Kidney Stones肾结石 · 反直觉的多吃钙

Place · Level 3 · Condition

草酸钙 70% · 反直觉膳食钙保护 · 水 3 L + 柠檬酸 + DASH · 4 种类型区分 · 急性绞痛处理 · 24h 尿代谢

4 main types

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肾结石 · 4 种主要类型

Nephrolithiasis (kidney stones) is one of the most common urological emergencies. Chinese prevalence ~ 5-7%, substantially higher in hot, humid southern regions (Guangdong / Fujian).

4 main types:

Calcium oxalate (70%): most common, linked to calcium + oxalate + hydration + citrateCalcium phosphate (5-10%): alkaline urine + hypercalciuriaUric acid (10-15%): acidic urine + hyperuricemia (linked to atlas gout)Struvite (5-10%): infectious, caused by urease-producing bacteria (Proteus, etc.)Rare: cystine (cystinuria) / xanthine / drug crystals
Clinical presentation:

Renal colic: unilateral / flank radiating to the groin / severe pain / nausea and vomitingHematuria (gross / microscopic)Frequency + urgency + dysuriaFever = infectious complication, emergency< 5 mm often passes spontaneously; > 5 mm needs intervention (ESWL / ureteroscopy)
Recurrence:

Without prevention: 50% recur within 5 years, 80% within 10With preventive intervention: recurrence halved
Risk factors:

Male:female ~ 2-3:130-60 y/oFamily historyHot, humid climate + low water intakeMetabolic syndrome + obesity + T2DDiet: high animal protein + high salt + high oxalate + low K + low citrate + low waterDrugs: thiazide diuretics (raise Ca paradoxically — note: actually lower urinary Ca, but topiramate etc. raise risk) / Topiramate / high-dose vitamin C / calcium supplements between mealsSurgery: Roux-en-Y gastric bypass → hyperoxaluriaDiseases: hyperparathyroidism / Crohn / short-bowel syndrome / RTA

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