Drugs used for urolithiasis. Medicines for the treatment of urolithiasis. Causes of urolithiasis

Urolithiasis is an ailment in which calculi, similar to stones, appear in the organs of the urinary system. These formations can appear in the kidneys, and then move to the ureters, bladder, urethra, which causes severe inflammation of these parts of the body. Treatment of urolithiasis depends on the volume and location of this formation.

Symptoms of the disease can also be different, some people may practically not feel unpleasant signs, while other patients experience severe pain and other manifestations of the inflammatory process. Medicines for urolithiasis are selected individually by a doctor, you cannot prescribe drugs yourself, otherwise the condition can only worsen, and the disease will manifest itself more strongly. It is known that this pathology often occurs in people of reproductive age at about 20-55 years.

What does the manifestation of the disease depend on?

There are many reasons for the formation of stones in the urinary tract. Sometimes even the efforts of the attending physician aimed at determining the specific factor that influenced the appearance of this ailment are in vain.

Causes of the disease

There are a significant number of factors that can have such a negative effect on the body. Among them are:

Often, the factor that influenced the formation of a stone in a given area of \u200b\u200bthe body disappears after a certain time, but the pathological process has already started. If urolithiasis of the kidneys occurs in conjunction with the inflammatory process, then the person experiences vivid symptoms, the pain is permanent.

Urine with urolithiasis changes its composition, the doctor can, by analyzing urine, see the presence of an inflammatory process, since small stones scratch the mucous membrane.

By itself, a kidney infection often causes the formation of stones and sand in this area, because the composition of urine also changes, pathological processes contribute to its saturation with salts and other decay products, which leads to the formation of calculi.

How is the disease detected?

The symptoms of urolithiasis (Urolithiasis) largely depend on the functional characteristics of the organs, if the stones have not disturbed the activity of the kidneys and urinary retention is not detected, then the signs of the disease will be weak. Small stones usually do not show severe pain, especially if they do not move. As soon as the stone begins to move, pain will arise, regardless of the size of this formation.

Medicines for urolithiasis are selected depending on the size of the stones and the symptoms that a person experiences. Patients complain of a significant deterioration in their condition, therefore, it is necessary to facilitate their manifestation of symptoms. Renal colic can be very intense, pain does not change when changing body position or during any procedures, this requires long-term therapy.

Main features:

Renal colic may also develop, which is triggered by compression of the ureter. When such a situation arises, the pressure in the renal pelvis increases greatly, which leads to stretching of this part of the organ. It is in the pelvic part that there are many pain receptors, the effect on which causes intense pain in urolithiasis. Obstruction is not able to resolve spontaneously if the urinary tract is narrowed or there are large stones in them, which can provoke complete kidney dysfunction.

The doctor diagnoses the signs of urolithiasis primarily on examination, based on the patient's complaints and the positive Pasternatsky's symptom, pain in the lumbar region and along the ureteral canal are also indicators of this disease. Changes in the analyzes of such a patient also speak for themselves. The increased level of ESR, microhematuria, an increase in the volume of leukocytes, proteinuria is poorly expressed, all of this indicates an ICD.

Attention! It is very dangerous if there is a simultaneous blockage of both ureters. In such patients, renal failure may develop in a short period, which threatens with serious consequences, up to and including death.

In about 70% of patients with urolithiasis, symptoms can also signal the development of pyelonephritis. Since this disease develops rapidly with renal colic, it is treated in a hospital, primarily by prescribing antibiotics.

Coral nephrotiliasis is characterized by a severe course. This ailment is due to the presence of large stones, which usually occupy the entire area of \u200b\u200bthe calyx-pelvic system. This type of urolithiasis requires a special approach to treatment, because masses disrupt the functioning of the kidneys, leading to renal failure. This pathology does not manifest itself with vivid symptoms, usually patients do not experience pain, there is only weakness or aching pain in the lumbar region.

Drug therapy

Treatment of urolithiasis depends on the type of education itself. The means of therapy are selected individually for each patient, but antibiotics are usually included in the course of therapy always, since it is impossible to reduce a strong inflammatory process without them.

General principles

With urolithiasis, treatment begins only after establishing the type of calculus. The types of stones in terms of chemical composition are as follows:

Drugs for the treatment of urolithiasis are selected by a doctor to improve the advancement of such an education along the pathways of the urinary system, dissolve this calculus, as well as prevent other neoplasms, for which there are special medicines.

Functions of conservative therapy:

• normalization of metabolism;
• opposition to inflammatory processes with stones in the kidney area;
• strengthening the body's defenses;
• positive effect on the hemodynamics of internal organs.

Preparations for dissolving and removing stones

The most gentle method of treating nephrolithiasis involves their gradual dissolution through certain medications. The list of the most effective drugs that dissolve neoplasms is as follows:

1. Magurlite, Soluran, Blemaren solutions.
2. Magnesium salts.
3. Methionol.
4. Benzoic, boric, ascorbic acids.
5. Ammonium chloride.

However, not all stones can dissolve. In this case, stone expelling therapy is used, which is considered one of the most effective in the world. Treatment of urolithiasis with drugs of this action helps to reduce pain that occurs during the advancement of formations along the urinary tract. As an adjunct treatment, doctors use antibiotics to help reduce possible inflammation that occurs during this period.

Aggressive therapy that expels stones is used only in cases where doctors are sure that calculi will begin to move naturally in the near future. Today there is a large selection of such medications, they have become more affordable and safe. However, you should not buy such a medicine on your own, since it is necessary to conduct a full examination to find out the size of the stone, its localization, and also to find out if there is an inflammatory process in this area.

Taking medications without a doctor's prescription increases the risk of developing complications, sometimes even deadly. Only a specialist knows how to treat urolithiasis correctly.

The effectiveness of such drugs for the treatment of KSD has been proven for patients with kidney stones measuring 3-7 mm. If the treatment is carried out correctly, then the probability that the formations come out of the kidneys increases to almost 70%.

Expelling stones:

Home therapy

Treatment of kidney stones is possible at home if the kidney stones are small. There are certain terpene-containing preparations for this therapy. Such drugs have antispasmodic, sedative, and bacteriostatic properties, so often the doctor does not even prescribe antibiotics for such treatment.

