Vanjukov Dmitry Anatolevich Zavedujushchy therapeutic branch. Military sanatory SibVO "Eltsovka"

the Stone urine, and ability of the doctor

Occurrence of each kind of stones it is connected with the certain reasons, but is i the general factors promoting kamneobrazovaniju:

a. In connection with their superfluous allocation because of those or others exchange infringements - for example, giperparatireoidizm and a bone trauma, lead raised to allocation with urine of calcium and phosphates;

b. Owing to small diureza in the conditions of reaction of the urine interfering their dissolution that can occur owing to change rn urine and maintenance reduction in urine so-called protective kolloidov, oversaturated solutions providing stability. Urine is 2 substances (kolloidy and kristalloidy) which keep each other and not allow to salts to drop out in a deposit.

MKB many reasons can have Theories, however a definitive explanation of occurrence mochevyh stones in all details till now to give it is impossible. Basically it is possible razlichat two categories of theoretical explanations of education of uric stones:

• the First theory explains urolitiaz speaks exclusively physical and chemical processes, such as giperekskretsija, glut and crystallisation - i.e. processes which occur in tubuljarnyh gleams and is not mentioned by cages.
• the Second theory - more fashionable and modern - cellular. Defeat of cages precedes education of stones. Some researches speak well for the concept of primary cellular damage (data with 4th European a symposium on uric stones. Tjubingen, on April, 1-3st, 1993).

Some newest researches (1996) The concept pervichnogo speak well for cellular damage, including an establishment of the genetic nature MKB.

Pochechno-stone illness amazes half of representatives of families in which ona it is observed. It proves once again its genetic nature.

For a long time it is noticed, that MKB "is linked" to a female H-chromosome. Therefore infringements v to the given chromosome affect first of all at the men having only one takuju form of a genetic material. At their women two, therefore mutations in a gene dovolno appear often "are covered" by a normal gene in the second H-chromosome. Eto also explains that fact, that pochechno-stone illness meets at 12 % of men i only at 5 % of women (though, of course, these data rather conditional since vrjad li who managed to collect the full statistics).

It has been proved, that the gene of the given disease is localised in a short shoulder of the H-chromosome (mutations in this site conduct to heavy disease of people). What it for a gene? Eto a gene of the albuminous channel "exchanging" ions of chlorine on ions of calcium. It udivitelnoe opening as till now was considered, that same illness Denta vyzyvaetsja as calcium frustration, but at all chlorine. It is known already a little tipov chloric channels. The fifth type of the chloric channel (ХлК5) is specific to kidneys, and tochnee - epitelija nephritic klubochkov and kanaltsev. Calcium, as is known, svobodno is filtered from blood in klubochkah nefrona, but then 70-80 its % should vsosatsja back in kanaltsah. The mutation in a gene of the chloric channel breaks normalnyj ionoobmen therefore superfluous calcium is postponed in a kind nefrolitov.

Introduction of such medicines protecting cage as antagonists of calcium, in eksperimente has allowed to lower education of stones in spite of the fact that not nabljudalos respective improvement of indicators of urine and blood whey.

results of researches Available now yet do not allow to make okonchatelnyh conclusions about, whether cellular infringements precede education kamnej or they come again because of damage of cages by stones.

By sight such stones of white or light grey colour with smooth or slightly sherohovatoj a surface, a consistence soft.

• primary or secondary giperparatireoz
• a phosphoric diabetes
< li> syndrome Fankoni
• illness Kushinga
• pochechno-kanaltsevyj atsidoz
• sindro We Olbrajta-Battlera-Blumberga, Boyd-Sterns.

Oksalaty contain in all 2/3 stones, more often in a kind oksalata calcium. nesmotrja na that the majority of nephritic stones contains oksalaty, giperoksalurija at MKB ne so it is frequent. By sight such stones dense black-grey colour with shipovidnoj poverhnostju.

• Endogennaja or primary giperoksalurija it can be called by deficiency enzymes or deficiency of vitamin В6 (piridoksina), blocking transition glioksilata in glitsin and thus raising education oksalata.
• Secondary or ekzogennaja giperoksalurija is a consequence raised absorption shchavelevoj acid in intestines that can occur for some reasons:
  • considerable consumption of the products containing shchavelevuju acid in a considerable quantity.
  • the use of high doses of vitamin C
  • diseases ZHKT, accompanied steatoreej and insufficiency of absorption fat acids (illness the Crone, NJAK, spru, hr. A pancreatitis, a cirrhosis, diabetic enteropatii, a status after a resection of thin intestines).

