Straub Michael, Hautmann Richard E
Urolithiasis Research Group, Department of Urology and Pediatric Urology, University of Ulm, Prittwitzstrasse 43, D-89075 Ulm, Germany.
Curr Opin Urol. 2005 Mar;15(2):119-26. doi: 10.1097/01.mou.0000160627.36236.6b.
This review focuses on new developments in stone prevention. Unfortunately, no major progress in this field has happened. There is a worldwide lack of randomized and controlled trials, which could confirm our theoretical assumptions and preventive concepts in stone disease. With these preconditions in mind, this review presents the current knowledge of metabolic influences causing the symptom "stone" and the effective measures against it.
Modern lifestyle, dietary habits and obesity emerge to be the promoters of idiopathic stone disease. Cross-sectional studies showed significant correlations between these factors and kidney stones with direct implications on our preventive concepts: normalization of body mass index, adequate physical activity, balanced nutrition and sufficient circadian fluid intake. Modern diets containing a lot of animal protein, refined carbohydrates and salt act on the metabolism like an acid load. To overcome these disadvantageous effects, a sufficient supply of potassium and alkali is required. Last but not least, calcium should not be restricted. There is clear evidence from clinical and experimental research that a normal or a high calcium supply is appropriate in calcium stone disease. Only in absorptive hypercalciuria calcium restriction remains beneficial in combination with thiazide and citrate therapy.
Up to 85% of all stone patients could anticipate lower risk of stone recurrence with elementary reorientation of their lifestyle and dietary habits. Normalizing the major risk factors is easy and cheap. About 15% of patients forming stones require additional specific pharmacological prevention. The specific measures to avoid recurrence of the stone disease are precisely defined.
本综述聚焦于结石预防的新进展。遗憾的是，该领域未取得重大进展。全球范围内缺乏随机对照试验，而这类试验能够证实我们在结石病方面的理论假设和预防理念。基于这些前提条件，本综述介绍了目前关于导致“结石”症状的代谢影响因素的知识以及针对结石的有效防治措施。
现代生活方式、饮食习惯和肥胖已成为特发性结石病的诱发因素。横断面研究表明，这些因素与肾结石之间存在显著相关性，这对我们的预防理念有着直接影响：使体重指数正常化、进行适当的体育活动、保持营养均衡以及保证充足的昼夜液体摄入量。含有大量动物蛋白、精制碳水化合物和盐的现代饮食对新陈代谢产生类似酸负荷的作用。为克服这些不利影响，需要充足的钾和碱供应。最后但同样重要的是，不应限制钙的摄入。临床和实验研究有明确证据表明，在钙结石病中，正常或高钙供应是适宜的。仅在吸收性高钙尿症中，结合噻嗪类药物和柠檬酸盐疗法限制钙摄入仍有益处。
高达85%的结石患者通过基本调整生活方式和饮食习惯，可预期降低结石复发风险。使主要风险因素正常化既简单又经济。约15%的结石形成患者需要额外的特定药物预防。预防结石病复发的具体措施已得到明确界定。