Terpene based preparations:

1. Olimetin.
2. Rovatinex.
3. Enatin.
4. Spasmotsistenal.
5. Palin.

Such drugs increase blood circulation in the problem area of \u200b\u200bthe body, relieve spasms, increase peristalsis, and also increase diuresis in a sick person, due to which stones and small calculi are released.

Physiotherapy and surgical treatments

Despite the effectiveness of modern medicines, sometimes only operations for urolithiasis are indicated. Also, the physiotherapy methods used in such cases have a certain positive dynamics.

Surgery for urolithiasis is necessary only if the size of the kidney stones is very large or drug therapy is ineffective.

Surgical treatment is used regardless of the location of such a neoplasm. However, most often operations are performed urgently, with stones stuck in the ureter, this causes terrible pain in the patient and requires immediate help.

Types of surgical treatment:

Depending on the location of the stones in the urinary system, various surgical interventions are used. There are separate types of surgical treatment for the ureters, kidneys, bladder.

Among the methods of treating urolithiasis, physiotherapy can also be distinguished. This method is quite effective in combating this ailment.

Most often used:

Physiotherapy for urolithiasis allows you to achieve a good therapeutic effect in the treatment of urolithiasis. In some cases, the patient's condition improves so much that the doctor cancels the prescribed antibiotics and some other drugs.

ICD, the symptoms and treatment of which can be very diverse, is a pathology that affects mainly young people. Many, due to their busyness or carelessness, do not want to be treated until a kidney or bladder stone is bothering them, but this is very dangerous. If this calculus moves and gets stuck in the ureter, severe pain, inflammation and other problems cannot be avoided. The doctor should control the situation, he will prescribe a treatment with which you can get rid of stones at an early stage of their development, without resorting to surgery.

Kidney stones are very painful. To get rid of them, it is necessary to use medications for kidney stones. Modern drugs allow you to remove small stones by dissolving them. For the treatment of urolithiasis, drugs, mineral waters and folk remedies are used.

Traditional drugs

Solid deposits (stones) in the kidneys are formed as a result of a violation of the acid-base balance and the metabolic process in the body. It should be noted that certain preparations intended for dissolving stones should be used only for a certain kind kidney stones. If the patient does not adhere to this rule or independently changes the dose of the drug, then the violation of the acid-base balance changes even more in one direction or another. This process will increase the size of existing stones or the formation of new ones.

1. Allopurinol is a drug that helps fight different kinds solid deposits. The components of the drug help to reduce the concentration of uric acid.
2. Asparkam - helps to get rid of oxalates and urates. The drug affects the heart, so it must be taken with great care. Asparkam is considered one of the most effective drugs.
3. Blemaren is a drug that dissolves oxalates in the kidneys and bladder. The drug helps to alkalize the urine.
4. Dye madder extract is a plant extract that can be used to dissolve phosphate stones. While taking the drug, the urine turns red, which scares the patients, but this is not blood, but an extract of madder.
5. Cyston - helps dissolve oxalate calculi. The drug can also be used for resorption of hard stones of a different composition, while the acid-base balance of urine does not change.

The above drugs are available in pill form. Also, preparations are used in the form of a solution and a paste. Among them are:

1. Ksidifon is a medicinal solution that is taken by mouth. Helps dissolve phosphate and oxalate kidney stones.
2. Urolesan - drops, they help to remove solid deposits from the kidneys due to the antispasmodic and diuretic effect.
3. Phytolysin is a paste that gradually destroys kidney stones, washing out their inner part. Oxalate becomes sieve-like and then collapses.

When removing stones, it is necessary to use not only drugs that promote destruction, but also drugs that help remove stones through the urinary tract. Therefore, the treatment regimen should include a set of drugs. All drugs must be prescribed by a doctor, self-treatment can worsen health.

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Mineral water as a remedy against stones

Many urologists believe that mineral water helps dissolve stones. Water is selected based on the type of solid deposits in the kidneys. The intake and dosage of mineral water should be prescribed by the attending physician, because its uncontrolled use can lead to the leaching of nutrients and disrupt the functioning of the kidneys. Each mineral water has a number that determines its alkalinity. The following main types of mineral water are distinguished:

• medicinal alkaline mineral water - helps to dissolve oxalates and uratates (Polyana Kvasovaya, Borzhomi, Essentuki 17);
• mineral water with high acidity - used in the presence of phosphates (Narzan, Mirgorodskaya).

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Treatment with folk methods

You can cure urolithiasis with the help folk remedies, but only if the disease is at an early stage, while the formations are small. The following folk remedies can be distinguished:

1. When renal colic appears, it is recommended to use strawberry leaves. 100 g of leaves (or berries) pour 1 liter of boiling water. The dishes in which the leaves are brewed should be tightly wrapped in a warm towel for 24 hours, then filtered. Take 200 ml 2 times a day with meals for 7 days. After that, a break is made for 3 days and the course is repeated. No more than 4-5 courses of treatment are allowed.
2. Fresh cranberries help dissolve stones and remove sand from the genitourinary system. 100 g of cranberries are poured into 1 liter of boiling water and insisted for 5 hours. The medicine is taken once a day for 30 days.
3. Birch juice. It is necessary to drink 200 ml of birch sap every morning on an empty stomach. In the afternoon after meals, you should drink 2 tbsp. l. olive oil, and before bedtime another 200 ml of birch sap.
4. Infusion of birch buds. 2 tbsp. l. the kidneys should be poured with 500 ml of boiling water and insisted for 24 hours. After that, the agent is filtered and taken in 100 ml daily, 2 times a day. The infusion helps to relieve pain, therefore, after their elimination, the intake of the drug must be suspended.
5. Flax seed infusion. It has an analgesic effect. Pour 100 g of seeds into 1 liter of water and boil over low heat for 1 hour. The infusion is taken at 500 ml per day.
6. Decoction of burdock root. 2 tbsp. l. root, pour 500 ml of boiling water and boil in a water bath for 30 minutes. The tool is taken 3 times a day, 100 ml before meals.

Traditional and alternative medicine offers a wide range of drugs for the treatment of urolithiasis, but only a specialist should prescribe them.