Their occurrence is connected with constantly concentrated and sour urine (it is observed pri many diseases ZHKT with a diarrhoeia). By sight such stones yellow-brick tsveta with a smooth surface, a firm consistence.

the Possible reasons primary giperurikurii can be fermental infringements.

Secondary giperurikemiju can call:

TSistinurija. By sight such stones of yellow-white colour, roundish, firm.

Or magnievo-ammonium-calcium-phosphatic: infitsirovanie mochevydelitelnogo trakta (chronic or retsidivirujushchee) the bacteria producing ureazu (enzyme, rasshchepljajushchy urea) - Proteus, Klebsiella, Pseudomonas, Providencia, Serratia, shtammy Enterobacter. Such stones are accompanied often characteristic kristalluriej - "grobovidnye" crystals.

Calcium-karbonatnye stones of white colour, smooth, soft.

Albuminous stones of white colour, soft.

Cholesteric stones have black colour, soft.

the Clinic can essentially vary. Patognomonichnyj an illness sign - othozhdenie a stone. The small stone gives the big clinic since it is mobile.

1. Probably latent passage « asymptomatic » stones of the small sizes. Odnako more often asymptomatic stones reveal in kidneys casually at rentgenologicheskom inspection concerning other statuses.

2. Gematurija usually accompanies stone passage on mochevyvodjashchim putjam and there can be obvious or revealed at microscopic an inspection. Can protekat with a pain or to be painless. Gematurija it is observed in 80-90 % sluchajah, and at 60 % of patients can be piurija.

3. Frequent mocheispuskanie and dizurija (are characteristic at an arrangement of stones in vnutripuzyrnom a segment distalnoj parts mochetochnika) can be accepted for simptomy a cystitis. Dizurija also it is observed at passage of clots. The more low kamen in mochetochnike, the it is more sharply expressed dizurija.

4. The leader in semiology nefrolitiaza is the stupid, aching or sharp pain. Boli in a stomach, tenezmy and a pain in a rectum are characteristic for a stone arrangement in pochechnoj lohanke and often are accompanied by a nausea and vomiting.

5. Nephritic kolika with a pain in a side and irradiatsiej in pahovuju a sheaf, mocheispuskatelnyj the channel, sexual lips, jaichki or a sexual member it is typical for a stone, raspolozhennogo in average departments mochetochnika.

6. The sharp obstruction a stone calls nephritic koliku [and a sharp pyelonephritis?] . Podostraja the obstruction can be a little - or bessimtomnoj.

7. The infection - frequent complication MKB also is usually accompanied by a pain in a side or pojasnitse, a fever and a fever, especially at obstruction mochevyvodjashchih ways.

1. The anamnesis. It is necessary to learn about application of medicines and vitamins (especially And, D and in the past or now and presence MKB from other members of a family.

2. Objective inspection. It is necessary to differentiate a sharp attack nephritic koliki and pains in a stomach, tazovyh bodies or a waist, caused by others prichinami. At the moment of nephritic gripes can be irritation symptoms brjushiny, in chastnosti at a stone arrangement in an average third mochetochnika. Though mochetochnik and raspolagaetsja zabrjushinno, nevertheless, it adjoins to a back wall brjushiny, poetomu any process in mochetochnike can feign disease of bodies brjushnoj cavities.

3. The urine analysis is informative in all cases.

4. The chemical analysis of urine and blood can have some value at studying metabolizma at the patient nefrolitiazom.

the Biochemical analysis at MKB - is unreliable criterion, since it izmenjaetsja and at other pathological statuses. For example, raised soderzhanie uric acid testifies about uratnyh stones, but giperurikemija mozhet to be observed and at hepatic insufficiency, and at malignant novoobrazovanijah.

5. Radiological research.

6. In some cases can appear informative ultrasonics and KT (define kamni any chemical compound). Eholokatsija accurately finds out stones in diameter ne less than 1,5 mm. Reliability of ultrasonic on the average makes 90 %.

