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Stone in Tiie Kidney

renal, water, symptoms and calculi

STONE IN TIIE KIDNEY In addition to uric acid infarction, endemic conditions have a decided influence upon the formation of a renal concretion.

This is the reason why physicians for children who have seen hundreds of cases are contradicted by those who, because they have not had the experience, believe that the occurrence of renal calculi in chil ren is very rare. In Thuringia, and in Hungary there are regions of stone formation. Heredity, especially from gouty parents, is of im portance in addition to endemic conditions. The amount of calcium in the drinking water is also considered an important factor in the eti ology. Boys are more disposed to this disease than girls. The phos phates take part in the formation of renal calculi, as w-ell as do the uric acid salts and the oxalate of calcium. Cystin stones are exceedingly rare.

Symptoms.—The concretions produce an inflammation of the renal pelvis, and symptoms of pyelitis and pyelonephritis predominate. There may be serious paroxysms of pain, which are the result of the incarceration of the stones. Their symptomatology is well known from the pathology of the adult. As a rule they arc followed by ha,maturia. The diagnosis is established by the discharge of calculi in the urine, by the changes in the urine, resulting from pyelitis, by the paroxysms of pain with consecutive haunaturia, and by the results of palpation, and of examination by means of the X-ray-.

The tendency to remission of the symptoms renders the condition very chronic in its course. Amongst the complieations there have been noted the formation of abscess of the kidney, with subsequent escape of the pus towards the surface, and occasionally but fortunately less frequent, into the peritoneum.

Internal therapeutic measures are confined to the prescription of a vegetable diet and a liberal supply of alkaline water 'Vichy, Wildunger, Carlsbad water). More recently- the gly-cerin cure recommended by Herrmann, 5-15 Gm. tl +-I dr.) at a dose to be taken in water, has been extolled. Crotopin fails to relieve the symptoms of cystopyelitis as long as the concretions have not been washed out or removed by some other means. Where there are symptoms of incarceration we cannot escape the use of narcotic drugs, in older children, morphine, in younger ones chloral hydrate by enema. In the present state of renal surgery we need not hesitate to recommend the operative removal of the calculi.