Urolithiasis (Urolithiasis) is a metabolic disorder that leads to the formation of stones (calculi) in the urinary tract (urolithiasis) and kidneys (nephrolithiasis). The use of the terms "urolithiasis" and "nephrolithiasis" as synonyms is not entirely correct.

The diagnosis of ICD is made at different ages. However, in most patients, this disease occurs during the period of working capacity (30-50 years).
A little more often, the area of \u200b\u200blocalization of calculi is the right kidney, and bilateral kidney damage occurs in every fifth case of urolithiasis.

Exogenous and endogenous factors are the main causes of KSD:
Endogenous

• Violations of the properties of urine (disruptions in the metabolism of oxalic acid, purine metabolism).
• Birth defects and injuries of the urinary tract.
• Bacterial infections.
• Pathologies of the genitourinary system, leading to impaired urination (pyelonephritis, nephroptosis, hydronephrosis, cystitis and others).
• Inherited genetic diseases (cystinuria).

Exogenous

• Taking medications containing calcium, sulfonamides.
• Lack of vitamins A and B6 in the body, an excess of D, C.
• A sedentary lifestyle and the quality of food consumed.

Methods of treatment of KSD are conservative, instrumental, operational. They are prescribed depending on:

• etiology;
• metabolic disorders;
• states of urodynamics;
• urine pH;
• kidney function;
• places of localization of the stone;
• the chemical composition of the calculus and its size;
• associated complications.

The diagnosis and the appointment of treatment are made according to the results of the following examinations: general urine analysis, ultrasound examination, radiography of the pelvic organs, intravenous urography, cystoscopy.

To choose correct treatment, it is necessary to determine what components the stones are made of.

Several types are distinguished by chemical composition. Approximately 60-80% of all calculi are inorganic calcium compounds: veddellite, wevellite (calcium oxalate), vitlockite, apatite, brushite, hydroxyapatite (calcium phosphate). Concrements formed from uric acid and its salts (uric acid dihydrate, ammonium and sodium urates) are found in 7-15% of patients. Stones containing magnesium (newberite, struvite) account for about 7-10% of all calculi and often accompany infection. Cystine stones are rare (1-3%). Concrements that completely occupy the renal pelvis are called coral-shaped.

A mixed composition of stones, detected in most cases, indicates a simultaneous violation in several metabolic links and a concomitant infection. It has been proven that the climatic and geographical factor, living conditions, the content of various salts in drinking water and food products affect chemical composition calculi.

Medicines used for nephrolithiasis and urolithiasis

Treatment of KSD is based on the use of pharmacological drugs. When they are taken, the risk of recurrent stone formation is reduced due to the correction of biochemical parameters in urine and blood.

In addition, they facilitate the process of moving small stones (up to 5mm).

The litholysis method, as a rule, affects urates. Considering that such calculi are formed at a reduced pH of urine, it is necessary to maintain the pH balance at the level of increased indicators (6.2-6.8) - to alkalinize urine. This effect is achieved with the drugs blemaren, uralit U, soluran, margulite and others.

Blemarine is available in the form of effervescent tablets or granular powder, and comes with a control calendar and indicator paper. It contains citric acid salts - potassium or sodium citrate, which together create an increased concentration of potassium and sodium ions in urine. However, we must not forget that against the background of the use of citrate mixtures, phosphate and oxalate stones can form (at urine pH more than 7). This is because citric acid increases the concentration of oxalic acid in the urine.

The use of litholysis for stones with a different chemical structure is auxiliary. Medicines based on citrates help dissolve not only urates, but also small calcifications, mixed stones. In addition, they help to inhibit the process of stone formation. However, the alkalization method must be carried out in the absence of other diseases of the genitourinary system.

Antispasmodic drugs relieve pain during bouts of renal colic. They facilitate the exit of small stones, reduce tissue swelling during prolonged presence of the stone in the organs. As a rule, colic is accompanied by severe pain and fever, so it makes sense in some cases to combine the use of antispasmodics with anti-inflammatory nonsteroidal drugs.

According to the mechanism of action, antispasmodic drugs are divided into neurotropic and myotropic.

The antispasmodic effect of neurotropic drugs is aimed at blocking the transmission of nerve impulses to nerve endings that stimulate smooth muscle tissue. Myotropic antispasmodics reduce muscle tone.

Neurotropic drugs - M-anticholinergics (atropine, metacin, scopolamine) are not often used in KSD, since they have pronounced side effects and low antispasmodic activity.

The myotropic antispasmodic drotaverin is widely used in Russia. It selectively blocks PDE IV (phosphodiesterase), which is found in the smooth muscle of the urinary tract. This achieves an increased concentration of cAMP (adenosine monophosphate), due to which muscle relaxation occurs, edema and inflammation caused by PDE IV decreases.

A-blockers (tamsulosin, alfuzosin and others) can act as stimulants for the independent passage of stones.

Tamsulosin helps to reduce tone and improve detrusor function. This medicine is taken once a day, 400 mg. Severe liver disease and orthostatic hypotension are contraindications to this drug.

In the presence of stones in the ureters and renal colic accompanying this process, analgesics-antispasmodics are prescribed, such as Maksigan, Spazmalgon, Trigan, Baralgin. To relieve pain, it is recommended to use baralgin orally or intramuscularly in combination with Avisan or no-shpa (drotaverin), 1 tablet each. If their action is ineffective, intramuscular administration of diclofenac (dicloran, voltaren and the like) is performed. Also, in these cases, there is a reason to prescribe nonspecific anti-inflammatory drugs (indomethacin, piroxicam) and to carry out therapy with hepaprotectors with antioxidant activity (Essentiale, Lipostabil, phospholip and others). Often, with urolithiasis, lytic mixtures containing promedol or analgesics such as pentazocine, tramadol, butorphanol are indicated for use.

Antimicrobial and anti-inflammatory drugs

Antibiotics are prescribed for patients with struvite stones because calculi from mixed magnesium and ammonium salts form due to infection caused by microorganisms. Most often, the urinary tract is infected with Escherichia coli, less often with staphylococci and enterococci.