7. To diagnostics nephritic gripes especially promote endoskopicheskie methods, v to a particular hromotsistoskopija. Enter v/v a solution indigokarmina, carry out tsistoskopiju and observe allocation of dye from mochetochnikov. The method gives out protivorechivye results of all in 2-3 % of cases. For example, at the patient doubling mochetochnika and the stone settles down in one of doubled mochetochnikov. In it sluchae allocation delays indigokarmina will not be, since second half udvoennogo mochetochnika is passed. Or at an appendicitis, when an appendix raspolagaetsja retrotsekalno or retroperitonealno, inflammatory infiltrat rasprostranjaetsja on mochetochniki and then at hromotsistokopii it will not be allocated krasitel.

TSistokopija it is shown for revealing and extraction of stones from a bladder and udalenija from mochetochnikov the stones located close mochetochnikovo-puzyrnogo soustja.

8. If during pains (nephritic gripes) to enter kateter in lohanku kidneys po to it it will start strujno to be allocated under a pressure wetting. It testifies about povyshenii vnutrilohanochnogo pressure and confirms the diagnosis nephritic gripes. Esli after introduction katetera wetting will arrive on drops, and a pain not prekrashchajutsja, means, pressure in lohanke normal both pains in a waist and a stomach vyzvany any other reasons which have been not connected with kidneys.

• gematurichesky a nephrite (Ig A - nefropatija, at system diseases)
• a kidney tuberculosis
• the kidney cancer

• At MKB gematurija is observed after a pain attack then as at a kidney tumour precedes a painful attack.

Treatment MKB last 15 years has received new development thanks to application ekstrakorporalnoj litotripsii, and also new kinds endoskopii. Today more 80-90 % of stones it is possible to remove by means of noninvasive (ekstrakorporalnaja litotripsija) or it is minimum invazivnyh (endoskopija) ways. Operational, and takzhe conservative methods of treatment almost that are forgotten and occupy no more than 10-20 %. Odnako collecting experience of application of these ways of treatment reveals their borders primenenija. It has appeared, that they are not absolutely free from undesirable collateral effektov so, for example, ekstrakorporalnaja litotripsija by means of shock wave mozhet to call infringement of function of kidneys. Therefore researches pathogenetic faktorov removals of stones, and also actions for prevention of relapses (metafilaksija) snova call the liveliest interest. (4th European symposium on uric stones. Tjubingen, on April, 1-3st, 1993)

It is offered parafinosoderzhashchy a belt "Fizomed". The belt is made from hlopchatobumazhnoj fabrics of 8 sm in which pockets inserts parafinosoderzhashchego a material processed on special technology in rezultate of those are placed influence on stones [whether nozody that is carried out?!]

• Hydration.
• Diuretiki.
• Exile of small stones and sand.
• Shift rn urine.
• Influence on exchange infringements.

Is carried out according to the established metabolic infringement. Konservativnoe treatment is directed on liquidation of the conditions promoting kamneobrazovaniju, preventive maintenance of relapses nefrolitiaza and its complications, exile melkih stones, litoliz stones (uratnyh, it is possible and oksalatnyh).

• the General principle of treatment is concentration reduction the dissolved substances by increase in volume of urine - under all circumstances urine allocation should make not less than 2 l/days

very important time of reception of a liquid, since It is necessary to break off a normal cycle kontsentrirovanija urine (maximum during a dream). It is necessary to recommend to drink 1 stakan liquids each hour in wakefulness and 1-2 glasses before a dream, chtoby to achieve nikturii; additional reception of 1 glass of a liquid after nochnogo mocheispuskanija and right after a dream is desirable in the morning. Hydration pri uratnom litiaze is especially effective.

Is better to drink water. Acidifying liquids, and also containing carbohydrates mogut to raise calcium allocation. Kalijsoderzhashchie liquids are useful at odnovremennom treatment diuretikami.

