枸橼酸氢钾钠降低草酸钙结石成石危险性的机制

目的:探讨枸橼酸氢钾钠降低草酸钙结石成石危险性的机制.方法:经B超、X线、尿生化检查诊断为肾或输尿管含钙结石18例,其中肾结石16例,输尿管结石2例.测定口服枸橼酸氢钾钠前后尿生化参数进行比较.结果:口服枸橼酸氢钾钠2周时,尿pH值、枸橼酸、(可溶解钙×枸橼酸)/(总钙×草酸)明显升高,尿钙降低,与服用前比较,差异均有统计学意义(P＜0.05).24 h尿中尿酸、草酸变化无统计学意义.结论:枸橼酸氢钾钠可有效降低含钙结石成石危险性.     

双波源ESWL联合枸橼酸氢钾钠治疗双J管滞留的临床疗效观察(附7例报告)

目的:总结双波源体外冲击波碎石联合枸橼酸氢钾钠治疗双J管滞留的策略和技巧,评价其临床疗效。方法:回顾性分析我院2016年3月~2017年3月应用体外冲击波碎石联合枸橼酸氢钾钠治疗7例双J管滞留的疗效。结果:7例患者行双波源体外冲击波碎石联合枸橼酸氢钾钠均成功拔出双J管,患者治疗后排出的结石呈蛋壳样碎片,均行结石成分分析,提示为尿酸结石或包含尿酸结石的混合结石。结论:应用双波源体外冲击波碎石联合枸橼酸氢钾钠可作为双J管滞留的有效方法。     

移植肾尿路结石46例诊治体会

目的探讨肾移植术后尿路结石的诊断和治疗,提高长期存活率。方法回顾性分析1980年1月至2011年6月46例移植肾结石患者的临床资料。结果 35例为肉眼血尿,10例为体检时B超发现,1例为急性无尿发病,均无肾绞痛。移植肾结石24例,移植输尿管结石22例,结石大小0.7～2.0 cm,结石发病时间为术后3.5（0.4～15）年。42例行体外冲击波碎石（ES-WL）,其中3例无效行输尿管镜下钬激光碎石术和1例行经皮肾镜取石术（PCNL）,4例尿酸结石给予枸橼酸氢钾钠（友来特）药物治疗。随访3个月：42例ESWL中,结石排净36例（85.72%）,结石残留2例（4.76%）,4例（9.52%）无效改用腔镜治疗后结石排出;4例尿酸结石口服枸橼酸氢钾钠结石大部分排出。结论移植肾结石缺乏典型肾绞痛表现,体外冲击波碎石术是治疗移植肾结石安全、有效的主要方法。     

枸橼酸氢钾钠治疗泌尿系混合性结石的疗效分析(附44例报告)

目的：探索枸橼酸氢钾钠[Uralyt-U[（C6H5O7）5-H3K6Na6]]治疗泌尿系结石的确切疗效。方法：将44例患者随机分为A、B两组。A组20例采用654-2、黄体酮及排石中药方剂治疗，所选剂量较大；B组24例采用枸橼酸氢钾钠治疗。两组均于10天内取已排出的结石样一同送检，结果进行统计学对照分析。结果：Uralyt-U[（C6H5O7）5-H3K6Na6]治疗混合性结石的疗效最好，B组显著性好于A组。结论：Uralyt-U[（C6H5O7）5-H3K6Na6]对泌尿系结石有较好作用，疗效满意。     

友来特治疗肾结石65例临床观察

目的探讨友来特治疗直径<0.8cm的肾结石的有效性及安全性。方法友来特(枸橼酸氢钾钠)每日10g,分2次口服。同时检测pH值,根据尿液pH值调整药物剂量。结果65例病人治疗3～6个月,所有病例经B超检查。该药物有效率:3个月46%(30/65),6个月为63%(41/65)。临床症状变化情况:血尿减轻或消失32例,血尿改善率49%(32/65),腰痛减轻或消失18例,肾积水或肾盏积水改善26例。结论友来特通过调节尿液的pH值,枸橼酸根又是尿中最丰富的阴离子,也是钙性结石的重要抑制因子。能有效地抑制结石的形成,溶解结石,消除结石及预防结石的再发。     