Antibiotic treatment is recognized as effective in initial stage therapy. Observing the clinical picture of the disease, the administration of drugs is carried out by oral or intravenous routes. The antibiotic has the ability to penetrate the site of inflammation and accumulate in it in the required concentrations.

The simultaneous appointment of bacteriostatic and bactericidal antibiotics is unacceptable. In order to prevent the occurrence of bacterio-toxic shock, antibacterial drugs should not be taken in case of violations of the outflow of urine. The duration of antibiotic treatment should be at least one to two weeks.

For urinary tract infections with bacteria, the most common use of the following types of drugs:

1. Fluoroquinolones (ofloxacin, ciprofloxacin, lomefloxacin, pefloxacin, gatifloxacin, levofloxacin).
2. Cephalosporins III (ceftriaxone, ceftazidime) and IV generation (cefepime).
3. Aminoglycosides (amikacin, gentamicin).
4. Carbapenems (meropenem, imylene / cilastatin).

Fluoroquinolones are used for infections arising from lesions by aerobic bacteria - staphylococci, Pseudomonas aeruginosa, Shigella.

Cephalosporims have a high degree of bactericidal activity and have a wide field of action. The latest generation of drugs are active against gram-positive and gram-negative microorganisms, including strains resistant to aminoglycosides.

All antibiotics-aminoglycosides in small doses cause bacteriostasis (stop protein synthesis), in large doses they cause a bactericidal effect.

Carbapenems are equally active on aerobic and anaerobic bacteria. During treatment with these drugs, the synthesis of peptidoglycan is inhibited, and lysis of bacteria occurs. However, with long-term treatment, there is a risk of pseudomembranous enterocolitis.

Anti-inflammatory nonsteroidal drugs (NSAIDs) are prescribed in combination with antibiotics when an infection is detected in order to destroy the focus of inflammation. These drugs include ketoprofen, ketorolac, diclofenac and others. However, these drugs are ulcerogenic, so they need to be taken with great care.

If the inflammation process is insignificant, agents of the nitrofuran series (furadonin, furangin, furazolidone), pipemidic acid (pimidel, palin), oxolinic acid (dioxacin, gramurin), norfloxacin (norflox, nolicin), sulfanilamides (etazol, others) are prescribed.
Medicines that correct biochemical changes in blood and urine

Allopurinol is a drug that reduces the formation of uric acid in both waste products and blood serum, thereby preventing its accumulation in tissues and kidneys. Allopurinol is prescribed for patients with recurrent urolithiasis with calcium oxolate calculi. This drug is prescribed immediately when biochemical changes are detected.

The means that correct the biochemical composition of urine include thiazide diuretics (indapamide, hypothiazide).

Also, with ICD, it is important to take drugs that promote microcirculation in tissues (trental, pentylin, pentoxifylline, pentylin, relofect and others), as well as taking calcium anatagonists (verapamil). These medicines are prescribed together with antibiotics.

However, if the stone violates urodynamics, complete elimination of the infection with urolithiasis does not occur. As a rule, antibacterial therapy is prescribed before and after surgery.

If there are stones in the body, which, according to doctors' forecasts, will be able to move away on their own, drugs containing terpenes are prescribed. They improve blood circulation in the kidneys, increase urine output.

In addition, by enhancing peristalsis, they contribute to the discharge of stones. This group of drugs includes cystenal, enatin, phytolysin, avisan, artemizol. Most of these drugs are contraindicated in patients with peptic ulcer disease, impaired renal function, and chronic and acute glomerunephritis.

Cistenal, a preparation containing tincture of madder root, various essential oils, magnesium salicylate. It comes in the form of an alcoholic tincture. To block an attack of colic, it is recommended to take 20 drops of the medicine in sugar.

Alcoholic tincture of artemizol contains essential oils of wormwood and peppermint leaves, peach oil. Its pharmacological action is similar to that of cystenal. You need to apply a few drops (depending on clinical picture) under the tongue on a lump of sugar. The course of treatment is 10-20 days.

Olimethrin and enatin are similar in composition: peppermint, terpene oils, calamus, olive, refined sulfur. They are taken 1 tablet up to 5 times a day.

Cyston, consisting of extracts of many plants (saxifrage reed, bicarp, stalky, filmy onosomes, bracts, madder, vernonia ashy, rough straw), powder of mummy and lime silicate, helps to reduce spontaneous crystallurgy, stabilizes balance crystal-colloid. Thanks to him active substances, the concentration of elements contributing to stone formation decreases, it turns out to be diuretic, antimicrobial, spasmolytic, anti-inflammatory action.

The use of cyston can be prescribed both as monotherapy and in combination with additional drugs for urolithiasis and other ailments of the urinary system. With ICD in complex therapy, daily intake of cyston is prescribed, 2 tablets 2-3 times. Treatment can last up to six months or until the stones come out.

The composition of the Polish preparation phytolysin includes terpenes and other essential oils containing flavin, saponins, inositols, glycosides (sage, pine needles, peppermint), extracts of parsley seeds, birch leaves, horsetail herb, wheatgrass rhizomes, etc.) antispasmodic, bacteriostatic, diuretic action. It has excellent anti-relapse effects after surgery. One teaspoon of pasta, diluted with 100 ml of sweetish water, is consumed 3-4 times a day. Long-term use of this drug negative impact on the body was not observed.

The German drug nieron contains in its composition the tincture of dental ammonia, madder dye, steel field, calendula, oxalic acid. It improves the process of blood supply to the kidneys, muscles, has an enhancing effect on the peristalsis of the urinary tract, has a diuretic and bacteriostatic effect. Nieron is used up to 3 times a day, 30-35 drops for 1-2 months. In the postoperative period, nieron is prescribed as an anti-relapse and anti-inflammatory agent.

Kanephron improves the condition of the body as a whole, promotes increased output of urate stones, improves the general indicators of urine analysis, phosphorus-calcium metabolism, creatinine, reduces the permeability of blood vessels, enhances the effect of antibiotics. The therapeutic effect of canaferon is due to the extracts of centaury, lovage, wild rose, rosemary, ascorbic, citric, pectin and malic acids, vitamins included in its composition.