• At primary giperparatireoze is shown urgent paratireoidektomija.
• Distalnyj kanaltsevyj atsidoz demands an independent estimation.
• At idiopaticheskoj giperkaltsijurii appoint diuretiki (tiazidy or amilorid) or neutral phosphate kalija inside. gipotiazid in a daily dose of 50-100 mg are reduced in two steps by allocation of calcium and warns education of stones. Operate orofosfaty (inorganic phosphorus salts), also reducing calcium allocation a little bit more poorly. A recommended dose 750-2000 mg of elementary phosphorus. It is effective also allopurinol (200-300 mg/days) which not only reduces giperurikozuriju, but also warns education kaltsievyh stones.
• Special attention to an exception of dairy products, oshchelachivajushchih urine, it is necessary to turn at fosforno-kaltsievyh stones (fosfaturija). Such diet is especially effective at idiopaticheskoj giperkaltsijurii. Limit vegetables and fruit (oshchelachivanie urine), recommends meat, fish, flour products, vegetable oils.

Treatment consists in restriction of food intake with the high maintenance oksalata, iskljuchenie the big doses (more than 500 mg/days) Ascorbic acid and application gipokaltsijuricheskih diuretikov (tiazidov or amilorida) or neutral fosfata kalija inside. Peroralnoe application tsitrata kalija can be useful dlja increases ekskretsii with urine tsitrata - the core helatora ionised kaltsija in urine and ingibitora growth of crystals oksalata calcium. Recommend piridoksin (especially at primary giperoksalurii) on 200 mg 2-3 times a day, ortofosfaty, magnesium preparations, tsitratnye preparations (see more low).

Exclude from a food the products containing a considerable quantity vit. With - pepper, inzhir, a dogrose, a black currant, shchavel, tea, green salad, a rhubarb, spinach, boby. Limit the use of a string bean, a potato, tomatoes, cheese, cottage cheese, eggs, krepkih meat broths.

Conservative therapy is most effective at uratnom nefrolitiaze. The basic napravlenija therapies - hydration, oshchelachivanie urine, reception decrease purinov, naznachenie allopurinola.

Allopurinol ( milurit ) - possesses spetsificheskoj ability ingibirovat the enzyme participating in transformation gipoksantina in ksantin, and ksantina in uric acid. At the reception termination urikemija and urikozurija come back for 3-4th day to initial level, therefore lechenie should be long, admissions in reception of a preparation over 2-3 days nezhelatelny. Apply to treatment and preventive maintenance of the diseases accompanied gi perurikemiej: a gout, MKB with education uratov, at the strengthened disintegration nukleoproteidov and increase of uric acid in blood (gemoblastozy, beam and tsitotoksicheskaja therapy, psoriaz), massive therapy kortikosteroidami. Minimalnaja a dose 0,1 g/sut, maximum - 0,8/days>

Etamid - brake reabsorbtsiju uric acid in nephritic kanaltsah, sposobstvuet to its deducing with urine and to maintenance reduction in blood. Apply at hronicheskoj a gout, polyarthritises with infringement purinovogo an exchange, MKB with obrazovaniem uratov. Appoint on 0,7 g (2 tablets on 0,35 4 times a day in techenie 10-12 days. After 5-7 day breaks spend the second year prodolzhitelnostju 7 days.

TSinhofen ( atofan ) - promotes perehodu uric acid from fabrics in blood and strengthens its deducing by kidneys, okazyvaet analgezirujushchee action (it is effective at sharp attacks of a gout?) . Primenjajut at a gout. In connection with by-effects (the jaundice, a liver atrophy, gastrit, a cystitis) apply now seldom. It is counter-indicative at bronhialnoj to an asthma, a stomach ulcer of a stomach, a hay fever. In avoidance oslozhneny the preparation is given by cycles for 5 days with week breaks.

Oshchelachivat urine is better tsitratnymi preparations. These are medicamentous preparaty for dissolution uratnyh stones, represent buffer systems, dejstvie which it is defined by their buffer capacity. The cores operating komponentami are lemon acid and tsitraty kalija and sodium. Preparations have blizky structure and at correctly spent therapy the effect can be received at ispolzovanii any of them. Some advantage uses magurlit into which structure the components promoting profilaktike of education oksalatov are entered. Preparation dose patients on dannym regulate definitions pH urine directly ahead of preparation reception (it sostavljaet on the average 5-7 g/sut). For dissolution of stones it is supported rn urine in intervale 6,2-6,6. Big oshchelachivanie urine it is fraught with loss of phosphates and karbonatov which sedimentation on a stone complicates its dissolution.

