In many cases the stones formed in the kidneys, so small that they are more or less easy to go along with the urine. Those or other methods break up kidney stones are used only in cases where due to their large size stones can not go out without surgery. Usually, crushing kidney stones assigned when stones diameter exceeds 6-7 mm.

Ways to break up kidney stones: ultrasound

Ultrasound fragmentation of kidney stones, or Remote shock-wave lithotripsy - the most common current methods of treatment for kidney stones. During the procedure, the ultrasonic wave acts on the rock outside the body - that is, through the skin.

This method has certain limitations. For example, crushing kidney stones ultrasonication Crushing kidney stones with ultrasound - safe and virtually painless   not suitable for patients who rocks formed more than two centimeters in diameter. This procedure is also not recommended for pregnant women, people with bleeding disorders, some infectious diseases, severe diseases of bone, and patients with extreme obesity.

Ultrasound breaking up kidney stones began to be used in the early 1980s, and to date, this procedure is a tool of first choice in the treatment of large stones. Since it is non-invasive, associated with it is much less risk than surgery, which in some cases are also used for the treatment of urolithiasis Kidney stones - why women tolerate it harder? .

Although the procedure of crushing of stones in the kidney is performed without incisions and sutures, it is very painful, so its use of local or general anesthesia. Once the patient is on the operating table, and start acting anesthetics, doctors using ultrasound establish the exact location of kidney stones, and then "hitting" them with ultrasonic waves. To destroy gems, you need one or two thousand of such attacks. First, shock waves are sent to the stones is not immediately after each other, and after a certain period of time, and gradually increasing their frequency - this provides the most effective destruction of kidney stones. The surgeon then inserts into the urethra of a thin flexible tube made of plastic to facilitate the entry of stones. The procedure takes a total of 45 to 60 minutes. Usually, the patient remains in the hospital for a few hours, but in the evening to go home.

In the weeks following the break up kidney stones fragments will gradually come out in the urine; patients are advised to collect them for analysis. At this time, it is recommended to drink plenty of fluids, and if necessary, take painkillers. Sometimes, patients can be administered calcium channel blockers or alpha blockers - according to the results of several studies, these drugs make it easier to output kidney stones after they split.

The consequences of fragmentation of kidney stones with ultrasound. Some time after the procedure, the patient may experience symptoms such as blood in the urine Blood in the urine - a reason for serious concern , Abdominal pain, and sometimes - severe cramping that can accompany yield large fragments of stones. Approximately 50-75% of patients within one month after the ultrasonic crushing kidney stones completely eliminated from the body; the remaining kidney fragments may be more or less large. The most successful, this procedure occurs for patients whose kidney stones diameter does not exceed 1 cm. Occasionally, patients remain large stone fragments, and their removal requires additional treatments. In rare cases, serious complications arise, such as internal bleeding, which may require a blood transfusion, tissue damage in the kidney stone blocking the ureter or a piece of stone.

If after the procedure you would feel a strong urge to urinate, even if you just emptied your bladder, or severe pain, which does not help to cope analgesics, contact a doctor immediately. However, most patients remote fragmentation of kidney stones do not cause any major complications, and they can return to work within 1-2 days after the procedure.

Contact lithotripsy

Contact fragmentation of kidney stones can be administered to patients who, for whatever reason are not suitable crushing kidney stones with ultrasound. This procedure is performed under general anesthesia. The doctor inserts a cystoscopy into the ureter through the urethra, and there effect on stones with ultrasonic waves. Thereafter, the fragments are crushed stones leave alone, but sometimes with a special tool was collected during the procedure. Contact crushing lasts, on average, thirty minutes, and is effective in almost 100% of cases; using this method successfully removed even very large and dense rocks, are not amenable to percutaneous exposure to ultrasound. Complications of contact lithotripsy may be:

• Hematuria - usually passes in a few days;
• Perforation of the urethra;

The migration of stone. To the doctor can better see the stones in the ureter before the procedure under relatively strong pressure is applied water, because of what the stones can get into the kidney, where they will not be able to work using urethroscope. If this occurs, the operation usually has to bear.

Laser lithotripsy

An alternative to the procedures described above is a laser fragmentation of kidney stones, or laser lithotripsy. Thin tool at the end of which the camera is also inserted through the urethra and bladder into the urethra. The laser beam is supplied through a thin wire (its thickness is 0.2 mm), which is sufficiently flexible so it can be used to direct laser was stones positioned in the ureter and kidney. This significantly reduces the risk of damage to adjacent tissues. Crushing kidney stones laser is performed under general anesthesia and lasts from ten minutes to one hour, depending on the size and number of stones.

This procedure is safe and rarely causes complications. However, in some cases, it can cause damage to the urethra, bladder Urinary bladder - structure and function   or kidney disease. There is a small probability of severe internal bleeding and infections and complications associated with general anesthesia. Typically, the most serious complications occur in a couple of days after the procedure.

Kidneys - a body whose task is to filter the blood. Dialysis - a procedure that can take on the duties of the kidneys. It becomes necessary when the accumulation of waste in the body leads to a significant deterioration of the patient's health. Increased waste is usually slow.

To decide whether the required dialysis for a specific patient, checking the level of various chemical substances in the blood. The two most important of them - creatinine Creatinine - will talk about the work of the kidneys   and blood urea nitrogen. Increased levels of these substances in the blood indicates that the kidneys can not properly cleanse the blood of waste products. Liver function is also evaluated by comparing the level of creatinine in the urine and blood. If the patient feels very sick, complaining of heart problems, lung, stomach, if it is broken, the ability to taste and / or reduce the sensitivity of the legs, dialysis may be appointed regardless of the results of analyzes.