Herbal treatment

Herbal preparations are an important part of complex therapy and preventive measures the occurrence of urolithiasis. An antiseptic, antispasmodic, diuretic effect on urinary tract stones is exerted by phyto-assemblies, which in their composition contain: roots of parsley, madder dye, horsetail, steel, juniper berries, rose hips, peppermint leaves, stinging nettle and others plant components... It is important to know that some herbal infusions should not be taken with glomerulonephritis.

Preventive actions

Urolithiasis is prone to recurrence, therefore preventive measures are very important. At the initial diagnosis, it is necessary to find out the nature of the stones formed in the urinary system. Thanks to this, it is possible to adjust nutrition, as well as prescribe anti-relapse, preventive drug treatment.

Urolithiasis disease (ICD) is a metabolic disease characterized by the formation of calculi (stones) in the kidneys ( nephrolithiasis) and urinary tract ( urolithiasis). Urolithiasis is caused by various endogenous and (or) exogenous factors, often hereditary, characterized by a tendency to relapse and persistent severe course.
Sometimes the terms urolithiasis and nephrolithiasis are used interchangeably, however, nephrolithiasis is more correctly called the presence of calculi in the kidneys (but not in other parts of the urinary system).

The insidiousness of urolithiasis is that it is asymptomatic before the onset of complications.
The first manifestation of urolithiasis is an attack of renal colic, which occurs when a stone passes through the ureter. The attack begins suddenly, the pain is localized in the lumbar region and radiates downward, along the ureter and into the genitals. The pains are very strong, the patient cannot find a place for himself, he constantly changes position. An attack of urolithiasis is accompanied by frequent painful urination and various reflex symptoms (nausea, bloating, delayed bowel movements). Erythrocytes and protein are found in the urine. The attack stops after the stone enters the bladder. Sometimes the stone passes through the urethra and is released outward. Renal colic, acute or chronic, are the most common complications of urolithiasis.

People suffering from urolithiasis, in 95% of cases, at least once suffer an attack of renal colic. You should know that it is unacceptable to start therapy at home at high body temperature in doubtful cases, in the presence of hematuria. You can only enter antispasmodics.

Causes of the formation of stones with urolithiasis

The causes of urolithiasis are not fully understood.
IN recent times due to changes in diet, sedentary lifestyle, exposure to a variety of unfavorable environmental factors, urolithiasis occurs more and more often.
Kidney stones appear when the volume of urine decreases or the amount of stone-forming substances in the urine increases. due to a decrease in fluid intake or prolonged disruption of water metabolism, one of the reasons for the formation of stones in urolithiasis.
Obstructing urine flow increases the risk of kidney stones.
Kidney stones are formed in various diseases:
- Infections in the urinary tract.
- .
- Kidney disease, such as renal tubular acidosis, and some hereditary metabolic disorders.
- Chronic illnesses such as diabetes and high blood pressure ().
- Irritable bowel syndrome.
Some medicines also increase the risk of kidney stones. These include drugs containing calcium, neutralizing the acidic environment, and protease inhibitors.
Heredity also plays an important role and can lead to the formation of stones in urolithiasis.

The mechanism of stone formation in urolithiasis

What is the mechanism of kidney stones formation? Urine is a supersaturated solution; in its normal state, stone formation does not occur, since protective colloids contribute to the dissolution or dispersion of its constituents. Protective colloids (mucopolysaccharides or high molecular weight polysaccharides) are found in urine and blood plasma, being a type of mucoprotein. With an insufficient concentration of protective colloids, a certain number of molecules are grouped, forming the core of the stone. The material for the formation of the nucleus can be fibrin, blood clot, amorphous sediment, foreign body. Further stone formation depends on the concentration of salts, hydrogen ions (pH) and the composition of urinary colloids. Stones in urolithiasis are formed as a result of oversaturation of urine with crystalloids and their precipitation.
Urinary stones are composed of crystals of urinary salts, held together by a substance of various protein compounds. Chemicals that can form urinary tract stones include calcium salts, uric acid, and amino acids. In 65-75% of cases of urolithiasis, there are stones containing calcium (calcium salts of oxalic, phosphoric, less often carbonic acids). Mixed stones containing phosphates of magnesium, ammonium and calcium (the so-called struvite) are found in 5-15% of urolithiasis. 5-15% of all stones are urate stones. In about 5% of cases with urolithiasis, cystine, protein, cholesterol stones are found.
Kidney stones and sediments have various shapes and vary in size - from small stones about 1 mm, to giant ones - more than 10 cm in diameter, in weight - from fractions of a gram to 2.5 kg or more. Often the stone fills the calyx-pelvic system like a cast with thickenings at the ends of the processes in the calyx. Such stones are called coral stones.
In some cases, small calculi up to 0.5 mm are independently excreted from the body without causing suffering to the patient. Some stones can exist in a patient for a long time without increasing in size, while others grow to large sizes in 6 months and fill the entire pelvis and calyx in the kidney.

Direction of therapy for urolithiasis

1.Detection and correction of metabolic disorders
2.Anti-inflammatory therapy
3.Influence on organ hemodynamics
4.Immunomodulation

Medicines used for urolithiasis

Pharmacotherapy of urolithiasis directly depends on the chemical composition of renal calculi.

1. Drugs that inhibit the synthesis of uric acid: allopurinol.
2. Drugs that alkalize urine and prevent the loss of urate stones (urates): blemaren, uralite U.
3. Drugs preventing the formation of urinary calculi, promoting the dissolution of urinary stones in the kidneys and facilitating their excretion in the urine: blemaren, uralit U, madder dye extract, cyston, cystenal, phytolysin, Urophyt and Urosan and others.
4. Drugs that improve urodynamics and the discharge of calculi due to the antispasmodic effect:
kanefron N, urolesan, cystenal, phytolysin, phytolysin plus, cyston, herbal teas, urochol
α1-blockers,
doxazosin, tamsulosin, terazosin.
5. Antimicrobial agents: uroseptics, N. kanefron.
6. Phytotherapeutic agents: with antimicrobial and / or anti-inflammatory effect: nephrol, bearberry leaves, lingonberries, oregano, half-fallen (erva woolly), with a diuretic effect - kidney tea, urohol, birch buds and others.
7. Anticholinergics:
non-selective: atropine sulfate;
selective: fenpiverinium, butylscopolamine;
8. Myotropic antispasmodics: drotaverine.