"友来特"对输尿管尿酸结石的排石促进作用

目的探讨尿液碱化剂"友来特"对输尿管尿酸结石排石治疗的促进作用.方法输尿管尿酸结石45例,其中男28例,女17例.结石大小为0.5～1.0 cm,平均0.7 cm.经腹部平片、静脉肾盂造影、逆行肾盂造影、螺旋CT及血、尿生化检查确诊.随机分成溶石排石组和单纯排石组.前者23例,口服"排石冲剂"的同时加服"友来特"(枸橼酸氢钾钠颗粒剂),调整尿液pH值至6.8,每日监测尿液pH值3次;后者22例,单纯服用"排石冲剂",疗程均为1个月.比较两组的排石成功率和平均排石时间.结果溶石排石组和单纯排石组分别排石18例和11例,排石成功率分别为78.3%和50.0%,两组排石成功率差异有统计学意义(P<0.05).溶石排石组平均排石时间(17±6)d较单纯排石组(22±7)d明显缩短,差异有统计学意义(P<0.05).结论尿液碱化剂"友来特"能显著提高输尿管尿酸结石的排石成功率,缩短排石时间.作用机制可能与"友来特"对尿酸结石的溶解作用有关.     

枸橼酸氢钾钠降低双J管继发管壁沉积结石危险性研究

目的 探讨枸橼酸氢钾钠降低双J管留置后继发管壁沉积结石危险性的效果及机制.方法 选取2008年3月至2010年7月间术后留置双J管病例共123例,以治疗先后顺序随机分为奇偶数两组,选取奇数组术后给予口服枸橼酸氢钾钠,偶数组不作特殊治疗.分别于拔管前应用彩超及腹部平片(KUB)和拔管时肉眼观察比较双J管留置期间两组管壁沉积结石发生率差异.结果 留置双J管1～3个月内,应用枸橼酸氢钾钠组双J管管壁沉积结石发生率为6.7％,未用枸橼酸氢钾钠组双J管管壁沉积结石发生率为19.8％,两者管壁结石发生率比较差异有统计学意义(P＜0.05).结论 留置双J管期间应用枸橼酸氢钾钠能显著降低双J管继发管壁沉积结石的危险性.     

复式脉冲体外碎石机治疗泌尿系结石1206例小结

目的:总结新碎石设备-复式脉冲体外碎石机治疗泌尿系结石的经验.方法:应用该机治疗泌尿系结石患者1206例,其中肾结石508例,输尿管结石603例,膀胱结石95例.结石大小0.4cm×0.5cm～2.5cm×2.5cm.碎石机工作电压4.0～8.5 kV,放电次数2 000～3 000.结果:肾结石治愈率达58.3%,输尿管结石为72.7%,膀胱结石82.4%.其中986例(81.8%)ESWL后有不同程度的肉眼血尿,164例(13.6%)出现肾绞痛,14例出现高热,2例出现肾被膜下血肿,经对症处理均消失.结论:体外复式脉冲碎石技术仍然是泌尿系结石的首选治疗方法.     

微创经皮肾穿刺取石术治疗复杂性肾结石67例体会

我院自2005年3月至2006年6月,采用钬激光微创经皮肾穿刺取石(mPCNL)治疗复杂性肾结石67例,效果满意。临床资料1.一般资料:本组67例,男41例,女26例;年龄26~65岁,平均46岁。腹部平片(KUB)、肾盂静脉造影(I VU)及CT平扫检查示:肾脏集合系统单个铸型结石32例,铸型结石合并肾盏多发性结石29例,肾窦内肾盂多盏均有结石6例。其中12例既往有肾开放手术取石史,9例曾行体外震波碎石治疗(ESWL)。2例为孤立肾。结石大小(单个最大结石KUB面积)3.0cm×4.0cm以上者48例,其中1例无积水患者一整块结石充满肾脏集合系统;2.0cm×2.5cm~3.0cm×4.0cm者19…     

