Investigation and treatment of renal calculi

We have investigated and treated 176 patients who were suffering from renal calculi. The stones contained calcium in 87% of patients, predominantly urate in 11%, and rarely contained magnesium ammonium phosphate or cystine. Of the patients with calcium stones, hypercalciuria was present in 75% and was identified in 57% by the measurement of the 24-hour urinary calcium excretion, and in a further 18% by a standardization calcium "fast-and-load" test. Nine patients were found to have primary hyperparathyroidism and were treated surgically. A further 21% were suspected to have normocalcaemic hyperparathyroidism, and metabolic studies are being developed to clarify this. The treatment of hypercalciuria included a low-calcium diet, and various combinations of a thiazide diuretic, phosphate supplements and sodium cellulose phosphate. Hypercalciuria was controlled in all compliant patients, and only two developed further stones. Hyperuricosuria was rarely the sole metabolic abnormality in patients with calcium stones, though this might reflect the referral pattern of the Unit. Uric acid stones were frequently, but not invariably, associated with hyperuricosuria and acid urine, and even large uric acid calculi dissolved with a combined therapy of high fluid intake, allopurinol and an alkalinizing agent. Surgical treatment was rarely required in these patients. A stone in the renal pelvis of one patient was removed percutaneously and did not require ultrasonic fragmentation. Modern methods of investigation and treatment have greatly improved the outlook for patients with recurrent renal calculi.     

延边地区100例泌尿系统结石成分分析及代谢评价

[目的]了解延边地区泌尿系统结石的化学成分及与尿代谢异常、性别和民族差异性的关系,探讨其在泌尿系统结石预防和治疗中的临床价值.[方法]收集长期居住在延边地区的上尿路结石100例,利用化学试剂方法对其结石中的草酸盐、磷酸盐、尿酸及尿酸盐、胱氨酸、碳酸盐、铵、钙、镁等主要成分进行测定,结合患者临床资料中的尿酸、尿比重、尿pH值、尿钙水平等进行分析.[结果]100例上尿路结石中含有草酸盐成分的为92例(92%),磷酸盐成分为49例(49%),尿酸及尿酸盐为20例(20%),碳酸盐成分为27例(27%),铵成分为13例(13%),钙成分为92例(92%),镁成分为42例(42%),无含有胱氨酸成分结石.100例中含有1种成分的结石为35例(35%),2种成分为44例(44%),3种成分为19例(19%),4种成分为2例(2%).24h尿分析结果示代谢异常为43例(43%),其中高尿酸尿症为13例,高尿比重为21例,pH值低于5.5的为7例,高尿钙症为2例.汉族与朝鲜族泌尿系统结石成分中尿酸及尿酸盐差异明显(P<0.05).[结论]延边地区泌尿系统结石成分以草酸盐和磷酸盐为主;不同尿代谢异常、不同民族及性别人群的生活习惯及饮食方法不同导致结石成分不同.     

Renal calculi and their management.

Any patient presenting with renal colic requires the taking of a detailed history-- with inquiries about diet and drugs, an examination of the urine, intravenous pyelography and measurement of the calcium concentration in serum and urine. Any stone passed should be analysed. Recurrent stone formation warrants more comprehensive metabolic investigation. The cause of renal calculi in most patients is still not known. When a cause is found, specific treatment can prevent or control stone formation. For the majority in whom no abnormality is detected, various methods of reducing stone formation have been tried but results are disappointing. The most important points in management are the early detection and effective treatment of urinary tract infection or obstruction and the maintenance of a high fluid intake.     

The natural history of calcium urolithiasis

The course of untreated calcium renal stones, derived from the retrospective study of 300 patients with defined metabolic disorders and from the analysis of two prospective, published studies, is complex and heterogeneous. Generally, stones provoke considerable morbidity; hyperuricosuria is associated with an unusually severe stone disease. Stone recurrence rates usually remain stable, or rise with successive stones; in a minority of patients, the reverse is true. A single stone is likely to be followed by a recurrence. The mean time to recurrence averages 6.78 years, with peaks at 1.56 and eight years. Because the disease is likely to be morbid and chronic and does not wane with age, diagnostic evaluation and treatment should be strongly considered for any patient with recurrent stones, and for those in whom recurrence is likely to pose more than the usual risk.     

Diet and calcium stones.

