Stone disease diagnosis

In the diagnosis of stone disease must be taken into account various situations
The diagnosis of urolithiasis should include three steps:

    the diagnosis of stone disease itself,
    the stone and analysis
    the determination of the underlying disease.

It must also be taken into account different situations. There is a difference whether someone will be treated as part of an acute Steinkolik, or whether one stone removal is planned. The general measures of the physician, the history, examination of the patient, laboratory examination of urine and blood, ultrasound and x-ray and Urography.


Medical history and medical history may provide clues to the causes
When the histories are all facts of importance, which could indicate a stone disease. In familial predisposition to kidney stones, previous stone outlets or ESWL treatment (extracorporeal shock wave lithotripsy of stones = destruction) of the person concerned is a direct relationship can be easily produced. But surgery can not only to the kidney itself, but generally in the abdominal cavity leading to a later stone disease, if by chance the intervention of the ureter was pinched or constricted. Metabolic disorders such as gout, cystinuria, hyperparathyroidism, or treatment with vitamin D supplements can provide important clues (see background of stone formation).


The urinalysis is part of the "standard range"
Basically, the examination of the urine (see urine testing) is. They are for example Information on the extent of possible hemorrhage (micro / macroscopic haematuria). It provides clues about the nature of the stone, because the calculated value of urea allows for conclusions on protein intake and thus on the Ernährungsgewohnheiten.Sie indicates whether there is associated urinary tract infection, when a significant amount of white blood cells (leukocyturia) can be determined.


Imaging techniques necessary to identify the location, size and number of stones is essential
An ultrasound scan can show whether there is a urinary obstruction, whether in addition there is an inflammation of the kidney tissue and they can locate the stone. The radiograph can also visualize the stones. Uric acid stones are not only giving shade and can not be depicted on a radiograph. With the help of a urogram, a contrast study of the kidney, the size and function of the kidney, as well as size, number and location of the ureter or kidney can be determined. This study, however, should not be performed during a colic, because the contrast agent may lead to increased urination and thus to strengthen the complaints.


Colicky pain occurs not only on urinary stones - the differential diagnosis can be difficult
The symptoms of stone disease may be confused with various other diseases. Therefore, a doctor must rule out this disease in its diagnosis. Such disorders are summarized under the term differential diagnosis. These diseases include inter alia:

    Biliary colic and acute cholecystitis. Here the pain is usually higher but below the right costal margin and may radiate to the shoulder.
    gynecological diseases such as ovarian cysts, ectopic pregnancies or pregnancies outside the uterus (ectopic pregnancy), twisted stalk, etc. fibroids can also cause severe pain. The pain is usually located deep and not have the recurring (labor-like) character of a Harnsteinkolik.
    various diseases such as acute abdominal Sigmadivertikulose, diverticulitis (pain in the left lower abdomen), or acute appendicitis (pain in the right lower abdomen) or a bowel obstruction express themselves similarly. When bowel obstruction, the vomiting symptoms are different, however: colic patient vomiting at the height of pain, patients with bowel obstruction after the attack of pain. The radiograph of the abdomen is then ultimately the Enlightenment.
    Shingles (herpes zoster), if it occurs in the flank area, may be a fool like colic to be performed when pulling flank pain. However, the urinary findings are inconspicuous and the zoster appears several days later.


For stone removal, additional measures are required
If a stone removal is planned, the location of the stone must be accurately determined. Even its size is very important. The individual circumstances of Harnstraktes and functionality must also be reassessed. There is a missing or renal excretion of the kidney or there is a contrast agent allergy, a retrograde Pyelografie is necessary.