儿童和成人头孢曲松结石致上尿路梗阻的外科治疗

目的:探讨儿童及成人头孢曲松结石致上尿路梗阻的外科治疗方法。方法:回顾性分析2017年7月～2020年2月于我院诊治的4例儿童和成人头孢曲松结石致上尿路梗阻的临床资料,探讨其临床表现、影像学特征及外科治疗方法。结果:4例患者中,有3例的临床表现为肾绞痛或腹部疼痛,1例的临床表现为无尿。B超和CT检查发现肾结石和(或)输尿管结石,患侧肾、输尿管积水经外科治疗均已痊愈,结石成分分析为头孢曲松,术后随访3～6个月肾功能均正常,无结石残留或复发。结论:长期和(或)超量使用CTRX、脱水、长期卧床、补钙、输尿管狭窄是形成头孢曲松结石的高危因素。头孢曲松结石致上尿路梗阻时通过及时留置输尿管支架解除梗阻,并通过口服枸橼酸氢钾钠和适当喝水促进结石排出,达到较好地治疗效果。     

Stone forming risk of calcium citrate supplementation in healthy postmenopausal women

PURPOSE: We evaluated the effect of calcium citrate supplementation alone or in combination with potassium citrate on the stone forming propensity in healthy postmenopausal women. MATERIALS AND METHODS: A total of 18 postmenopausal women without stones underwent a randomized trial of 4 phases comprised of 2 weeks of treatment with placebo, calcium citrate (400 mg calcium twice daily), potassium citrate (20 mEq twice daily), and calcium citrate and potassium citrate (at same doses). During the last 2 days of each phase urine was collected in 24-hour pools for complete stone risk analysis. RESULTS: Compared to placebo, calcium citrate increased urinary calcium and citrate but decreased urinary oxalate and phosphate. Urinary saturation of calcium oxalate, brushite and undissociated uric acid did not change. Potassium citrate decreased urinary calcium, and increased urinary citrate and pH. It decreased urinary saturation of calcium oxalate and undissociated uric acid, and did not change the saturation of brushite. When calcium citrate was combined with potassium citrate, urinary calcium remained high, urinary citrate increased even further and urinary oxalate remained reduced from the calcium citrate alone, thereby marginally decreasing the urinary saturation of calcium oxalate. Urinary pH increased, decreasing urinary undissociated uric acid. The increase in pH increased the saturation of brushite despite the decrease in urinary phosphorus. CONCLUSIONS: Calcium citrate supplementation does not increase the risk of stone formation in healthy postmenopausal women. The co-administered potassium citrate may provide additional protection against formation of uric acid and calcium oxalate stones.     

Pharmacologic treatment of uric acid calculi

Uric acid stone disease is dependent on three pathogenetic factors: acid urine pH, low urine volume, and hyperuricosuria. The management of nonobstructing uric acid calculi should include maintenance of an alkaline urine, an increase in urine volume, and reduction in urinary uric acid excretion. It appears that potassium alkali may avoid the complication of calcium stone formation in patients with uric acid stones. In patients with obstructing uric acid calculi, more rapid dissolution may be accomplished with intravenous alkalinization or direct irrigation of the stone with an alkaline solution.     