OBJECTIVE: To review the current literature on the dietary modification of urinary risk factors as a means of reducing the likelihood of recurrent stone formation and to develop practical dietary recommendations that might be useful to this end. DATA SOURCES: MEDLINE was searched for English-language articles published from 1983 to 1990. Additional references were selected from the bibliographies of identified articles. STUDY SELECTION: Nonrandomized trials and retrospective reviews were included because of a paucity of randomized controlled trials. DATA SYNTHESIS: Information on the dietary intake of calcium, oxalate, protein, sodium and fibre and on alcohol and fluid intake was used to develop practical guidelines on dietary modification. CONCLUSION: Dietary modification plays an important role in the reduction of urinary risk factors in patients with calcium stone disease of the urinary tract. As an initial form of prevention attention should be directed toward moderating the intake of calcium, oxalate, protein, sodium and alcohol and increasing the intake of fibre and water. Future research should include an assessment of the long-term reduction of dietary and urinary risk factors and the rates of recurrence of calcium stones.     

枸橼酸钾预防舰艇人员尿草酸钙结石复发的疗效观察

目的：探讨枸橼酸钾预防尿草酸钙结石形成的机制及其对尿草酸钙结石复发的影响。方法选择72例舰艇人员经过门诊体外震波碎石治疗后肾结石患者,按治疗方法分为对照组34例和枸橼酸钾组38例。对照组碎石后要求多饮水、多运动、少吃富含高钙、高草酸、高尿酸食品;枸橼酸钾组碎石后口服12．5％枸橼酸钾液10 ml,每日3次,在服用前和服用7 d后测定血、尿生化指标,每3个月1次肾脏B超,随访12个月,观察肾结石复发情况。结果7 d后枸橼酸钾组尿pH值、钾和枸橼酸明显升高,尿钙显著降低。随访12个月,对照组结石复发5例（14．7％）,枸橼酸钾组结石复发1例（2．6％）,经χ2检验,2组复发率比较差异有统计学意义（ P＜0．01）。结论枸橼酸钾可降低尿钙,有效预防尿草酸钙结石复发。     

体外震波碎石采用尿液分析指导临床治疗及预防术后复发

目的通过探讨尿液成分与结石类型之间的关系,为临床尿石症类型的诊断与ESWL术后复发提供依据,以利于临床上采用更准确的治疗方案及ESWL的术后复发预防措施。方法取体外震波碎石术（ESWL）后排出结石做红外光谱分析,来确定结石类型之间的关系。采用t检验进行统计学处理。结果尿酸结石与其他结石之间比较,尿液pH值和尿草酸含量明显低于其他类型结石,差异有显著性（P〈0．01）;一水、二水草酸钙结石与草酸钙＋羟基磷灰石结石、尿酸结石之间比较,尿总钙、尿草酸、尿枸橼酸含量均高于草酸钙＋羟基磷灰石结石,差异有显著性（P〈0．01）。尿酸结石与草酸钙＋羟基磷灰石结石比较,尿液pH值、尿草酸含量均明显低于草酸钙＋羟基磷灰石结石,差异有显著性（P〈0．01）。结论检测24h尿液成分的变化对推断结石类型,指导临床对结石治疗方案的选择及ESWL术后预防有指导意义。     

177例新疆南部维吾尔族尿结石成份分析与代谢评价

目的：研究新疆南部维吾尔族结石成分与代谢异常的关系。方法：分析177例泌尿系结石患者的结石成分及完整血生化及24h尿分析结果。结果：草酸钙结石135例（76．3％）,感染性结石2例（1．1％）,尿酸结石24例（13．6％）,磷酸盐结石14例（7．9％）,胱氨酸结石2例（1．1％）。24h尿分析结果患者中代谢异常129例（72．9％）,其中高钙尿症40例（22．6％）,高尿酸尿症62例（35．0％）,高草酸尿症43例（24．3％）,高尿磷71例（40．1％）,低枸橼酸尿症117例（66．1％）,低尿镁症59例（33．3％）,24h尿量〈2000ml者124例（70．1％）,高胱氨酸尿症2例（1．1％）。结论：结石与多种代谢异常关系密切;确定结石成分及患者的代谢评价对泌尿系结石的成因、治疗和预防有重要的临床意义。     