The chemical composition of renal calculi

Urate stones consist of uric acid or its salts and are yellow-brown calculi with a smooth surface of a solid consistency. Urate stones are formed in urolithiasis due to a violation of the metabolism of uric acid - with gout and at a urine pH below 5.5, and at a pH above 6.2 they dissolve. With urate nephrolithiasis, conservative therapy is most effective. Its main directions are hydration, alkalinization of urine, reduced intake of purines, and the appointment of allopurinol. Allopurinol has the specific ability to inhibit the enzyme involved in the conversion of hypoxanthine to xanthine and xanthine to uric acid. However, when you stop taking allopurinol, uricemia and uricosuria return on the 3-4th day to the initial level, so the treatment should be long, gaps in taking the drug for more than 2-3 days are undesirable.

"Acidic" urine (pH below 5.5-5.0) indicates the possibility of the presence of not only uric acid stones, but also cystine stones... They consist of a sulfur compound of the amino acid cystine, yellowish white, rounded shape, soft consistency, with a smooth surface. To alkalize urine more than 7.5, sodium bicarbonate is prescribed, and to maintain an alkaline reaction at night, acetazolamide is prescribed before bedtime. Excretion of urine should be maintained at a level exceeding 4 L / day.

Oxalate stones are formed during urolithiasis from calcium salts of oxalic acid. These stones are dense, black-gray in color, with a prickly surface, they easily injure the mucous membrane, as a result of which the blood pigment stains them dark brown or black. Increased secretion of oxalic acid salts and the formation of stones from calcium oxalate occurs at a urine pH of about 5.5, so urine pH during litholysis must be maintained at 6.2-6.8, that is, urine must be alkalized.
This is best done with the help of citrate preparations, the main active ingredients of which are citric acid and citrates of potassium and sodium uralit-U, blemaren.
Scientists say carbonated citrus drinks may prevent kidney stones. Several years ago, experts found that homemade lemonade markedly increases the citrate content in the urine of patients with kidney stones. The mechanism for preventing stone formation has not been fully understood, but doctors recommended that patients consume this drink more often.
It should be remembered that even more alkalinization of urine, when the pH values \u200b\u200bbecome higher than 6.8, is fraught with the fact that in the kidneys phosphates and carbonates begin to crystallize and precipitate, forming new stones. Whereas with insufficient alkalization, when the pH values \u200b\u200bare below 6.2, the process of destruction of oxalate stones slows down.

Phosphate stones contain calcium salts of phosphoric acid. They are white or light gray in color, their surface is smooth and slightly rough, the shape is varied, the consistency is soft. Carbonate stones are formed from calcium salts of carbonic acid. They are white, with a smooth surface, soft, different in shape. Formed during urolithiasis in alkaline urine (pH about 7.0), grow rapidly, easily crushed. For hypercalciuria, diuretics (thiazides or amiloride) or oral neutral potassium phosphate are usually prescribed. Allopurinol is also effective in preventing the formation of calcium stones.

Thus, having an understanding of the risk factors for stone formation and acting on them, it is possible to reduce the frequency of recurrent calculus formation.

Diet for urolithiasis

Dieting for urolithiasis helps to reduce the concentration of stone-forming substances in the urine, which in turn helps to stop the growth of small stones and can even lead to the dissolution of large stones.
The principles of a diet for urolithiasis depend on the chemical composition of the stone. The chemical composition of kidney stones is usually established during the examination of a patient with urolithiasis.
Diet for uric acid stones (stones from uric acid crystals) provides for limiting the amount of meat consumed (especially in fried and smoked form, as well as in the form of meat broths), legumes (beans, peas), chocolate, cocoa, coffee. Complete rejection of alcohol and spicy foods.
The diet for uric acid stones can be supplemented with special drugs uricuretics and citrate mixtures that accelerate the excretion of uric acid from the body (Allopurinol, Blemaren, Uralit U) and help dissolve stones. Treatment with uricuretics is carried out for at least 1 month under medical supervision. The dosage of citrate mixtures and uricuretics is selected individually for each patient.
Diet for calcium stones (stones from crystals of calcium salts) provides for the restriction of lactic acid products, cheese, lettuce, sorrel, carrots, black currants, strawberries, coffee, black tea, cocoa. The diet for calcium stones is supplemented with an intake (0.02 g 3 times a day with meals for 1 month).
Diet for phosphate stones (stones from crystals of phosphorus salts) provides for limiting the consumption of all dairy products, eggs, vegetables and fruits. It is recommended to eat more meat, fish, flour dishes.
When cystine stones it is recommended to consume more than 3 liters of liquid per day.

Attention! One of the most important dietary principles for stones of any chemical composition is to increase fluid intake to 2.5-3 liters per day or more. It is desirable that part of the liquid is taken in the form of cranberry juice, which has a strong diuretic effect. If you drink tap waterthen be sure to buy a water filter and drink only filtered water

Herbal medicines used for urolithiasis

With phosphate and calcium stones: madder dye, burdock,.
For uric acid stones (urate stones): leaves, seeds, strawberries, lingonberries, parsley fruits,.
With oxalate stones: knotweed, dill, strawberries, field horsetail,.

Collection of herbal medicines used for urolithiasis

Treatment of urolithiasis with herbs is an integral part of the complex therapy of urolithiasis.

Collecting according to Yordanov: stinging nettle (leaves), calamus (rhizome), peppermint (leaves), field horsetail (grass), black elderberry (flowers), common juniper (fruits), rose hips (fruits). With urolithiasis, take a decoction of 30-50 ml 2-3 times a day with meals.
Collection according to S. Ya. Sokolov: madder dye (root), field steel (grass), drooping birch (leaves), kidney tea (grass), field horsetail (grass), chamomile (flowers), garden dill (seeds). Take an infusion of 30-50 ml 2-3 times a day with meals.

