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Gravel or Stone Renal Colic Dropsy of the Kidney

urine, acid, uric, phosphates, size, deposit and lime

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Gravel or Stone (Renal calculus, Latin, ren, a kidney, calx, chalk). The urine contains certain substances in solution, whose natural condition is that of a solid, and which, under certain circumstances, tend to separate out and, assuming the solid form, appear as a sediment In the urine. The chief of these are uric acid, combinations it forms with soda, ammonia, &c., called urates, and phosphates of lime and mag nesia. (See p. 407.) Now uric acid may be present in the urine in excess, and as it is not a very soluble body it is readily crystallized out in the form of red particles. Anyone may cause them to be formed in healthy urine by adding a small quantity of strong hydrochloric acid to the urine and setting it aside in a tall glass for a (lay or two. In time small red par ticles will be seen forming on the sides of the glass—these, examined by a lens, are found to be crystals of uric acid. Various bodily con ditions, connected specially with the digestive system, produce a deposit of uric acid, con ditions due to too free living, excess in sugary and nitrogenous foods, and in heavy wines, beer, &c., indolent habits, and affections of the liver that accompany or are aggravated by such habits. Phosphates are held in solution in urine by its acid character, and if the urine becomes alkaline the phosphates are precipi tated.. The urine is alkaline in various dis orders of nutrition, in nervous dyspepsia, and conditions of general debility ; and thus a de posit of phosphates occurs. But after quite healthy urine has been excreted by the kidney, it may undergo decomposition before it is ex pelled from the body ; the result of decom position is that the urine becomes strongly alkaline, and so again phosphates will be de posited.

Besides these two substances, uric acid and phosphates, there is another, oxalate of lime, which readily separates out from the urine. It should not exist in healthy urine, but ap pears there as the result of some interference with the due performance of the nutritive pro cesses in the body, it being only a stage in the breaking down of non-nitrogenous food-stuffs.

We see, then, that these three substances, uric acid, phosphates, and oxalate of lime, are liable, under certain circumstances, to separate out from the urine as a deposit. They may exist in the urine, however, in a state of such fineness as only to give an unusual cloudiness to the urine, a microscope being required to reveal that the cloud is actually due to solid particles. They may form larger particles capable of being felt or seen, In which case the deposit is termed gravel, while again they may form masses of varying size, to which the name of calculus or stone is given.

Now the deposit may be formed in any part of the urinary organs, from the urinary tubules or pelvis of the kidney to the bladder. A par ticle deposited in a tubule may be swept on to the pelvis, may be detained there, and grow in size from successive deposits on its surface, may pass to the bladder, down the ureter, and being detained there continue to grow. There may, therefore, be stone in the kidney or stone in the bladder, or both. A gritty particle of uric acid swept from a urine tubule may become a stone of size before it is finally got rid of. It may reach the bladder as a uric acid particle, and there, owing to decomposition taking place in the urine, it may be coated with phosphates, so that it consists of uric acid in the centre and phosphates outside.

Gravel thus differs from stone only in size ; and the size of stone may vary from that of a pin's head to that of a goose's egg. The uric acid stones are the most common. They are smooth, hard, and reddish or yellowish brown in colour. Oxalate of lime stones are next in frequency, and form what is called the mul berry calculus, because of their appearance, being of a dirty purplish colour, and with a very irregular and rugged surface. Phosphatic stones are also common. They are smooth, light, and earthy in appearance. There are also stones formed of mixtures of these, as already mentioned, and also of other substances which are too rare to be noted here.

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