代谢综合征与泌尿系结石尿液危险因素的相关性

 目的  研究代谢综合征与泌尿系结石尿液危险因素的相关性。方法  选取2013年4月至2013年12月在复旦大学附属中山医院泌尿外科住院治疗的泌尿系结石患者。收集其一般资料、现病史、既往史、血液及尿液检查结果。比较伴有与不伴有代谢综合征者之间血液、尿液指标的差异,并进一步采用多因素分析研究代谢综合征与尿液成分的关系。结果  共纳入188例泌尿系结石患者,其中50例伴有代谢综合征。伴有代谢综合征者的尿液pH值小于不伴有代谢综合征者,24 h尿液中钙、磷、尿酸、草酸、钠、钾均多于不伴有代谢综合征者。多因素分析显示,相比较于不伴有代谢综合征者,伴有代谢综合征者的尿液pH值偏低04(95% CI:-0.7~-0.1,P=0.014),24 h尿液中钙偏高1.03 mmol(95% CI: 0.08~1.99,P=0.034),尿酸偏高608 μmol(95% CI: 133~1 083,P=0.012),草酸偏高700 mg(95% CI: 2.52~11.47,P=0.002)。结论  代谢综合征与尿液中钙、草酸、尿酸含量增多和尿液酸性程度增加等泌尿系结石的危险因素相关。     

Urine citrate and renal stone disease.

Calcium stone disease is attributable to supersaturation of the urine with calcium and other salts, the presence of substances that promote crystallization and a deficiency of inhibitors of crystallization. Citrate is a potent inhibitor of calcium oxalate and calcium phosphate stone formation whose excretion is diminished in some patients with stone disease owing to idiopathic causes or secondary factors such as bowel disease and use of thiazides. The pH within the proximal tubule cells is an important determinant of citrate excretion. Multivariate analysis has shown that the urine concentrations of calcium and citrate are the most important factors in stone formation. In uncontrolled studies potassium citrate, which increases urinary citrate excretion, appears to be promising as a therapeutic agent for patients with stone disease and hypocitraturia refractory to other treatment. On the other hand, there are potential drawbacks to sodium alkali therapy, such as the precipitation of calcium phosphates.     

ASSESSMENT OF URINE SATURATION AND INHIBITORY INDEX IN PATIENTS WITH CALCIUM OXALATE KIDNEY STONE AND NORMALS

The formation of calcium oxalate nephrolithiasis can be estimated by measuring the concentration of calcium oxalate versus the inhibitory role of crystal formation in the urine. In recent studies, the calcium oxalate saturation index and the inhibitory activity (by modified Sarig's method) of the urine during fasting and after oral calcium loading in normal subjects and in patients with calcium nepliro- lithiasis were determined. It was shown that, in normal comrols after calcium loading the inhibitory activity of the urine increased in parallel with the increase in urinary excretion of calcium oxalate; in contrast, in patients with kidney stones, it remained unchanged or fell slightly. This abnormal response might result in a disturbance of the saturation-inhibi- tion balance and formation of kidney stone. In normal individuals, there may be a "protective re- sponse" to prevent the precipitation of calcium oxalate when the urrine is oversaturated with calcium oxalate while a defect of the "protective response" in patients may be an important factor in calcium oxalate stone formation.     

草酸钙尿石症患者尿液和结石中凝血酶原片段检测及其意义

为比较正常人和尿石症患者尿液中凝血酶原片段1（UPTF1）在含量及其与草酸钙晶体的结合能力，以探讨UPTF1含量或功能异常与草酸结石形成的关系，用ELISA法检测正常人和尿石症患者24h尿液、用过饱和结晶法制备的晶体表面结合物质和结石基质中UPTF1的含量。结果发现尿石症患者尿液中能与草酸钙结合的UPTF1的浓度及其在24h尿中含量显著低于正常人组；UPTF1普遍存在于含钙结石中。结果表明：尿石症患者尿液中抑制结石形成的UPTF1明显减少可能是结石形成的重要原因。     

尿石形成的尿危险因素分析

本实验证实含钙尿石形成的尿危险因素是24小时尿高pH、钙、尿酸、草酸和低镁、钠/肌酐、渗透压/肌酐。本组测定值不宜计算形成结石的相对概率,宜采用判别分析。判别值为—22.620,正常人符合率为100.00％,病人为80.56％,两者判别能力有极显著性意义。其中钙、尿酸和草酸对尿石形成的贡献率较高,因此,尿石防治的重点应控制这3个因素。此外还讨论了各危险因素的作用机制及用雷达图形象地表示尿石形成的危险因素。     

