=Renal calculi= are concretions formed by precipitation of solids
derived from the urine, and are found in the kidney or its pelvis. If
large, they are called stones; the smaller masses are known as gravel
or sand, according to their size. When the stones attempt to pass
through the ureters, it brings on an attack of renal colic; rarely are
they voided without this symptom.
=Osteopathic Etiology and Pathology.=—The affection occurs at all ages,
more commonly, however, in children and in old people. The male sex is
more liable than the female. Sedentary habits, gout and excessive meat
eating are predisposing causes. Heredity seems to be a predisposing
cause in some families. Inflammation of the pelvis of the kidney,
caused by derangement of the ribs and vertebræ of the tenth, eleventh
and twelfth dorsals or first lumbar, is an important etiological factor.
=Pathologically=, the chemical varieties are:
(1) =Uric acid and urates= are the most common. The stones are usually
smooth or lobulated; are hard and of a reddish color. Usually in these
stones, both uric acid and urates are to be found. This material may
be passed in the form of sand or large stones. The sediment in the
urine may be the nuclei of the stones; as may foreign matters, such as
the mucus or desquamated epithelium caused by the inflammation of the
pelvis of the kidney, blood clots, or, in fact, any foreign matter that
may reach the urinary passages. Individuals passing a small amount of
urine, and old people are the principal subjects. “As a consequence of
concentration and high acidity of the urine, the uric acid and urates
are readily separated in solid form and held together by the albuminous
matrix.”
(2) =Phosphatic Calculi= are white in color, soft and mortarlike. They
are composed of phosphate of lime, ammonia and magnesium phosphate.
These are found more often in the bladder than the kidney. Disease of
the bladder is the cause.
(3) =Oxalate of Lime= are a mixture of oxalate of lime and uric acid.
They are dark in color, very hard and uneven, with hard, pointed
projections. On account of their uneven shape they have been named
mulberry calculi. These stones produce great pain as they pass through
the ureters.
There are other concretions of rare occurrence.
=Symptoms.=—There is pain in the back in the region of the kidneys
with more or less tenderness. The pain may be severe and paroxysmal.
There may be bleeding, which is seldom profuse; this will give the
urine a smoky hue, but may be present to such a small degree as to be
only apparent by the use of the microscope. The stone may obstruct
the ureter and cause pyonephrosis or hydronephrosis. Pyelitis of a
catarrhal character is common. In pyelitis there may be intermittent
fever of several degrees, then sweating. There may or may not be pus in
the urine.
=Renal Colic= is caused when the calculus attempts to pass through the
ureter so that ureteral spasms result. The stone, however, may become
lodged at the entrance to the ureter. There is a sudden onset and great
pain which starts in the back, radiating downward into the groin,
down the side of the thigh and into the testicle and glans penis. The
testicle is often retracted, the face pale, the features pinched, and
there is frequently vomiting. There are cold sweats and the pulse is
weak. The paroxysm may last only a few minutes or extend over several
hours. If uric acid is found, it points to uric acid or oxalate of
lime calculi and the urine is acid in reaction. If alkaline phosphatic
stones may be suspected, examination of the urine directly after the
attack aids greatly in diagnosis, for at other times the urine is
usually negative.
=Diagnosis.=—=Biliary Colic.=—The jaundice in biliary colic comes on
very soon after the obstruction begins. The stools are without bile
and the pain extends from the right hypochondriac region to the upper
abdomen and the right shoulder. The urine is negative and a stone may
be passed in the stools. =Renal colic= is often =simulated= when the
ureter is obstructed from any cause whatever. It may be compressed from
a floating kidney or tumor, or obstructed by a clot of blood, fragments
of hydatid cysts or plugs of mucus. =Lumbo-abdominal neuralgia=,
=intestinal colic=, =and renal tuberculosis= may simulate renal colic.
The X-ray plate is of decided value.
=Prognosis.=—As complications may arise, it is best to give a guarded
prognosis, but the prognosis is generally favorable. It is a disease
that is very apt to recur when strains or falls affect the innervation
to the kidney, but many cases have been permanently cured. If the stone
is large, its passage along the ureter may prove fatal unless surgical
interference is instituted at once, but if it is renal sand it may be
easily voided in the urine and thus the prognosis will be favorable.
=Treatment.=—Treatment should be given toward overcoming the cause
producing the calculi, which will often be found at the tenth rib.
Treat the kidneys thoroughly, both through the renal splanchnics
and directly through the abdomen, anteriorly. But direct abdominal
treatment should be given very cautiously. Treatment here corrects
disorders and seems to release some solvent that acts upon the various
forms of calculi and disintegrates the ones already formed and prevents
the formation of others. Possibly this solvent is an internal secretion
of some gland; possibly like the splenic secretion is to the biliary
calculi (Dr. Still.). Dr. Still held that one of the functions of the
suprarenal capsule was to prevent the formation of these concretions.
In the =uric acid tendency=, the free use of alkaline mineral waters
for the solution of uric acid may be helpful. Much may be done by
dieting. The amount of nitrogenous food should be limited, eating a
minimum amount of meat and using plenty of milk and vegetables. In the
=phosphatic tendency=, diluted drinks freely used are helpful. Meats
are indicated. Milk and vegetables should not be used freely as they
tend to make the urine alkaline. In all instances care of the general
health and avoidance of beer drinking and excessive meat eating are
demanded.
During an attack of =renal colic=, when a stone had lodged in a ureter,
one may be able, by very careful manipulation, to aid the stone in
its progress downward, (somewhat after the manner of manipulating
gall-stones), but do not delay surgical measures too long. By
inhibiting the nerve force of the spinal nerves along the lumbar and
sacral regions (chiefly tenth dorsal and first lumbar), relief may
be given. The nerves of the ureters are derived from the inferior
mesenteric, spermatic and pelvic plexuses. Employ the hot bath; this
may relax the spastic condition. Cloths wrung out of hot water and
applied locally are of aid. Occasionally a change of posture will
give relief. Even inversion of the patient is sometimes followed by
immediate cessation of the pain. The patient may drink freely of hot
lemonade or water. An anesthetic may be of aid in the manipulation
of a renal calculus in the ureter, as the anesthetic will relax the
tissues over the abdomen, making it much easier for one to get near
the impacted calculus, but =be cautious=. Morphine may be necessary.
During the intervals the patient should lead a quiet life and avoid
sudden exertions of any kind. It is important to keep the urine
abundant, consequently have the patient drink a large quantity of
distilled water. “Renal calculus is brought about by lesions affecting
the suprarenal capsule of the kidney, or spinal lesions from the tenth
dorsal to the first lumbar, affecting the lower ribs.”