Antiseptic and antispasmodic action for calculi in the urinary tract is provided by the appointment of fees:

Horsetail herb - 10 g; flowers of common tansy - 10 g; lingonberry leaves - 20 g. The broth is taken in 1 glass in the morning during breakfast and in the evening.
Stinging nettle leaves - 5 g; calamus rhizome - 5 g; peppermint leaves - 5 g; field horsetail herb - 15 g; black elderberry flowers - 15 g; linden flowers - 15 g; juniper fruits - 15 g; rose hips - 15 g. The decoction is taken in 1 glass in the morning during breakfast and in the evening.
Parsley fruits - 50 g; anise fruits - 50 g; shepherd's purse grass - 15 g; juniper fruits - 15 g; bearberry leaves - 15 g; steel root - 15 g; dandelion root - 15 g. Take 1 glass of broth in the morning and evening.

Birch leaves - 20 g; steel root - 20 g; juniper fruits - 20 g; celandine herb - 20 g; goose cinquefoil grass - 20 g. 4 tbsp. l. collection, pour 1 liter of boiling water, wait until it cools down, and drink immediately, trying to delay urination as long as possible. A sitz bath is recommended when urinating. Collection is contraindicated when.
In the presence of oxalate stones, the following collection is prescribed: madder root - 10 g; steel root - 20 g; flaxseed - 40 g. Cook and take as the previous infusion.

Relieve renal colic and have an anti-inflammatory effect.:

Bearberry leaves - 10 g; bird knotweed herb - 10 g; hernia herb - 10 g; corn stigmas - 10 g. Infusion is taken in 1/4 cup 3-4 times a day 1 hour after meals.
Celandine herb - 25 g; St. John's wort herb - 25 g; creeping thyme herb - 25 g Infusion (1 liter) is drunk immediately after cooling.
Parsley fruits - 5 g; juniper fruits - 5 g; anise fruits - 5 g; lily of the valley flowers -30 g; birch leaves - 30 g. Take 1/3 cup infusion 3 times a day 1 hour after meals. Contraindicated in glomerulonephritis

Ready-made herbal remedies used for urolithiasis

Cyston take 2 tablets 2 times a day after meals for 4-6 months.
Kanephron apply 2 pills or 50 drops 3 times a day for 2-3 weeks.
Spilled take 5 pills 1-3 times a day for 2 weeks.
Phytolysin take 1 teaspoon of paste in 1/2 glass of water 3-4 times a day after meals for 2 weeks.
Dry madder extract appoint 2-3 tablets (0.25 g each) in 1/2 glass of warm water 3 times a day. The course of treatment is 20-30 days. If necessary, repeat the course of treatment in 4-6 weeks.
Complex preparation olimethine - capsules contain 0.5 g of the drug. Take 2 capsules 3-5 times a day before meals (with - after meals). After the stones have passed as a preventive measure, it is recommended to take 1 capsule per day. The drug is contraindicated in violation of urination, acute and chronic glomerulonephritis, hepatitis, gastric ulcer.
Avisan contains a complex of substances from the fruits of the plant. Take 1-2 tablets (0.05-0.1 g) 3-4 times a day after meals for 1-3 weeks. To facilitate the removal of stones in the absence of contraindications from the cardiovascular system, the patient drinks 1.5-2 liters of water or liquid tea within 2-3 hours. This technique is repeated after a few days.
Pinabin - 50% solution in peach oil of heavy fractions of essential oils obtained from pine or spruce needles. Assign orally 5 drops 3 times a day on sugar 15-20 minutes before meals, the course of treatment is 4-5 weeks. With colic, a single dose can be increased to 20 drops. Contraindicated in nephritis.
Cistenal appoint orally 2-3 drops on sugar 30 minutes before meals 3 times a day (with - during and after meals). With an attack of colic, take 20 drops on sugar. Contraindicated in acute and chronic glomerulonephritis, urolithiasis with impaired renal function, gastric ulcer.
In case of inflammatory processes in the urinary tract, in addition to the appointment of antibacterial agents, they are used decoction of horsetail herb 1/4 cup 3-4 times a day. Contraindicated in glomerulonephritis

Orlovetskaya N.F. candidate of pharmacological sciences, Garbuz A.S., Eremenko V.O., NUPh

Treatment of urolithiasis, depending on the etiological factors, the functions of the organs of the urinary system, urine pH, the state of urodynamics and metabolic disorders, is carried out promptly or conservatively, while the prognosis directly depends on how accurately it is possible to identify and completely eliminate the causes of stone formation, as well as on the effectiveness of the prescribed method of prevention and the presence of complications. In order to choose the right medicine for kidney stones, it is necessary to first determine the nature of the calculus and its location in the urinary tract.

The chemical composition of the main types of stone formation

1. Calcium-containing - mixed, calcium phosphates and oxalates
2. Infectious - ammonium-phosphate-magnesium and struvite
3. Uric acid neoplasms.

Coral calculi are called calculi that occupy absolutely the entire renal pelvis. It is worth noting that the ratio of the chemical composition of stone formation in patients is not the same and depends entirely on the nature of the diet, food products, the salt content in drinking water, environmental conditions, the climatic zone of residence and the patient's age. As a rule, urolithiasis of the kidneys in an elderly person most often occurs in the form of phosphate or urate deposits, and in a young person - oxalate.

Conservative methods for eliminating urolithiasis

Preparations and medicines for kidney stones, prescribed by a specialist urologist, should be aimed at improving the movement of solid chemical deposits through the urinary system, its complete dissolution and the prevention of new stone formation.

The conservative method must fulfill certain important functions:

1. Correct metabolic disorders
2. Resist inflammation of various kinds with kidney stones
3. Strengthen the immune system of a sick person
4. Render positive effect on the hemodynamics of organs.

Dissolving uric acid calculi

Almost all urates dissolve rather quickly and effectively with special alkalizing oral therapy, with the help of potassium bicarbonate solutions and citrate mixtures - uralite U, blemaren, soluran and magurlite. It is important to note that these solutions must be applied freshly prepared three times a day. As a rule, a three-month therapy based on citrate mixtures ensures complete dissolution of stone formation, but it should be carried out under the guidance of a urologist, in the absence of pyelonephritis and satisfactory urodynamics. Drugs for the treatment of urolithiasis of the kidneys of a citrate nature are dosed depending on the patient's pH, where the pH should be in the range of 6.2-6.9, while a sharp alkalization of the urine concentrate can lead to the accumulation of phosphate salts, which impede the dissolution of urates, completely enveloping them.

