Marangella M, Petrarulo M, Daniele P G, Sammartano S
UOA Nefrologia Dialisi e Centro Calcolosi Renale, Ospedale Mauriziano Umberto I, Torino, Italy.
G Ital Nefrol. 2002 Nov-Dec;19(6):693-8.
The pathogenesis of nephrolithiasis, based on the anomalies of the urinary environment, demands metabolic and physicochemical assessment for the medical management of patients. Standard metabolic protocols include the measurement of pertinent urine chemistry values and the calculation of the extent of saturation in stone-forming salts. However, patients are often given fragmentary and hard-to-consult reports and so this weakens the strength of the therapeutic recommendations. This paper introduces LithoRisk, a dedicated software which graphically represents risk profiles of stone formation, including the extent of saturation.
LithoRisk uses the results of 24-h urine chemistry values widely available in hospital laboratories, i.e., sodium, potassium, calcium, magnesium, ammonia, phosphate, sulphate, citrate, oxalate, chloride, pH and urine volume. Uric acid and cystine are optional. The relative supersaturation (beta), estimated according to our own ab initio calculation, is given in a scale whereby beta=1 is saturation, beta < 1 under - and beta > 1 oversaturation. LithoRisk is available as a CD-ROM and can be loaded on Windows 95/98/Millenium/XP. Colour or laser printers are suitable for printed records.
LithoRisk is easily loaded on any PC by following video instructions. Once the loading of the program is completed a grey icon LithoRisk appears on the Desktop. The program can be opened by clicking twice on the icon. The patients data page first appears on the screen and is followed by the evaluation page for the input of variables. This generates the graph representing the diagnostic lithorisk profile, which is drawn as a line connecting different values, according to a specific scale and related to an arbitrary normal point. Normal values are shown as green lines, whereas abnormal ones are red. The beta values for calcium oxalate and phosphate, uric acid and cystine are instantaneously calculated and reported on the graph.
LithoRisk produces a complete, unique and easy to understand report that includes all relevant parameters, it therefore expresses the overall risk of stone formation. It requires the results of chemistry tests done on the same 24-h urine collection, and carried out using suitable preservatives. If the tests for unusual parameters, i.e. sulphate and ammonia, are unavailable, one can use default values with minimal alterations on beta calculation. In spite of being arbitrary, the normal thresholds values are based on widely accepted literature data. The risk profile recognises the most relevant abnormalities and enables the establishment of individual targets aimed at reducing the propensity towards stone formation.
基于尿液环境异常的肾结石发病机制，要求对患者进行医学管理时进行代谢和物理化学评估。标准代谢方案包括测量相关尿液化学值以及计算结石形成盐的饱和度。然而，患者通常收到的报告零散且难以查阅，这削弱了治疗建议的力度。本文介绍了LithoRisk，一款专门的软件，它以图形方式展示结石形成的风险概况，包括饱和度。
LithoRisk使用医院实验室广泛可得的24小时尿液化学值结果，即钠、钾、钙、镁、氨、磷酸盐、硫酸盐、柠檬酸盐、草酸盐、氯化物、pH值和尿量。尿酸和胱氨酸为可选项目。根据我们自己的从头计算法估算的相对过饱和度（β），以一种刻度给出，其中β = 1为饱和度，β < 1为欠饱和度，β > 1为过饱和度。LithoRisk以光盘形式提供，可加载到Windows 95/98/千禧版/XP系统上。彩色或激光打印机适用于打印记录。
按照视频说明，LithoRisk可轻松加载到任何个人电脑上。程序加载完成后，桌面上会出现一个灰色的LithoRisk图标。双击该图标即可打开程序。首先在屏幕上出现患者数据页面，随后是用于输入变量的评估页面。这会生成代表诊断性结石风险概况的图表，该图表根据特定刻度绘制为连接不同值的线条，并与一个任意的正常点相关。正常数值显示为绿色线条，而异常数值为红色。草酸钙、磷酸盐、尿酸和胱氨酸的β值会即时计算并显示在图表上。
LithoRisk生成一份完整、独特且易于理解的报告，其中包含所有相关参数，因此表达了结石形成的总体风险。它需要对同一24小时尿液样本进行化学检测的结果，并使用合适的防腐剂。如果无法获得异常参数（即硫酸盐和氨）的检测结果，可以使用默认值，对β计算的影响最小。尽管正常阈值是任意设定的，但基于广泛接受的文献数据。风险概况识别出最相关的异常情况，并能够确立旨在降低结石形成倾向的个体目标。