泌尿系结石成分分析与预防复发健康指导

目的通过对泌尿系结石成分分析,以期对预防其复发进行健康指导。方法收集本院泌尿外科最近234例患者的结石,并对其成分进行分析。结果结石成分含有草酸盐、磷酸盐、尿酸盐、钙盐、镁盐的患者为108例（46.2%）;含有草酸盐、尿酸盐、钙盐、镁盐的患者为63例（26.9%）;含有磷酸盐、钙盐、镁盐的患者为45例（19.2%）;含有草酸盐、尿酸盐、钙盐的患者为18例（7.7%）。另外,分析的结石全部为含钙结石;92.3%的结石含镁盐;草酸盐和尿酸盐均为80.8%;磷酸盐为65.4%。结论泌尿系结石成分分析是代谢评估的一项主要内容,可以为预防结石的复发提供针对性的治疗依据。     

尿路结石成分与发样和土壤中有关元素相关性分析

目的:探讨吉林省尿路结石患者结石成分与发样和土壤有关元素的关系.方法:用原子吸收光谱分析法测定发样和结石中元素含量. 结果:尿路结石病人发样中钙(Ca)、钠(Na)、铁(Fe)含量(ωβ/10-6)(71.1±12.77,7.69±1.10,0.59±0.18)低于正常人(700±100,360±40,40±10).结论:病人发样中Ca、Na、Fe含量与其尿路结石和土壤中相应元素含量呈负相关.Ca代谢异常是尿路结石形成的重要原因,高Ca饮食饮水是形成结石的危险因素.     

肾鹿角形结石患者结石成分的红外光谱分析

目的 通过红外光谱分析法分析肾鹿角形结石的化学成分,探讨其与泌尿系统感染的关系,为肾结石的治疗和预防提供帮助.方法 回顾性分析北京大学人民医院泌尿外科2009年8月至2010年2月共51例肾鹿角形结石病例,以红外光谱法分析结石的化学成分,并对尿/结石细菌培养等临床资料进行总结.结果 共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、六水磷酸镁铵、尿酸、L-胱氨酸等6种化学成分.结石以混合成分为主,单一成分结石15例(29.4%).含钙结石41例(80.4%),含尿酸结石10例(19.6%).感染石26例(51.0%).术前尿常规阳性率78.4%(40/51),尿/结石细菌学培养阳性率64.7%(33/51).结论 肾鹿角形结石成分多样,病因复杂,与泌尿系统感染密切相关.     

12.5%枸橼酸钾溶液治疗泌尿系结石的疗效评价

目的:探讨12.5%枸橼酸钾溶液治疗泌尿系结石的疗效。方法:将260例确诊为泌尿系结石(结石直径≤1.0cm)的患者随机分为治疗组和对照组,每组130例,两组均采用多饮水、多运动、注意饮食、应用药物等常规治疗方法,治疗组加服12.5%枸橼酸钾溶液,记录每个患者的尿pH、尿钙、尿枸橼酸浓度、排出结石及结石大小等情况。结果:治疗组的有效率为97.69%,对照组的有效率为86.92%,两组间采用χ2检验(χ2=18.44,P<0.05),差异具有统计学意义。治疗组患者的尿pH、尿酸钙等较对照组患者下降明显,两组间均采用u检验(P<0.05),差异具有统计学意义。结论:12.5%枸橼酸钾溶液能够有效排出泌尿系结石,值得临床推广应用。     

红外光谱分析尿路结石成分及个性化饮食指导在泌尿系结石的应用价值

目的：探讨根据泌尿系结石成分进行针对性的饮食指导对预防泌尿系结石复发的作用。方法根据260例泌尿系结石患者（干预组）的结石成分,给予相应的饮食指导。以既往在我科住院治疗未行结石成分分析及饮食指导的259例患者为对照组,比较两组泌尿系结石的复发情况。结果干预组260例中无泌尿结石复发者219例（84．2％）,复发者41例（15．7％）;对照组259例中无复发者194例（74．9％）,复发者65例（25．1％）,两组结石复发率差异有统计学意义（P ＜0.01）。结论结石复发与饮食关系密切,根据结石成分给予相应的饮食指导对预防泌尿系结石的复发有重要作用。     

含钙尿石患者低钙饮食,钙和草酸负荷对尿液草酸排泄影响的初步观察

本文报道20例含钙尿石患者在低钙饮食、钙负荷和草酸负荷前后尿液草酸排泄情况.口服草酸400毫克负荷后,有16例尿液草酸排泄量明显增高;3例高草酸尿症患者口服草酸负荷前后尿液草酸排泄量没有明显的改变,提示这些患者体内存在着草酸代谢的内源性紊乱.