TSitratnye preparations 3 times a day, most tselesoobrazen are recommended to accept to meal reception 2-3 hours prior to occurrence of the most sour values rn mochi within days (before treatment of the patient independently makes the schedule kolebany rn urine within 7-10 days by means of a litmus piece of paper at everyone mocheispuskanii in usual vital conditions, including features of a food).

Contra-indications: the infected urine, insufficiency of blood circulation (because of soderzhanija in a considerable quantity of sodium and kalija in a preparation).

Structure of preparations.

• Solimok (the USSR): lemon acid 14,5 g - tsitrat kalija 46,3 g - tsitrat sodium 39 g
• Uralit-U (Germany): 14,5 - 46,3 - 39
• Blemaren (GDR): 39,9 - 27,85 - a hydrocarbonate kalija 32,25 g
• Soluran (NRB): 33,7 - a hydrocarbonate of calcium 35,6 g - tsitrat sodium 30,6 g
• Magurlit (VNR): 13,5 - tsitrat kalija 39,7 - tsitrat sodium 36,16 g - tsitrat magnesium 9 g - piridoksina a hydrochloride of 0,4

It is necessary peroralnoe application of bicarbonate of sodium for maintenance alkaline reaktsii urine (pH more than 7,0) and consumption restriction purinov with food or primenenie allopurinola (at some patients), reducing giperurikozuriju, on 200-300 mg a day.

In a diet exclude meat broths, fried meat and fat meat (pork, a goose, utka), an offal (a liver, kidneys, brains, language), cocoa and chocolate, limit mjaso and alcohol. Switch on products, podshchelachivajushchie urine, for an obstacle vypadenija crystals-cucumbers, a beet, carrots, a potato, a cherry, grapes, smorodina, apples, bahchevye.

For maintenance pH urine more than 7,5 appoint sodium bicarbonate, and for podderzhanija alkaline reaction at night - atsetazolamid before a dream. Allocation mochi should be supported at the level exceeding 4 l/days to patients, not sobljudajushchim a mode, and to patients with heavy or refrakternym nefrolitiazom it is shown peroralnoe application D-penitsillamina.

Penitsillamin ( kuprenil ) possesses vysokoj kompleksoobrazjushchej activity concerning ions of metals. It connects glavnym in the image ions of copper, mercury, lead, iron, calcium. Formed kompleksy leave kidneys. Therefore penitsillamin apply at poisonings etimi metals, at illness Konovalova-Vilsona. Sometimes at nefrolitiaze (for uskorenija calcium deducing), gemosideroze. This one of "basic" means lechenija revmatoidnogo an arthritis. At reception the control of blood, temperatures is necessary. Protivopokazan at a hypersensibility to penicillin.

Or intranephritic dissolution of stones irrigatsijami atsetiltsisteina or alkalis.

Treatment is directed on struggle with bakteriuriej, that defines necessity antibiotikov. At the mixed stones conservative treatment usually is a little effective. Pokazano (especially at korallovidnyh stones) surgical treatment, for profilaktiki relapses first of all struggle against an infection, is recommended also obilnoe drink and podkislenie urine.

It is carried out with the help elektricheski the induced shock waves generated v to a bath with water and focused on a stone that leads to its dissolution in situ. There are some restrictions in use of this method at very bolshih korallovidnyh stones since at litotripsii it can be necessary for increase in noninvasive access chreskozhnaja ekstraktsija.

It is necessary to tell, that when in 80th years in the West began to apply ekstrakorporalnuju litotripsiju in an euphoria status it has been declared, that more 90 % of stones it is possible to remove by means of noninvasive (ekstrakorporalnaja litotripsija) ili minimum invazivnyh (endoskopija) methods. Operational and conservative metody it seemed it is possible to send on a history dump. However, collecting experience primenenija these ways of treatment has revealed borders of their application, plus they not svobodny from undesirable by-effects. Therefore 4th European symposium (1993) has called again for research of conservative methods of removal of stones.

