Symptoms of urolithiasis

Kidney stones can be asymptomatic and can be detected as an accidental finding on an X-ray or ultrasound examination of the kidneys, which is often done for other reasons. They can also show dull pain in the side from behind. The classic symptom of kidney stones is a periodical painful pain. It starts in the lumbar region from behind, then spreads anteriorly and downward to the abdomen, into the groin, the genitalia and the medial part of the thigh. Vomiting, nausea, increased sweating and general weakness are also possible. Intensive pain can last several hours, followed by a dull pain in the side. The patient with renal colic looks gravely ill and restless, turns from side to side, trying to ease the pain. A frequent symptom in renal colic is hematuria of varying severity, up to the development of macroscopic hematuria. Sometimes they notice fever and chills. An objective examination can reveal the soreness and reflex tension of the corresponding lumbar region. Deep palpation increases the patient's discomfort, but soreness is not present when there is a sudden decrease in pressure. Possible infection of the urinary tract. Obstruction of the urinary tract, if it exists, is usually one-sided. However, in young children, a typical classic pattern of renal colic is rare, usually noted fever, signs of intoxication, anxiety and vomiting. In this case, the diagnosis can be made only after a comprehensive examination of the child.

In children, bladder concrements are clinically manifested by pain in the abdomen, dysuric phenomena (delay in urination, rapid and painful urination). In 10% of children stones and sand leave spontaneously. Bladder concretions are often phosphate or mixed, yellowish white, usually large, often tightly fixed to the bladder mucosa (ligature). In most cases, detect bacteriuria and unstable leukocyturia. When analyzing pedigrees in families of children with bladder stones, a genetic predisposition to kidney disease has not been identified.

The most severe course of urolithiasis is noted in children with coral stones and multiple recurrent stone formation in the kidneys. In these groups, boys predominate (4: 1). Almost all children have concrements in pre-school age with a persistently progressive increase in the size of the stone or the number of recurrences of calculi in the kidney. Coral gum formation most often proceeds asymptomatically, it is detected accidentally already with a sharp decrease in the function of the affected kidney. For all children with coral stones is characterized by stubborn torpid current and ineffective therapy of pyelonephritis. Often such children are noted to have chronic renal failure with a decrease in glomerular filtration by 20-40%. A part of the children radiographically reveal anomalies of the structure of the kidneys. According to the genealogy, in 40% of cases, hereditary predisposition to urolithiasis on the mother's line is noted.

In children with single stones of the kidneys and ureter, the concrements of different localization and degree of density are well determined by roentgenology. Concrements often cause violations of kidney function, expansion and deformation of the bowl-and-pelvis system. In children with single stones in the kidneys, spontaneous departure of the stones is often noted. Due to the elasticity and less rigidity of the urinary tract tissues, the symptoms in children are considered to be the lower frequency and severity of non-retiring kidney colic and the relatively more frequent withdrawal of small stones and sand. The concrements in children are more often phosphate or oxalate-calcium.

Features of urolithiasis in children

In recent years, there has been an increase in the detection of urolithiasis all over the world and in all age groups. And all researchers emphasize two circumstances: the detection is obviously much lower than the actual prevalence; reveals rather late manifestations of urolithiasis or its complications - the removal of stones, renal colic, the expansion of the renal cavity systems, calculous pyelonephritis. On average, in Europe, both among adults and among children, urolithiasis occurs at a frequency of 1 to 5%.

Stone formation in children of different age groups differs both for reasons of formation of stones and for clinical manifestations, which makes it difficult to diagnose urolithiasis. The younger the child, the greater the role of urinary tract infection among the causes of stone formation. In children under 2 years of age, the cause of stone formation is considered to be an infection. Among the infectious agents, the main role is played by the proteus and Klebsiella - microorganisms capable of decomposing the urine of urine with the formation of urate and phosphate stones. Obviously, therefore, the composition of stones in children under 5 years is dominated by phosphate-calcium-lithium. And phosphate-calcium stones in children under 5 years can be coral.

Classical symptoms of urolithiasis are renal colic, pain, dysuria, hematuria and pyuria. These signs are considered to be relative. Absolute sign - the passage of stones and sand. According to O.L. Tiktinsky, renal colic in adults is a symptom of urolithiasis on average in 70%, and with localization of stones in the ureter - up to 90%. However, the younger the child, the less common the typical renal colic occurs with urolithiasis. Among the children we observed with urolithiasis, typical renal colic met in 45%. Renal colic in both children and adults may not be accompanied by immediate removal of stones. The first withdrawal of the stone can occur in a few weeks or months after stopping colic.

Microcirculation is one of the most frequent causes for examination with subsequent detection of microhepatic disease in children. According to various specialists, it occurs as an excuse for examining 1/4 of all children with urolithiasis. Microhematuria can exist for a long time as the only symptom of urolithiasis. Episodes of "asymptomatic" macrohematuria, such as manifestations of urolithiasis, occur in children 2 times less frequently than microhematuria. Possible clinical manifestations of urolithiasis in children may be dysuria, as well as day urinary incontinence (urinary incontinence). Among the reasons for the examination leading to the diagnosis of urticaria in young children, there are fewer such as "unmotivated" fever, persistent anorexia, poor weight gain.

Among the causes of stone formation in younger children in second place after infection of the urinary tract are congenital anomalies that disrupt urodynamics and contribute to stagnation of urine. Urolithiasis is combined with anatomical abnormalities with a frequency of 32 to 50% of cases.

With age, the role of metabolic disorders and "idiopathic" stones increases. In older children, as well as in adults, oxalate-calcium stones predominate (more than 60% of all concrements). There is no direct relationship between stone formation and the level of urinary oxalate excretion. Oksalatnye stones do not form for many years with excessive excretion of oxalates with urine (more than 1,5-2 mg / kg per day), but can be formed and recur with persistent normal excretion of oxalates.

Thus, urolithiasis is found and can be diagnosed in children of any age. At a younger age, factors contributing to the formation of stones in the urinary tract are infection, especially microorganisms that break down urea with the formation of urate and phosphate-calcium stones, as well as a violation of urodynamics due to congenital anomalies in the development of the urinary tract. Symptoms of urolithiasis in young children have features: comparative rarity of typical renal colic, episodes of painless macrogematuria, long microhematuria, for many months and even years preceding the departure of stones. There is no parallel between the level of salt excretion and the intensity of stone formation.