Crushing of cystine stones

In case of kidney stones of an oxalate nature, the introduction of oxalic acid into the patient's body should be minimized and magnesium salts should be consumed up to three times a day, which have a positive effect on the binding of oxalic acid salts in the intestine and a decrease in their content in the urine. In order to reduce the synthesis of uric acid concentration, the urologist may prescribe treatment with tablets as allopurinol - three times a day. It has been proven that this therapy is able to reduce the frequency of relapses and neoplasms containing calcium oxalates.

Method of crushing and removing phosphatothuria

Preparations for the treatment of kidney stones of phosphate content should be directed to the complete alkalization of urine concentrate, which include alkalis and lemons. The main medicinal drugs that can change the alkaline reaction of urine to acidic are methionol, ammonium chloride, ascorbic, benzoic and boric acids, which must be used up to three times a day.

More details about the functions of the kidneys and the ICD are described in this video:

Modern stone expulsion therapy

Recently, urologists around the world have widely used stone-expelling therapy for kidney stones, while its effectiveness has been proven in reducing pain during the movement of calculus along the urinary tract and increasing the frequency of spontaneous passage of stones. As a rule, urologists can resort to the method of aggressive stone-expelling therapy only if the likelihood of a natural discharge of the neoplasm is high enough. To date, drugs for urolithiasis have become much more varied, more effective and more affordable, but before choosing one of them, you need to consult your doctor in order to avoid side effects and a number of complications.

Medicines for the treatment of urolithiasis and kidneys are effective for patients who have calculi with a diameter of three to seven mm, and with proper adherence to medication, the likelihood of spontaneous discharge of solid deposits increases to 65%.

The main stone-expelling medicines are:

1. Progesterone - designed to expand the lumen of the ureters by influencing adrenergic receptors, thereby reducing the tone of muscle fibers
2. Glucagon is a relaxant of smooth muscle fibers located in the walls of the ureters, which is able to stop strong contractions of the ureters
3. Anti-inflammatory nonsteroidal - pain relievers, the main task of which is to reduce the inflammatory process in kidney stones, where the most common drugs are ketorolac, imuprofen, acetaminophen and indomethacin
4. Amlodipine and Nifedipine are special calcium channel blockers aimed at relieving spasm and increasing the likelihood of stone formation progress, while, to achieve the maximum effect in treatment, urologists prescribe a combination of these medications with hormonal drugs as prednisolone
5. Alpha blockers - have a pronounced effect of relaxation on the wall of the ureter, thereby completely relieving spasm of the muscle layer.

Medicines prescribed for self-discharge of concretions

In the presence of small stone formations, predisposed to independent discharge, most often urologists prescribe special medications for the treatment of kidney stones with the presence of terpenes, which have antispasmodic, bacteriostatic and sedative properties.

The main advantages of a terpene-based kidney stone medicine such as enatin, cystenal, artemizole and avisan are:

1. Causing hyperemia, increase renal circulation
2. Increased urine output
3. Relieve spasm of smooth muscles of the ureters and pelvis
4. Significantly increase peristalsis, thereby affecting the discharge of neoplasms
5. The microbial flora is bacteriostatic.

The most common terpene medicines are:

1. Enatin are tablets for stones, which are prescribed three to four times a day, while one capsule contains 0.17 g of peppermint; 0.034 g of refined terpene oil; 0.25 g of calamus oil; 0.92 g of olive oil and 0.0034 g of purified sulfur
2. Olimetin - tablets for urolithiasis, which are similar in content to enatin and are used three to five times a day for two weeks
3. Spasmotsistenal - used three times a day for renal colic on a sugar cube and consists of essential oils, belladonna and alkaloids
4. Rovatinex - like cystenal, it contains essential oils and oily substances: pinene, pure terpene, camphene, rubia glucoside and fenchol
5. Kanefron is a special drug for urolithiasis, designed to improve the general condition of the patient's body, maximize the discharge of crystals of urine salts, improve urine color, as well as normalize the indicators of general urine analysis, phosphorus-calcium metabolism, urea, creatinine and uric acid
6. Cyston is a medicine for kidney stones of plant origin, aimed at removing uric acid and small stones from the body, regulating the crystal-colloidal balance of urine, providing antimicrobial and diuretic effect, while giving a positive result in calculous pyelonephritis
7. Phytolysin - in the form of a special paste, which has a diuretic, bacteriostatic, antispasmodic and anti-relapse effect in the postoperative period and is applied four times a day after meals in a glass of sweetened water
8. Palin is an antibacterial and antimicrobial medication intended for infectious and inflammatory diseases of the urinary tract, which must be used 2 times a day, while the course of intensive therapy should last at least 10 days from the start of taking the medication.

In order to find out which drug is better for treating kidney stones, first of all, it is necessary to determine the chemical composition, size and location of stone formation, as well as consult a specialist urologist who will help you choose an individual method of crushing for urolithiasis.

Benefits of Palin for urolithiasis

Palin is a unique antimicrobial and antibacterial medication that is widely used in gynecological and urological practice, due to the effective elimination of various infectious and inflammatory diseases of the urinary system. This drug contains the active component of pipemidic acid, which has a pronounced bactericidal property. It is important to note that any self-treatment of kidney stones with pills can lead to undesirable consequences and complications of varying severity, which is why, before you start taking medication, you should consult your doctor-urologist.

The main mechanism of the drug is the ability of pipemidic acid to strongly suppress the bacterial DNA-topoisomerase form, regulate the replication, transcription and repair of DNA bacteria. It should be noted that the use of large doses leads to a bactericidal effect, and at minimum doses - to a bacteriostatic one. Recently, urologists are increasingly using this modern medicine in their practice with ICD: kidney stones dissolve rather quickly and are excreted naturally.

The main indications for the use of the medication:

1. As an intensive care
2. For acute and chronic diseases of the urinary system, provoked by microorganisms
3. As a prophylactic agent for patients with recurrent urinary tract infections
4. In combination with other drugs, they are prescribed for women who have vaginal infections.