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Cálculos renais

O que são? Qual é o tratamento?

A urina contém determinados elementos químicos que podem formar cristais. Se eles forem muito pequenos podem deslocar-se através das vias urinárias e serem expelidos do organismo sem que a pessoa perceba. Porém, quando os elementos químicos da urina são concentrados de tal maneira que formam cristais sólidos, então se convertem em cálculos renais.

Normalmente começam de um modo semelhante a um pequeno cristal. Porém, vão se acumulando gradualmente até formar uma massa sólida maior. Os cálculos renais podem aderir-se à parede interna do rim, e hospedar-se em uma área onde a urina não possa transportá-los até expeli-los do organismo. Os cálculos maiores se alojam nas vias urinárias, provocando dor, obstrução e infecções.

Quais são as causas?

Algumas pessoas são mais propensas a desenvolvê-los.

Diversos fatores aumentam a probabilidade de que isso aconteça: sendo que são mais habituais na idade adulta, duas vezes mais frequente em homens que em mulheres, e em pessoas que estão imobilizadas ou que perdem uma quantidade excessiva de líquido através do suor. Além do mais, são mais habituais em climas cálidos ou durante o verão. Outro fator de incidência é ter antecedentes familiares.

Quais são os sintomas?

Os mais comuns são a presença de sangue ou dor ao urinar, ter vontade de urinar com mais frequência ou não conseguir fazê-lo (quando um cálculo obstrui as vias urinárias), ter náuseas e vômitos. Quando surge urina turva com cheiro muito forte, febre, calafrios ou fraqueza, estes sintomas podem ser indícios de uma infecção grave. Também existem cálculos renais chamados de “silenciosos”, porque não geram sintomas.

Ao identificar esses sintomas, consulte seu médico.

Como é realizado o diagnóstico?

O médico realiza uma série de perguntas ao paciente: tipo de alimentação, se toma remédios, e quais são estes remédios, qual é o seu estilo de vida e os antecedentes médicos familiares. Além disso, existem vários exames para detectar cálculos renais, incluindo a radiografia abdominal, o ultrassom, a pielografia intravenosa e a tomografia computada.

  • Radiografias: é possível que seja injetado um contraste antes de realizá-la, para obter uma imagem mais nítida do tamanho e da localização do cálculo renal.

Análise de urina: este exame detecta cálculos renais bem pequenos. A urina é coada e os cálculos encontrados são analisados para determinar sua composição química.

Em que consiste o tratamento?

A maioria dos pacientes com cálculos renais está apta a se submeter a um tratamento por ondas de choque. Fatores como tamanho, localização e quantidade de cálculos, altura, peso, gravidez e problemas cardíacos do paciente podem indicar a necessidade de realizar um tratamento diferente, utilizando-se laser ou ultrassom.

Antes de iniciar o tratamento, consultar sempre um médico.

Alimentos que devem ser evitados

Existem alimentos que podem aumentar o ácido úrico da urina, o que, por sua vez, também pode incrementar a formação de cálculos renais, por isso, recomenda-se evitá-los caso haja antecedentes. Eles são: chocolate, determinadas verduras como espinafre, repolho, beterraba e nabo, frutos do bosque, amendoim, espargos, chá, anchovas, caviar, arenque, vieras, mexilhões, fígado, rins, miolos e extratos de carne (caldo, sopa, molhos).

Prevenção  

Aquilo que cada pessoa come e bebe pode ajudar a evitar a formação de novos cálculos. Por isso, recomenda-se:
  • Beber muito líquido, pois isso contribui a “diluir” a urina e reduz bastante as possibilidades de formar cálculos renais. Recomenda-se beber pelo menos 2 litros de líquido por dia, dentre os quais  metade deve ser água pura e o resto pode ser suco, leite, café ou bebidas aromatizadas. Em relação ao álcool, aconselha-se consumir com moderação ou eliminá-lo da dieta. Também é importante beber uma xícara de líquido antes de se deitar à noite.
  • Reduzir o consumo de sal, tanto na hora de cozinhar quanto na ingestão de alimentos muito salgados.
  • Ingerir alimentos baixos em calorias e com alto conteúdo de fibras (pães de grãos inteiros, cereais e massas, além de frutas e verduras permitidas (ver abaixo).
  • Não fritar os alimentos. Utilizar como alternativa cozinhá-los no forno, assá-los, torrá-los, fervê-los ou cozinhá-los ao vapor. Reduzir a quantidade de manteiga, margarina, óleo, creme, molhos e temperos nas saladas.
No passado se sugeria evitar o consumo de lácteos para prevenir a formação de cálculos renais. Hoje, as pesquisas mostram que comer uma quantidade moderada de alimentos com alto conteúdo de cálcio (pelo menos duas porções por dia) pode reduzir as possibilidades de formação de cálculos.