are summed up the biggest research of results ekstrakorporalnoj litotripsii by a shock wave. At 1000 patients with stones of kidneys and mochetochnikov was primenyon this method in Canada. In 3 months to 801 patient have spent repeated issledovanija. It was Not revealed stones in general at 52 %, at the others (674) were pochechnye stones. Localisation and stone focusing defined with the help biplanarnogo a fluoroscope with which help then checked destruction of stones. Srednjaja duration of treatment has made 64 minutes. Exclusively important for effektivnogo applications of this way of treatment have appeared size, position, struktura and quantity of stones:

• stones in the size of 10 mm or have less collapsed at 59 % of patients, 11-20 mm - at 51 %, big - at 33 %
• the stones located in the field of a basin and in the field of the bottom nephritic cups, it was possible to shatter better, than stones in the field of top and average nephritic cups

the Most important danger is a damage of fabrics (a kidney, brjushiny) at nechyotkoj navodke. Naturally, the patient cannot lay motionlessly, receiving 2-3 tysjachi blows, and all time to hold the breath in one position, therefore focus volny is displaced also concentration of blow it is necessary not on a stone, and associates tkani.

By the way, at ZHKB gradually refuse from with great dispatch-wave litotripsy, zamenjaja it on endoskopicheskuju holetsistektomiju. Probably, on this way will go and pri MKB.

Pielolitotomija or nefrolitotomija is required infrequently, but are shown at nalichii:

• the stones calling obstruction, or at presence striktury, cicatricial changes mochetochnika below a stone arrangement;
• infections, lokali zovannoj proksimalno in relation to a stone;
• or if on the roentgenogram it is visible, that the sizes of a stone are too great, that it could pass independently (more than 1 sm in diameter);
• korallovidnye stones are subject to removal if there is a danger of infringement functions of kidneys.

Operative treatment should be directed not only on removal konkrementa, no and on restoration of normal outflow of urine for what sometimes it is required vypolnenie plastic and reconstructive operations.

After operative treatment relapse of stones arises at 30 %.

is for this purpose applied medicamentous treatment which is directed on exile melkih stones lohanki or mochetochnika and provides activation urodinamiki verhnih uric ways.

It is shown at konkrementah which can independently depart, in osnovnom when they do not break outflow of urine and have not called gidronefroticheskoj transformatsii or have not become complicated attack of a sharp pyelonephritis. With that end in view naznachajut group preparations terpenov (tsistenal, olimetin, enatin, artemizol, avisan, tsiston), possessing spazmoliticheskim, bacteriological and sedative svojstvom, moderate diuretic action also promote razryhleniju uric konkrementov.

madder Ex-expenditure krasilnoj (in tab. on 0,25 on 2-3 tablets 3-4 rivers in sutki (renders diureticheskoe and spazmoliticheskoe action, promotes razryhleniju uric konkrementov, calcium containing phosphates and magnesium). A madder okrashivaet urine in reddish colour, at sharp colouring in buro-red colour - umenshajut a dose or temporarily stop preparation reception. A course - 20-30 days (at neobhodimosti repeat in 4-6 weeks).

TSistenal - the complex preparation containing tincture of a root of a madder, magnesium salitsilata, butters radio, spirit ethyl, butters olive. Renders spazmoliticheskoe and moderate diuretic action, weakens muscles mochetochnikov and facilitates passage small konkrementov. The thaw on sugar appoints inside on 4-5 3 rivers a day for 1 2 - 1 ch to meal. At an attack of gripes - odnokratno 20 drops. Contra-indications: glomerulonefrity, MKB with infringement funktsii kidneys, a stomach stomach ulcer.

Olimetin - the complex preparation containing essence. Apply for lechenija (on 2 capsule of 3-5 times in day) and preventive maintenance MKB and ZHKB (on 1 capsule in den for a long time). On structure and the action mechanism olimetin shoden with foreign preparations - Enatin, Rovatin, Rovahol. Contra-indications: glomerulonefrity, a stomach stomach ulcer, hepatitises.

Avisan - the vegetative preparation, possesses selective spazmoliticheskim dejstviem on smooth muscles mochetochnikov, is offered in quality spazmolitika pri nephritic kolike and spasms mochetochnika, at a cystitis reduces dizuricheskie javlenija. Apply inside on 1-2 tablet 3-4 times a day after meal. A course lechenija 1-3 weeks.

