What inspections should kidney stone be done? 's treatment

What inspections should kidney stone be done? 's treatment
Check in the laboratory:
1.The urine is generally tested and can be divided into checking and special inspection.
(1)Generally check mainly as the urine routine: It includes pH, relative density (proportion) Erythrocyte, the intersection of suppuration and cell, albumen, candy, crystal,etc.. Can find hematuria, crystal urine and suppuration cell,etc. in the urine of patient Shi of the urine. The level of urine pH value is often briefed on calculus of a certain type: The phosphoric acid calcium, carbonic acid apatite calculus patient's urine pH value is often higher than 7.0; And urine acid, urine pH value of the cystine and oxalic acid calcium calculus patient are often less than 5.5. It is obvious the mirror plays hematuria or hematuria of the naked eye. But 15% of the patients have no hematuria. Non-infective calculus, there can be slight pyuria.
(2)Check specially and include:
Urine crystallization is checked: Should leave and fetch the fresh urine. There is cystine calculus such as seeing benzene a kind of cystine crystallization point out; Find the intersection of urine and sour crystallization in the urine, brief urine on often sour calculus possible; Find the crystal of kind of envelope may be two water calcium calculus oxalic acid; It is phosphoric acid magnesium ammonium crystal that the coffin covers a kind of crystal; Will find sulfanilamide crystallization in the urine of the patient suspected to have calculus of sulfa drugs.
The urine bacterium trains: Colony gt; 105 ml person is positive. Medicine quick to test, can understand the most effective antibiotic. The urine is trained if as producing the bacterium of the urea, it is possible to infect with calculus and exist.
The laboratory test of 24h urine: Must collect the urine of 24h correctly, the urine is measured accurately. The content tested includes: 24h urine calcium, phosphorus, magnesium, citron acid, urine acid, oxalic acid, cystine,etc..
2.Blood biochemistry is checked
(1)Serum calcium of normal adult is 2.13- 2.6mmol/L (8.5- 10.4mg/dl) ,The inorganic phosphorus is 0.87- 1.45mmol/L (2.7- 4.5mg/dl) . Serum calcium of patient that the gland function is hyperfunction is higher than the normal value by primary first form, often in 2.75mmol/L (11mg/dl) The above, and reduce with the inorganic phosphorus of serum at the same time.
(2)The male serum uric acid of normal adult does not exceed z416.36mmol/L (7mg/dl) ,Women are less than 386.62mmoL/L (6.5mg/dl) . It is high urine acidaemia when exceeding this value. Hematuria and acid of patient of gout increase.
(3)Kidney stone often has acidosis with the renal function obstacle, the serum electrolyte changes at this moment, serum sodium and the intersection of carbon dioxide and cohesion reduce, the intersection of blood and the intersection of potassium and at various degrees rising. Renal tubule can appear low potassium and high the intersection of chlorine and courageous and upright acidosis when the acidosis.
(4)Examining the renal function that should be able to understand the patient of urea nitrogen and skin anhydride, there can be increasing at various degrees in urea nitrogen, skin anhydride in the blood when the renal function is damaged.
In a word, urine blood and the intersection of urine and liquefaction of patient Shi test, contribute to, understand urine renal function, calculus of patient Shi erupt infection, calculus possible type and calculus cause simultaneously, and to guiding the treatment of calculus and preventing from working.
The image learns to check:
1. last urine way calculus most important method X-ray examination. Include the intersection of belly and flat block, the intersection of urine and the intersection of way and radiography of excreting etc., drive in the wrong direction the intersection of renal pelvis and radiography, or make, puncture radiography,etc. by leather kidney.
(1)Flat slice of urine way: Flat slice diagnoses the most basic method of way calculus of the urine in the urine way X-ray. According to kidney, ureter, bladder, the intersection of X-ray and shade completely of urethra area, can so preliminary that produce diagnosis to have calculus. The calcium content in calculus is different, seeing through the intensity to the X-ray is different too. About 40% calculus can until dense shadow that reveal judge the composition of calculus at the intersection of X-ray and flat sheet, the intersection of oxalic acid and the intersection of calcium and the intersection of calculus and X-ray completely most; Phosphoric acid magnesium ammonium takes second place; Urine is sour most common in calculus can X-ray calculus completely. The intersection of cystine and calculus slightly X-ray completely because of including sulphur. But indeno the intersection of ground and calculus and some the intersection of ground substance and calculus Wei that flat CT that sweep to can develop in slice. Kidney calcification common on the intersection of medulla and the intersection of sponge and kidney (close, deposit expand gather and manage) . The density that can also be dashed for ward with the lumbar vertebrae sideways is compared, and make diagnosis. Have to it includes the intersection of calcium and difficult calculus to be flat for block to find X-ray 10%.