三聚氰胺所致婴幼儿尿路结石的综合治疗分析

目的 总结含三聚氰胺配方奶粉所致婴幼儿尿路结石的治疗手段及疗效.方法 有三鹿奶粉喂养史尿路结石患儿228例.男165例,女63例,年龄4个月～3岁.平均11个月.双肾结石144例.单侧肾结石54例.结石直径0.5～2.5 cm;双侧输尿管结石合并中重度肾积水8例.一侧输尿管结石合并中重度肾积水7例,结石直径0.4～lI 1 cm;膀胱结石合并尿潴留5例,尿道结石合并尿潴留10例,结石直径O.5～1.3 cm.患儿均经B超、CT检查确诊.分4组:①肾功能衰竭组15例(6.6%),少尿5～10 d 2例、无尿1～5 d 13例,实验室检查BUN平均32一mmol/I,SCr平均750μmol/L.13例采用经尿道输尿管镜下碎石、碱性药物溶石、双J管置入术,术后碱性药物溶石治疗;2例在B超引导下行经皮肾穿刺造瘘引流术、肾盂内间歇性碱性药物灌洗溶石.②输尿管结石合并中重度肾积水15例,行输尿管镜下碎石清石、双J管置入术及碱性药物溶石治疗.③膀胱、尿道结石合并急性尿潴留15例,采用经尿道输尿管镜下第三代碎石清石系统碎石清石.④单纯肾结石183例,采用碱性药物治疗1～8周.其中113例口服碳酸氢钠片0.15 g,2次/d;23例口服柠檬酸氢钾钠2.4 g/d;47例口服10%柠檬酸钾溶液,5 m1,3次/d.61例经碱性药物治疗＞8周疗效差者行ESWL及碳酸氢钠注射液溶石治疗,尿pH＞7.5时停药.对有肾功能损害患儿每天复查肾功、电解质直至正常.228例患儿随访1～3个月.统计数据采用SPSS 13.0软件分析.结果 组①患儿术后12～24 h内即出现多尿,多尿期持续24～72 h.尿量800～2500 ml/24 h,术后48～96 h尿量逐渐恢复正常,术后1～5 d BuN及SCr均恢复正常,1～2周4例肾、输尿管结石基本排净,2～4周15例结石全部排净.组②患儿治疗后1～2周结石完全排净.组③患儿经微创手术均一次性清除结石,立即恢复正常排尿,3 d后复查B超,膀胱、尿道内均无残余结石.组④经碳酸氢钠治疗组结石2周排净4例,4周排净18例,13周排净15例,8周后结石明显变小变淡34例,结石无明显变化42例;口服柠檬酸氧钾钠治疗组结石1周排净4例,2周排净7例,4周排净10例,6周排净2例;口服10%柠檬酸钾溶液组结石1周排净3例.2周排净5例,4周排净16例,8周排净11例,8周后结石明显变小变淡8例,结石无变化4例.柠檬酸盐治疗组与碳酸氢钠治疗组疗效比较差异有统计学意义(P-O.001),柠檬酸盐组内比较差异无统计学意义(P=0.372).61例患儿行ESWL及继续碱性药物溶石治疗患儿1～6周结石排净49例,结石缩小8例,无明显变化4例.结论 三聚氰胺所致婴幼儿尿路结石早期以内科观察治疗为主,发生急性肾功能衰竭、输尿管中重度积水及下尿路急性梗阻时应以外科干预为主,解除梗阻、保护肾功能、恢复正常排尿.治疗后期,结石特点发生变化,单纯碱性药物治疗无效者应采用ESWL治疗.     

Slightly radiopaque uric acid calculi: impact upon therapeutic considerations?

Ten patients with slightly radiopaque urinary calculi were treated by percutaneous litholapaxy or even open surgery. The stone analysis revealed uric acid as the main stone composite suggesting that these patients should have been treated by oral litholysis alone alkalinizing the urine and decreasing uric acid levels with allopurinol. CT density measurements proved that concrements with HE less than 600 can be successfully dissolved by oral medication alone. Twenty-four patients were subsequently treated by oral citrate alkalinizing the spontaneous urine to pH 6.8-7.2 dissolving even large staghorns within 6-8 weeks. CT density measurements have become a routine diagnostic procedure when poorly radiopaque calculi are found on the standard plain film. The patient can thus be spared invasive treatment which is unnecessary in most cases.     

