Hudzaifah.org - Kidney stones are one cause of kidney failure. First to have to throw it through the surgery. Now, with advanced medical technology, small-sized stones can be destroyed without involving a scalpel.
Mr. Santo (40) had eight months of back and forth to the hospital for dialysis. He admitted, his kidneys damaged because of an infection that had long ngendon stones in their kidneys. Chronic infection is slowly eroding his kidney function. As a result, its function in a short time to live about 5%. Inevitably a lifetime, every three days she had to undergo dialysis.
Kidney disease and hypertension expert, the late Prof. R.P. Sidabutar once declared, chronic kidney stones infection is a factor the second leading cause of kidney failure in Indonesia. In this case the formation of stones occur in bladder (bladder) up or down as well as on kidney cup (calyx), not on the dial. However, a major cause of renal failure in general is an infection of the kidney stones or bladder above.
"Since the '70s the number of people with kidney stones increases. If it comes late '60s rock deposition occurs mostly in the bladder, kidney cup later on," said dr. David Manuputty of RS PGI Cikini.
Renal disease is also much influenced by environmental factors and diet. "The more prosperous a society, more and more happening on the precipitate kidney stones, compared to the bladder," added Manuputty. Consumption of beverages and foods that are less hygienic spur of concentrated urine, thus facilitating the formation of infection or crystal stones in the bladder. Conversely diet advanced societies that tend to choose foods that are calcium-oxalate (for example, processed foods with milk ingredients, cola drinks, high salty foods, sweet foods, high doses of vitamin C, coffee, strong tea, etc..) And uric acid (high in protein ), facilitate the formation of deposits on the kidney because the cup is quickly increasing the concentration of urine.
In addition, an equally important factor is the talent or the person's genetic inheritance. "If one of us have relatives who suffer from kidney stones or urinary stones, it means we have a greater tendency of the same disease than others."
Now the number of patients with bladder or kidney stones in RS PGI Cikini about 530 people per year. Age varies, 20s upwards. Meanwhile, dr. Puji Raharjo of RSUPN dr. Cipto Mangunkusumo added, kidney stone disease that affects 0.5% of Indonesia's population is more common in men than women. When 1-2% of the population examined urine calcium levels will rise, but only 10% affected by kidney stones. This, according to dr. Praise, indicating the existence of other factors that play a role in the formation of stones in addition to basic ingredients. These factors include the lack of body fluids leading to the production of small and dark urine. In their daily work in the open air (farmers, field workers) or in the engine room is hot, especially the lack of drinking, would rapidly effect changes in acidity or alkalinity of urine. The problem, here the inhibiting factors of stone formation is reduced or lost altogether. Or, it could also occur due to an increase in urine calcium mobilization of bone calcium due to someone no longer able to move paralyzed, for example.
Consumption of vitamin C and D of high-dose to a person who is genetically gifted, this disease will make it easier. In the talented rock, consuming 100-300 mg of vitamin C every day, according to dr. David, facilitate the formation of stones. You see, vitamin C-containing high-calcium oxalate. High doses of vitamin D also causes the absorption of calcium into the intestine increases. Cytostatic drugs for cancer also facilitate the formation of stones because it increases uric acid.
Silent Stone
In addition to calcium oxalate stones (60-80%), according to dr. Praise no longer a mixture of calcium oxalate-phosphate that are harder. On radiological examination, this stone looks white like bones because calcium is higher. There is another triple phosphate stones (10-15%) composed of calcium-magnesium-ammonium phosphate (struvite). These stones are formed due to urinary tract infections due to germs Proreous group, Pseudomonas, Klebsicla, or Stafilok. Deer antlers resemble stones form due to urinary tract filling shaped like deer antlers. Then there are cystine stones that occur due to genetic factors. However, a mixture of phosphate and cystine is rare. Meanwhile, because uric acid stones (5-15%) formed due to excessive secretion of uric acid in the urine due to genetic factors is exacerbated by the consumption of foods rich in purines, for example jerohan.
In radiology, the rock type is often not visible unless the element is mixed with calcium. Therefore, in addition to using the CT-scan, examination of kidney stones still require assistance intra-venus injection of concentrated liquid which can then be more clearly seen through ultrasound. "Similarly, in hematuri-macroscopic examination or examination of red blood cells that enter the urine, symptoms of the disease is often not clearly visible (90%)." Although the lab results stated already looked there early symptoms or symptoms sore waist, sufferers often ignored . Next thing I know the stone of chicken eggs, "said dr. David.
"The formation of stones slowly are called silent stones." In general, people just complain after the stones grow and can be detected clearly. Especially when starting a more obvious symptoms such as pain or sore lower back that sometimes feels up to the front of the lower abdomen, occurring colic (sudden blockage in the ducts or ureter abruptly resulting in excruciating pain because of sharp rocks that fell into the channel causes deployment channel) which is often accompanied by vomiting and sweating a lot or have an infection stone so that all channels are infected.
Even damage to the kidneys often does not appear in the system due to the smoothness of the small bowel with a smooth healthy kidneys the urine is not compromised. However, as both kidneys begin to function less ("catch" kidney infection), urine disposal system began to fail. At this stage the urine flow is not smooth or Anyang-ayangen (Bhs. Java), the body of a fever.
Enlarged prostate gland or an infection that attacks the majority of men aged 50 and above are also often cause complications incidence of bladder stones. Enlarged prostate cause disrupted the flow of urine so the urine is easy to form crystals.
Appropriate action
Management of treatment of kidney stones, according to dr. Praise, complaints regarding some of the strategies of symptoms. Early pains eliminated, then the infection and other complications. Finally, of course, attempt to destroy or lifting the stone. Before the stones removed or destroyed would need lab tests, radiology, ultrasound, etc..