But the calcification shade of the belly is obscured with urine way calculus. The shade of the calcification is mainly as follows, filth and gas in the intestine. Calcification shade of mesenteric lymph node. The island of bone of the skeleton part is formed (such as the area of articulation sacroiliaca) , the 11th, 12 costal cartilage calcide. Pelvis intravenous calcification of area form " The intravenous stone " Shade. External foreign matter is interfered with (take knot,etc. made such as the button, trousers) . Digestive tract barium pharmaceutical has not arranged net barium pharmaceutical after checking.
(2)The excreting way radiography of urine: The excreting way radiography of urine except can further confirm the X-ray shade and relation on the urine way completely on the flat sheet of X-ray, can be seen, suffer from side the intersection of the urine and Luis develop the delay also; The kidney shadow increases; Renal pelvis and obstruct ureter above, expand, tortuous etc. and change, and the renal function situation according to this. Need to lengthen the time of the radiography in order to suffer from the side satisfiedly and develop if necessary. To losing calculus of section of tube wall of urine, the plentiful bladder shadow can conceal the image of calculus, can advise a patient to take a photograph of one more slice of after urinating at this moment. Can calculus of the X-ray can be shown as and full of defect at the intersection of IVU and block completely. Can also understand situations such as renal shape, having deformity,etc. through IVU one. Can also demonstrate relation (Fig. 1) between calculus and set system between a diverticulum of the kidney through IVU .
(3)The X-ray radiography at the time of acute kidney angina is checked: To unable to define patient that diagnose, the intersection of emergency call and the intersection of kidney and now for the intersection of kidney and picture of obstructing etc. chart by routine inspection, can carry on the excreting urine way radiography inspection immediately. So long as prepare the essential one well (such as relieving pain for the patient) And lengthen the time of the radiography appropriately, most patients can obtain clear diagnosis. It is mainly shown as: Suffer from the side kidney and develop time delay (generally in 120- 240min can achieve the goal hour) , the renal volume increases, radiography pharmaceutical excretes the blockage on the position of calculus. In view of the above, can define the diagnosis of calculus. The emergency call secretes the mechanism that the urine is the radiography: The urine way is acute while obstructing on one side, strong in the renal compensation function of side and can't present quickly, enable radiography pharmaceutical to be held up in longer time in the blood. The ureter is acute after obstructing, have reflux that takes place to suffer from the side kidney inside. Reduce and suffer from the pressure of the urine way on the side on one hand, improve the blood circulation of the cortex of kidney, longer time maintains the function of the nephron; On the other hand make to obstruct the urine of the above retention of the position brings in constant renewal in, and get radiography pharmaceutical from the blood, after some time to make at last to obstruct in the above-mentioned positions and develop clearly.
(4)The radiography of driving in the wrong direction: Need the intersection of conduct and radiography of driving in the wrong direction in order to assist to diagnose in case of the following: While causing the excreting way radiography of urine to be unsatisfied with because of various reasons; The excreting way radiography of urine finds the kidney, ureteral pathological change, while needing further defining the position, range and property of pathological change; Suspect there is negative calculus in the kidney, at the time of polyp; Some the intersection of kidney and deerhorn type calculus in front of the operation, drive in the wrong direction radiography can help to understand calculus, renal pelvis, relation of one of kidney. Radiography pharmaceutical can be in order to be suffused with the shadow Portugal amine, it can also be the air. With diagnosing the constant progress of technology, drove in the wrong direction the application of the radiography has already been greatly reduced.
(5)The kidney punctures the radiography: When the radiography of driving in the wrong direction fails, can carry on the kidney and puncture the radiography. Because may cause some complications, so already seldom used now.
