Causes of kidney stones
Etiological factors for kidney stones are as follows.
1. Dietetic factors leading to kidney stones
A deficiency of vitamin A causes a desquamation of epithelium. The cells form a nidus around which the stone is deposited. From a study of economic conditions in districts where urinary calculi are common, it is evident that the inhabitants suffer from dietetic imbalances.
2. Altered urinary solutes and colloids causing kidney stone
In hot climate the concentration of solutes will rise. It has been postulated that any reduction of the urinary colloids which absorb solutes or excess of muco-proteins which may chelate calcium, form an insoluble complex.
3. Decreased urinary output of citrate
The presence of citrate in the urine (normal 60mg per 100ml) tends to maintain in solution otherwise relatively insoluble calcium phosphate and carbonate. The excretion of citrate is under hormonal control and decreased during menstruation.
4. Kidney stone due to Renal infection
Infections favor formation of renal calculi. Both clinical and experimental stone formation is common when the urine is infected with a urea-splitting streptococcus, staphylococcus or proteus. The predominant bacteria found in the nuclei of urinary calculi are a staphylococcus and e.coli.
5. Prolonged immobilization
From any cause e.g. paraplegia, is prone to result in skeletal decalcification and in increased output of calcium in urine.
6. Inadequate urinary drainage
Stones are prone to occur in patients with obstruction to free passage of urine.
7. Hyperparathyroidism as a kidney stone cause
Although rare, occurring perhaps in 0.2 % of all cases, hyperparathyroidism should always receive consideration. In cases of multiple or recurrent urinary calculi this cause should be eliminated by biochemical tests. Hyperparathyroidism results in a great increase in the elimination of calcium in the urine. A parathyroid adenoma should be removed before the urinary calculi are treated.
8. Randall’s plaque, Microliths
Randall showed that the initial lesion in many cases of renal calculus is erosion at the apex of one of the renal papillae. On this erosion are deposited urinary salts also known as Randall’s plaque. It has further been shown that minute concentration (microliths) occurs normally in the renal parenchyma. Should some of the renal lymphatic vessels become blocked by inflammatory exudates, a sub-endothelial calculus may form. Later the endothelium becomes ulcerated, leaving the calculus in contact with the urine.
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