Borghi L, Meschi T, Guerra A, Briganti A, Schianchi T, Allegri F, Novarini A
Institutes of Semeiotica Medica, University of Parma, Italy.
Kidney Int. 1999 Jun;55(6):2397-406. doi: 10.1046/j.1523-1755.1999.00483.x.
Cross-sectional studies have shown that nephrolithiasis is more frequently found in hypertensive patients than in normotensive subjects, but the pathogenic link between hypertension and stone disease is still not clear.
Between 1984 and 1991, we studied the baseline stone risk profile, including supersaturation of lithogenic salts, in 132 patients with stable essential hypertension (diastolic blood pressure of more than 95 mm Hg) without stone disease and 135 normotensive subjects (diastolic blood pressure less than 85 mm Hg) without stone disease who were matched for age and sex (controls). Subsequently, both controls and hypertensives were followed up for at least five years to check on the eventual formation of kidney stones.
Baseline urine levels in hypertensive males were different from that of normotensive males with regards to calcium (263 vs. 199 mg/day), magnesium (100 vs. 85 mg/day), uric acid (707 vs. 586 mg/day), and oxalate (34.8 vs. 26.5 mg/day). Moreover, the urine of hypertensive males was more supersaturated for calcium oxalate (8.9 vs. 6.1) and calcium phosphate (1.39 vs. 0.74). Baseline urine levels in hypertensive females were different from that of normotensive females with regards to calcium (212 vs. 154 mg/day), phosphorus (696 vs. 614 mg/day), and oxalate (26.2 vs. 21.7 mg/day), and the urine of hypertensive females was more supersaturated for calcium oxalate (7.1 vs. 4.8). These urinary alterations were only partially dependent on the greater body mass index in hypertensive patients. During the follow-up, 19 out of 132 hypertensive patients and 4 out of 135 normotensive patients had stone episodes (14.3 vs. 2.9%, chi-square 11.07, P = 0.001; odds ratio 5.5, 95% CI, 1.82 to 16.66). Of the 19 stone-former hypertensive patients, 12 formed calcium calculi, 5 formed uric acid calculi, and 2 formed nondetermined calculi. Of the urinary factors for lithogenous risk, those with the greatest predictive value were supersaturation of calcium oxalate for calcium calculi and uric acid supersaturation for uric acid calculi.
A significant percentage of hypertensive subjects has a greater risk of renal stone formation, especially when hypertension is associated with excessive body weight. Higher oxaluria and calciuria as well as supersaturation of calcium oxalate and uric acid appear to be the most important factors. Excessive weight and consumption of salt and animal proteins may also play an important role.
横断面研究表明，高血压患者患肾结石的频率高于血压正常者，但高血压与结石病之间的致病联系仍不清楚。
在1984年至1991年期间，我们研究了132例无结石病的稳定原发性高血压患者（舒张压超过95mmHg）和135例年龄和性别相匹配的无结石病的血压正常者（对照组，舒张压低于85mmHg）的基线结石风险状况，包括致石盐的过饱和度。随后，对对照组和高血压患者均进行了至少五年的随访，以检查肾结石的最终形成情况。
高血压男性的基线尿液水平在钙（263对199mg/天）、镁（100对85mg/天）、尿酸（707对586mg/天）和草酸盐（34.8对26.5mg/天）方面与血压正常男性不同。此外，高血压男性的尿液中草酸钙（8.9对6.1）和磷酸钙（1.39对0.74）的过饱和度更高。高血压女性的基线尿液水平在钙（212对154mg/天）、磷（696对614mg/天）和草酸盐（26.2对21.7mg/天）方面与血压正常女性不同，且高血压女性的尿液中草酸钙的过饱和度更高（7.1对4.8）。这些尿液改变仅部分取决于高血压患者较高的体重指数。在随访期间，132例高血压患者中有19例出现结石发作，135例血压正常患者中有4例出现结石发作（14.3%对2.9%，卡方检验11.07，P = 0.001；优势比5.5，95%可信区间，1.82至16.66）。在19例形成结石的高血压患者中，12例形成钙结石，5例形成尿酸结石，2例形成未确定类型的结石。在致石风险的尿液因素中，对钙结石预测价值最大的是草酸钙过饱和度，对尿酸结石预测价值最大的是尿酸过饱和度。
相当比例的高血压患者有更高的肾结石形成风险，尤其是当高血压与体重过重相关时。较高的草酸盐尿症和钙尿症以及草酸钙和尿酸的过饱和度似乎是最重要的因素。体重过重以及盐和动物蛋白的摄入过多也可能起重要作用。