In addition to passing the open surgery, the destruction of the kidney and urinary stones can be done with the method or process of destroying the stone lithotripsy uses shock waves or ultrasound. There are two procedures namely lithotripsy ESWL (Extracorporeal Shock Wave Lithotripsy) and Percutaneous Lithotripsy (puncture of the skin) that has been long used in some hospitals in Indonesia. "Method of ESWL of Germany that we use such as playing the jackpot," joked dr. David. Lithotripsy tool is outside the body (see picture). Before the stone was shot, x-rays to determine the position of the stone. Then through the monitor screen, look for more appropriate target. Here, patients should not be sedated. Position the patient supine or face down depending on the location of the stone. After repeated shots on target, fragments of stone will come out with the urine (urine mixed with blood for 12 hours). That patients in pain are not necessarily the process should not be shooting with high pressure.
While the percutaneous method of nefroskop tool (a tool similar to drill a small telescope) equipped with a wave of vibrating tools ultrasosonik conductor, is inserted into the kidney through a hole incision in the pelvis. With the vibrating ultrasonic waves, the stone can be broken and removed, then fragments are also out with urine. Perhaps the patient will feel pain when urinating out through the catheter because of urinary tract somewhat obstructed by fragments of rock.
Solving the stone with both tools require that patients stay in hospital for 2-3 days until the urine is clear again. After a week the patient can return to activity.
A more sophisticated now by using a laser beam. This type of laser used was originally a type of pulse dye. Later, since August 1997 RS PGI Cikini using laser type Ho: YAG or holmium U.S. origin. How, through a hose inserted ureta channel mini fiber, which can directly on the target rocks. If the type of pulse dye only for kidney stones or urinary course, this is more multipurpose holmium type. For example also for the treatment of prostate enlargement or infection, and benign tumors of the bladder.
Holmium this clever set the frequency of shots that rock is not pushed to the top. The distance between fiber hose with stones at most only 1 mm. With the wave pulsation system rocks eventually may be destroyed. Action with the advanced engine is rated faster (1.5 hours for large stone), the risk of bleeding or damage to surrounding tissue and virtually no postoperative pain and risk of complications is almost imperceptible. Patients do not need to stay in the hospital, can go home once awareness has been recovered. The cost is approximately $ 1 million cheaper than open surgery. Complications at most, felt a slight fever and sore after the action, which can be fixed with antibiotics. While the creation of such a cloud of dust (perforation) due to pulsation system earlier, according to dr. David, can be overcome with a continuous stream of physiological saline fluid. To handle the stones in the bladder for example, takes pulse on average 10-20 times per second. To rock the urinary tract (ureters), only 50-10 times per second. Here, patients need to be anesthetized and the condition of the heart, lungs and kidneys should be good so that the target is reached with success.
"How to kidney stones and urinary control is varied," said dr. David. The main one sought his case, the location and size of the stone. Then it is determined to overcome in a way which is most appropriate or a combination of a variety of ways. If the location of the stone is difficult to reach or too large, the only way to surgery. If kidney stones are overgrown start to break, should be lifted, so that healthy kidneys are still not were damaged. "Sometimes, according to dr. Puji, tailor-made shortcuts blockage of urine flow when the stone is difficult or can not be eliminated, so that the healthy kidneys do not participate damaged.
The possibility of relapse can occur if the patient does not pay attention to his health. "In general, bladder stones do not recur again, but not so with the stones in the kidneys," said dr. David. "However, every action should be able to get rid of the stone until it is clean," said dr. Praise. "Having removed the stone reanalyzed its kind, the cause of the stone, how the formation, etc..
Which is technically difficult to be destroyed or cleaned when the location of the stone away from the center of the urinary tract, or numerous and scattered. The most trouble when major surgery is not possible in the patient because the condition is weak or has some other disease. In such cases it would be done before action levels need to be studied carefully by examining the rock-forming substance forming substances in urine levels (stored for 24 hours) could then be analyzed concentrations of such substances. Only then what action is most appropriate and safe can be done. Stone is not organic (oxalate and calcium phosphate) according to dr. David usually can not be dissolved only with drugs, so it should be taken as above.
Businesses that need to be taken so that this disease does not recur al by drinking enough water to urinate out 2-3 a day. "If you need to drink before bed to urinate at night no less," said dr. Praise. Fresh drinks like cola or other carbonated beverages, not recommended for those who suffer from calcium oxalate stones, but not for uric acid stones.
Treatment and prevention of relapse is not much determined by the type of stone. For example, calcium stones caused by an increased calcium excretion in the urine can be prevented or reduced by reducing the intake of calcium in foods such as processed foods from the dairy cows, high soy for example. Or, the doctor gives a drug efficacious in reducing the excretion of calcium. For this type of stone excretion of uric acid is usually given alupurinol drugs that can reduce the recurrence of uric acid stones. Because uric acid stones easily formed in acidic conditions it is necessary also for example by changing the acidity of the atmosphere of sodium bicarbonate in addition to drug alupurinol earlier. While the stone is not accompanied by the excretion of calcium or uric acid is high, try to drink a lot first, do not need medication.
Exercise such as walking or jogging one morning along with drinking plenty of the smooth discharge of urine is highly recommended dr. David and dr. Praise. For someone who is talented kidney stones or urinary stones, should always observe the daily food consumption. Drinking water at least 5-8 glasses a day. Soto jerohan beef, ice cream, cheese, milk shakes, coffee, cola, was delicious, but remember, too much food and delicious drinks will ease the formation of stones in your kidneys! (Idionline / klippers)
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