Successful management of uric acid nephrolithiasis with potassium citrate

Eighteen patients with uric acid nephrolithiasis (six with uric acid stones alone and 12 with both uric acid and calcium stones) underwent long-term treatment (1 to 5.33 years, mean of 2.78 years) with potassium citrate (30 to 80 mEq/day, usually 60 mEq/day). Urinary pH increased from low (5.30 +/- 0.31 SD) to normal (6.19 to 6.46) during treatment. Urinary content of undissociated uric acid, which was high to begin with at 204 +/- 82 mg/day, decreased to the normal range (64 to 108 mg/day) following treatment. Urinary citrate rose from 503 +/- 225 mg/day to 852 to 998 mg/day. Urinary saturation of calcium oxalate significantly declined with potassium citrate treatment. New stone formation rate declined from 1.20 +/- 1.68 stones/year to 0.01 +/- 0.04 stones/year (P less than 0.001 by chi square). Remission was experienced in 94.4% of patients, and the group stone formation rate declined by 99.2%. Detailed case reports were obtained in five patients showing different responses between sodium alkali and potassium alkali treatment. All five patients had persistently low urinary pH (typically less than 5.5) and normouricosuria, and four had hyperuricemia. Before treatment, they had stones surgically removed or spontaneously passed, which were pure uric acid in composition. When sodium alkali was give (as bicarbonate or citrate, 60 to 118 mEq/day), new stone formation continued in four patients, and a radiolucent (uric acid) calculus become "calcified" in the remaining patient. The stone analysis disclosed calcium oxalate in five patients and calcium phosphate in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiology of nephrolithiasis in France

Nephrolithiasis is a frequent disease that affects about 10% of people in western countries. The prevalence of calcium oxalate stones has been constantly increasing during the past fifty years in France as well as in other industrialized countries. Stone composition varies depending to gender and age of patients and also underlines the role of other risk factors and associated pathologies such as body mass index and diabetes mellitus. The decrease in struvite frequency in female patients is the result of a significantly improved diagnostic and treatment of urinary tract infections by urea-splitting bacteria. In contrast, the increasing occurrence of weddellite calculi in stone forming women aged more than 50 years could be the consequence of post-menopausal therapy. A high prevalence of uric acid was found in overweight and obese stone formers and in diabetic ones as well. Another important finding was the increased occurrence with time of calcium oxalate stones formed from papillary Randall's plaques, especially in young patients. Nutritional risk factors for stone disease are well known: they include excessive consumption of animal proteins, sodium chloride and rapidly absorbed glucides, and insufficient dietary intake of fruits and potassium-rich vegetables, which provide an alkaline load. As a consequence, an excessive production of hydrogen ions may induce several urinary disorders including low urine pH, high urine calcium and uric acid excretion and low urine citrate excretion. Excess in calorie intake, high chocolate consumption inducing hyperoxaluria and low water intake are other factors, which favour excessive urine concentration of solutes. Restoring the dietary balance is the first advice to prevent stone recurrence. However, the striking increase of some types of calculi, such as calcium oxalate stones developed from Randall's plaque, should alert to peculiar lithogenetic risk factors and suggests that specific advices should be given to prevent stone formation.     

Citrate (CG-120) therapy in urolithiasis. 2. Effect on urinary and serum biochemistry

The long-term effects of citrate therapy (CG-120, 3 g/day or 4 g/day) were examined in 398 patients with upper urinary tract calculi. We studied the influence of citrate therapy on urinary and blood biochemistry in 353 of them. CG-120 caused a sustained increase in urinary citrate, urinary pH and potassium, but no substantial or significant changes in other urinary parameters (uric acid, phosphate, oxalate, sodium, chloride and urine volume). Although urinary calcium decreased significantly up to the 24th week, it did not change significantly there after and it tended to increase at the 54th week. Urinary creatinine excretion decreased after 34 weeks of administration, but this phenomenon could not be explained, because the level of blood urea nitrogen and serum creatinine was not elevated in any case before administration. There were no changes in the serum calcium, magnesium, phosphate, uric acid, sodium, potassium or chloride level.     