2.Kidney the intersection of picture and kidney picture to diagnose urine a that way obstruct safe and reliable, too simple and convenient to have painful method, can understand and divide the unobstructed situation of urine way on renal function and every side, as understanding the condition is developed and observe the index of curative effect. Its sensitivity is far higher than excreting way radiography of urine. Diuresis kidney picture can obstruct to functionality and machinery obstruct, go on distinguishing. At the time of acute kidney angina if the urine has had erythrocytes when KUB has not seen the shade of calculus but can't be diagnosed clearly conventionally, but check in kidney picture of walking of the emergency call. Present, suffer from the intersection of side and the intersection of kidney and picture of obstructing etc., can confirm to be, suffer from side the intersection of the urine and Luis obstruct, and distinguish with other acute abdomens.
3.Can diagnose whether there is calculus to check in the kidney and there are other amalgamation pathological changes while checking Ultrasonography B in supersound, whether there is water accumulation to confirm the kidney. Can especially can find the intersection of urine and the intersection of way and calculus of X-ray completely, can also damage with some cause of disease of calculus offering certain evidence to kidney that calculus lead to the fact. But Ultrasonography B has certain limitation, it can't distinguish renal calcification and calculus, can't understand the relation between the calculus and kidney, can't find out the concrete influence on the kidney of calculus either ocularly, the more important thing is Ultrasonography B can't until how treat calculus, offer enough evidences. About more than 1/4 of the patients with normal Ultrasonography B diagnose as ureteral calculus when IVU check. So Ultrasonography B to urine diagnosis, way of calculus can only as one auxiliary or screening test. After Ultrasonography B finds that there is calculus, should act as, check further, such as excreting way radiography of urine,etc..
4. check to need to if you can't make CT by CT, check urine patient Shi all. CT can reveal renal size, outline, kidney stone, kidney water accumulation, kidney essence pathological change and surplus situation of the kidney essence while checking, still can distinguish kidney cyst or kidney water accumulation; Can recognize urine the intersection of urine and way that cause obstruct pathological change such as tumour, the intersection of pelvis and tumour,etc. behind the peritoneum beyond the road; Can find out about renal function while strengthening the radiography; Depleted to the acute renal function caused by calculus, CT can contribute to the establishment that is diagnosed. So negative calculus and some that develop to X-ray only unable to confirm, diagnose then influence the intersection of operation and urine patient Shi that method choose through routine inspection, just need to carry on CT inspection. Non- enhanced spiral CT (NCHCT) Get application because the materials can be stored, rebuilt. The time to check is fast, the side effect low, without radiography pharmaceutical of the expenses, dosage radiated are small, can also be (such as appendicitis, ovarian cyst) with other belly and kidney angina and disease apt to obscure Distinguish. It diagnoses sensitiveness of kidney, ureteral calculus among 96%-100%, the specificity is among 92%-97%.
The range of the scanning of NCHCT is ensiform process to the lower side of the pubic symphysis. On NCHCT slice, all calculus is the high density, and can reveal the water accumulation of kidney and thickness of the kidney cortex.
5.Magnetic the intersection of resonance and magnetic the intersection of resonance and the intersection of urine and the intersection of way and to diagnose urine way expand very much effective radiography. Obstruct, diagnose to 96% the intersection of urine and way effective, especially to the intersection of renal function and damage, the intersection of radiography and the intersection of pharmaceutical and irritation, examiner, X-ray of taboo. Also suitable for pregnant woman and children.
Calculus reveals the low signal on the magnetic resonance. But need to study materials and blood clot to distinguish according to medical history and other images.
Formation of image of way of urine of magnetic resonance (MRU) Through make moisture the intersection of organ and apparent formation of image of principle that looks like to heavy the intersection of T2 and the intersection of weighting and result. This technology is slow to the velocity of flow or liquid stopped is (such as cerebrospinal fluid (CSF), bile, urine) Very sensitive, present the high signal; And substantive organ and liquid flowing present the low signal, reach the clear result of formation of image of water. This technology does not need radiography pharmaceutical, have radioactive rays, have advantage such as being safe, easy and simple to handle, can obtain the result of similar excreting way radiography of urine. On MRU, kidney stone, bladder calculus are shown as the low signal, is shown as and full of defect compared with high signal of urine around. However, it needs to distinguish with clot, tumour,etc.. MRU get rid of used in whom ureteral calculus cause, obstruct, the intersection of urine and way obstruct at the cause to other reason (such as the intersection of renal pelvis and ureteral narrow intersection) , ureteral cyst, ureteral the intersection of malposition and opening,etc. have very good diagnosis function too.
|