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Harrison's Principles of Internal Medicine, 18e
| Part 13. Disorders of the Kidney and Urinary Tract > |
Chapter 287. Nephrolithiasis
Sections: Nephrolithiasis: Introduction, Further Readings.
Topics Discussed: nephrolithiasis.
Excerpt:"Kidney stones are one of the most common urologic problems. In the United States, ~13% of men and 7% of women will develop a kidney stone during their lifetimes, and the prevalence is increasing throughout the industrialized world.Calcium salts, uric acid, cystine, and struvite are the constituents of most kidney stones in the western hemisphere (Chap. e14). Calcium oxalate and calcium phosphate stones make up 75–85% of the total (Table 287-1) and those constituents may be admixed in the same stone. Calcium phosphate in stones is usually hydroxyapatite [Ca5(PO4)3OH] or, less commonly, brushite (CaHPO4H2O), although the incidence of brushite stones is increasing.A stone can traverse the ureter without symptoms, but passage usually produces pain and bleeding. The pain begins gradually, usually in the flank, but increases over the next 20–60 min to become so severe that narcotics may be needed for its control. The pain may remain in the flank or spread downward and anteriorly toward the ipsilateral loin, testis, or vulva. A stone in the portion of the ureter within the bladder wall causes frequency, urgency, and dysuria that may be confused with urinary tract infection. The..."
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