Kasidas G P, Samuell C T, Weir T B
Department of Clinical Biochemistry, University College London Hospitals, 60 Whitfield Street, London W1T 4EU, UK.
Ann Clin Biochem. 2004 Mar;41(Pt 2):91-7. doi: 10.1258/000456304322879962.
Upper urinary tract stone disease is widespread in the developed world. On both clinical and economic grounds it is now accepted that evidence-based medical intervention is the only approach likely to make a significant impact on the incidence, and more importantly, the recurrence rates of this disease. Targeted medical prophylaxis requires reliable information on stone type which, when combined with relevant blood and urine analyses, allows identification of treatable risk factors. Data from an external quality assurance scheme indicate that stone analysis is poorly performed in many laboratories, and it is probable that this results in ill-informed patterns of investigation, inappropriate therapy, missed diagnoses of rarer causative disorders and wasteful further investigation of 'non-renal' stone artefacts. Renal stone analysis is a specialist investigation requiring appropriate analytical and interpretative expertise if the information is to be used to enhance patient care. For those laboratories not able to offer this, for whatever reason, referral is the only defensible approach to service provision. The methods currently employed in many departments have no place in modern clinical biochemistry practice.
上尿路结石病在发达国家广泛存在。基于临床和经济原因，目前人们公认循证医学干预是唯一有可能对该病的发病率，更重要的是复发率产生重大影响的方法。针对性的医学预防需要有关结石类型的可靠信息，将其与相关血液和尿液分析相结合，可识别可治疗的风险因素。一项外部质量保证计划的数据表明，许多实验室的结石分析做得很差，这很可能导致检查模式不合理、治疗不当、罕见病因疾病漏诊以及对“非肾性”结石假象进行浪费性的进一步检查。肾结石分析是一项专业检查，如果要利用这些信息来改善患者护理，就需要适当的分析和解释专业知识。对于那些由于任何原因无法提供此项服务的实验室，转诊是唯一合理的服务提供方式。许多科室目前采用的方法在现代临床生物化学实践中毫无用武之地。
