

Internally

Arq-e-Ajeeb 2-4-drops with water

Majoon-e-Barshasha 500 mg -1 g

Externally

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

Nutool

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-Duqu

Sheer-e-Kaknuj

Sheer-e-Hilteet

Sheer-e-T-e-Khyarain

Sheer-e-Kharpaza with sharbat-e-Buzoori Motadil

Evening

Majoon-e-Aqrab

Habul-Qilt

Sharbat-e-Buzoori 2T

Hab-e-Kabid Naushadari 2 Pills

Liquid diet – Arq-e-Badiyan, Dal ka pani, Sagudana

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