Types of dialysis

During hemodialysis patient's blood passes through a special filter. The blood of a special plastic tube enters the dialyzer is cleaned and infused back into the patient.

As a rule, you must go to dialysis twice a week, each treatment lasts from 2, 5 to 4, 5 hours. During this time, medical personnel repeatedly measures the pressure in the patient and adjusts the dialyzer, to ensure that the body of the patient takes the required amount of fluid.

During peritoneal dialysis as a filter used by the body tissue of the patient. The intestine is located in the abdominal cavity, the space between the abdominal wall and the spine. During the procedure, the abdominal cavity of the catheter through which the solution is poured into a special "washing" the intestine. The walls of the intestines begin to play the role of a filter between this fluid and blood flow. Using different solutions can excrete excess of both liquid and waste.

The procedure usually takes half an hour and should be held four or five times a day.

Selection of the type of dialysis is carried out for each patient based on lifestyle, presence of other diseases, and other factors. Regardless of the type of dialysis patients must adhere to a certain diet, monitor the fluid intake, taking vitamins and other drugs to control blood pressure, as well as the level of calcium and phosphorus in the blood.

For many patients, hemodialysis major advantage Hemodialysis: artificial kidney   it turns out that from them in the course of this procedure, virtually nothing is required - doctor or nurse customize the dialyzer and perform other necessary actions. A significant disadvantage is that the patient has to travel regularly to the hospital.

The advantage of peritoneal dialysis is a more flexible schedule and procedures to conduct them at home. On the other hand, peritoneal dialysis must be done every day, without exception. The biggest problem with peritoneal dialysis is a high probability to carry infection. However, prior to treatment of patients using the device taught spetsiano dialysis to reduce the risk to a minimum.

How does dialysis?

Like the work of healthy kidneys, dialysis supports the normal condition of the body. The essence of its operation is that it is:

• It removes toxins from the body, salt and excess fluid, preventing them from accumulating
• It maintains the normal ratio in the blood components such as potassium, sodium and bicarbonate
• It helps control blood pressure

Always there is irreversible renal failure?

Sometimes, in acute kidney failure, dialysis may be required only for a short time until the kidneys is restored.

In chronic renal failure Chronic renal failure - what to do and how to be? Or when passing in the terminal stage of the disease, the kidneys will not be restored and there is a lifelong need for dialysis. In that case, if your doctor says that you are waiting for just such a prospect, you can also be in a queue and a kidney transplant.

Where are the sessions of dialysis?

Dialysis can be prepared in a hospital, in a dialysis centers, which are autonomous institutions, or at home. Together with your doctor, you have to decide which of the sites based on your medical condition and your wishes, suits you best.

There are two types of dialysis - hemodialysis and peritoneal dialysis.

What is hemodialysis?

Hemodialysis, artificial kidney (hemodialyzer) is used to remove waste from the blood substances. To hit a blood artificial kidney, doctors need to have access to the blood vessels. This is done by a "small" surgery in the hands or feet.

Sometimes hemodialysis access is by implanting under the skin covering the artery into the vein, in order to get a broader blood vessel called a fistula.

However, if the type of the blood vessels is not appropriate to create a fistula, doctors use a stent - a flexible plastic tube, which is under the skin connecting an artery to a vein.

It also happens that the access is through a thin plastic tube - a catheter - which is sewn into a wide jugular vein. This type of access can be temporary, but is sometimes used in the long-term treatment.

How long does a session of hemodialysis?

The time required to dialysis depends on:

• how the kidney
• how much fluid is used between each session
• how many toxins in the body
• how much weight the patient
• what type of artificial kidney apparatus used herein

The high-dialysis, kind of dialysis takes less time session. If this kind of treatment is acceptable - you can offer it to the doctor.

What is peritoneal dialysis, and what is its essence?

During such dialysis blood is cleaned inside the body. Doctor performed surgery for sewing plastic tube - a catheter - into the abdomen (belly) for dialysis access. During the session, the abdomen (called the peritoneal cavity) through a catheter is gradually filled with dialysate. Blood enters the blood vessels, which are covered by the abdomen. Excess fluid and decomposition products diffuse into the dialysate. There are two main types of peritoneal dialysis.

What kinds of peritoneal dialysis there and what are these treatments?

There are several types of peritoneal dialysis but two major ones are:

• Continuous ambulatory peritoneal dialysis (CAPD) - the only type of peritoneal dialysis that is done without the help of machines. It is performed alone, usually four or five times a day, at home and / or at work. The contents of the container with the dialysate, about two quarts (about 2 liters) is poured into the abdominal cavity through the catheter. The dialysate remains there for 4 - 5 hours and then drained. This process is called an exchange. After each exchange of new capacity is put to the dialysate. At the time, while the dialysate is in the peritoneal cavity, can go about their daily lives at work, at school or at home.
• Continuous Cycling Peritoneal Dialysis (CCPD) - usually performed at home using a special device - a cycler. This type of peritoneal dialysis is similar to continuous ambulatory peritoneal dialysis, with the only difference that the change of cycles (exchanges) happens automatically. Each cycle typically takes 1 - 0.5 hours and at night, while you sleep Dreams: how to understand our dreams , Exchange occurs repeatedly.