Adequacy of a single stone risk analysis in the medical evaluation of urolithiasis

PURPOSE: We tested the hypothesis that a single 24-hour urine sample for stone risk analysis would be sufficient for the simplified medical evaluation of urolithiasis. MATERIALS AND METHODS: We retrospectively analyzed stone risk profile data on 24-hour urine samples obtained during random and restricted diets in 225 patients with recurrent urolithiasis. RESULTS: In 2 random samples we noted no significant difference in urinary calcium, oxalate, uric acid, citrate, pH, total volume, sodium, potassium, sulfate or phosphorus. For these risk factors there was a highly significant positive correlation in the 2 random samples (r > or = 0.68, p <0.0003) and the value of each was abnormal or normal in at least 81% of patients. Urinary magnesium and ammonium were significantly lower in random sample 2 than 1, the former by 4%. After calcium, sodium and oxalate dietary restriction mean urinary calcium and sodium plus or minus standard deviation decreased significantly by 25% from 251 +/- 125 to 187 +/- 98 mg. daily and by 38% from 183 +/- 87 to 113 +/- 57 mEq. daily, respectively. Other risk factors had a slight or no significant change. Correcting random urinary calcium for the excessive urinary excretion of sodium brought urinary calcium to 210 +/- 108 mg. daily, similar to the value on the restricted diet. CONCLUSIONS: The reproducibility of urinary stone risk factors is satisfactory in repeat urine samples. A single stone risk analysis is sufficient for the simplified medical evaluation of urolithiasis.     

尿酸结石的诊断及其溶石治疗

报告１９８４年１２月～１９９５年１２月对纯尿酸结石病人１７例的治疗经验。诊断标准：（１）ＫＵＢ阴性，（２）ＩＶＵ或逆行尿路造影见到充盈缺损，（３）Ｂ超或ＣＴ证实该充盈缺损系结石所致。尿酸碱化治疗在早期病人采用苏打片，后期病人选用枸橼酸钾，调节药物剂量使尿ｐＨ值维持在６８左右。尿酸结石导致急性梗阻性无尿亦可试作溶石治疗。本组１７例纯尿酸结石（包括２例已发生梗阻性无尿患者）均以碱化药物治疗治愈     

Long-term treatment of calcium nephrolithiasis with potassium citrate

The long-term effects of potassium citrate therapy (usually 20 mEq. 3 times daily during 1 to 4.33 years) were examined in 89 patients with hypocitraturic calcium nephrolithiasis or uric acid lithiasis, with or without calcium nephrolithiasis. Hypocitraturia caused by renal tubular acidosis or chronic diarrheal syndrome was associated with other metabolic abnormalities, such as hypercalciuria or hyperuricosuria, or occurred alone. Potassium citrate therapy caused a sustained increase in urinary pH and potassium, and restored urinary citrate to normal levels. No substantial or significant changes occurred in urinary uric acid, oxalate, sodium or phosphorus levels, or total volume. Owing to these physiological changes, uric acid solubility increased, urinary saturation of calcium oxalate decreased and the propensity for spontaneous nucleation of calcium oxalate was reduced to normal. Therefore, the physicochemical environment of urine following treatment became less conducive to the crystallization of calcium oxalate or uric acid, since it stimulated that of normal subjects without stones. Commensurate with the aforementioned physiological and physicochemical changes the treatment produced clinical improvement, since individual stone formation decreased in 97.8 per cent of the patients, remission was obtained in 79.8 per cent and the need for surgical treatment of newly formed stones was eliminated. In patients with relapse after other treatment, such as thiazide, the addition of potassium citrate induced clinical improvement. Thus, our study provides physiological, physicochemical and clinical validation for the use of potassium citrate in the treatment of hypocitraturic calcium nephrolithiasis and uric acid lithiasis with or without calcium nephrolithiasis.