Pinabin - a solution of the essence received from needles of a pine or a fur-tree. Okazyvaet spazmoliticheskoe action on muscles mochevyvodjashchih ways, possesses nekotorym bakteriostaticheskim action in the relation gramme of positive bacteria. Pri nephritic kolike and MKB on 5 drops 3 times a day on sugar for 15-20 to meal. Kurs treatments of 4-5 weeks.

Urolesan - a vegetative preparation. Apply at ZHKB and MKB, kalkulyoznyh pielonefritah and cholecystitises, a dyskinesia zhelchevyvodjashchih ways (renders spazmoliticheskoe action, promotes othozhdeniju stones, reduces vospalitelnye the phenomena in uric ways, strengthens zhelcheobrazovanie and zhelchevyvedenie. Inside till 8-10 a thaw 3 times a day before meal. A course from 5 days do 1 month. At gripes on 20 drops on reception.

fitolizin - vegetative paste. Renders diuretic, protivovospalitelnoe, spazmoliticheskoe action, loosens konkrementy and udaljaet them with urine. Razryhlenie konkrementov occurs slowly. Accept on 1 chajnoj to a spoon in a half-glass of the sweetened water 3 times a day after meal.

the Grass of the mountaineer bird`s (sporysha) promotes othozhdeniju konkrementov at MKB, moderate anti-inflammatory an effect has. Inside in the form of infusion on 2 dining rooms of a spoon 3 times a day before meal.

SMT-THERAPY in a combination to water loading (at stones mochetochnika). Effektivno introduction v/v 5 ml baralgina about 20 mg laziksa against water loading.

For othozhdenija small stones from mochetochnika prof. I.Derevjanko recommends vypit for 30 minutes of water of 1 l, to make an injection spazmolitika and active walking.

the National recipe : №1. To take 1 kg of carrots + 1 kg of raisin, to fill in with 5 glasses vody and to soar 2 hours on a tile, not opening a cover, yet there will be no 0,5 l of water. Protsedit. To squeeze out a lemon. To drink for an hour to meal. №2. To take a glass cucumber soka+sok one lemon.

SKL is expedient in 1,5-2 months after othozhdenija a stone or operative ego removals at satisfactory function of kidneys and at not broken passage mochi, and also at the small sizes konkrementa - to 6 mm.

• Spontaneous othozhdenie stones from mochetochnika in the size to 4 the mm is observed at 80-90 % of patients, the size 4-6 mm - at 50-60 % of patients, by the size more than 6 mm - at 8-17 % of patients. It is connected with the sizes mochetochnika, which in diameter 4-7 mm make, but can be stretched to 6-8 mm. If konkrement has the sizes more than 6 mm in diameter, to direct the patient on sanatorium treatment it is not recommended.

the Special attention is demanded by patients in korallovidnymi stones. After sanatorium lechenija at such patients the increase korallovidnogo a stone and uhudshenie a functional status of kidneys, despite degree decrease vospalitelnogo process in mochevyvodjashchej to system more often is observed. With korallovidnymi kamnjami it is possible to direct patients on sanatorium treatment only after operative vmeshatelstva.

• Mochekislyj a diathesis - alkaline mineral waters (essentuki № 4 and № 17, slavjanovskaja, smirnovskaja, borzhom).
• Oksalurija - slabomineralizovannye waters (essentuki № 20, naftusja, sairme).
• Fosfaturija - minvody, promoting urine oxidation (dolomitnyj narzan, naftusja, arzni).

Ancient believed, that some firm stones found in the nature, obrazovalis in kidneys. These stones a nephrite (from Greek "nefros" - pochka) also have named. There is a legend, that by a principle of similarity-anologii a nephrite well lechit people with nephritic stones.

Under condition of timely removal of stones and regular the subsequent lechenija a pyelonephritis for prevention recurrent kamneobrazovanija blagoprijatnyj. The forecast is most serious at korallovidnyh or plural kamnjah, become complicated chronic nephritic insufficiency.

• a sharp and chronic pyelonephritis
• gidronefroz
• OPN (at okkljuzii mochetochnikov)
• HPN, caused by a terminal stage hr. A pyelonephritis.