Bataille P, Achard J M, Fournier A
Service de néphrologie, centre hospitalier, Boulogne-sur-Mer.
Rev Prat. 1991 Oct 1;41(21):2024-36.
The main risk factors for calcium urolithiasis that are clinically detectable are low diuresis, hypercalciuria, hyperruricuria, alkaline urinary pH, hyperoxaluria, hypomagnesuria, hypocitraturia. They should be evaluated, all the more precisely that the disease is active, under both the urological and metabolic points of view, using 24 hour urine collection made at home on a free diet with a dietary record. In the majority of the cases the calcic urolithiasis is idiopathic, i.e. not related to a cause of secondary hypercalciuria like primary hyperparathyroidism, or to a hyperroxaluria either primary or of digestive or toxic origin. Its treatment if mainly dietary with high fluid intake (diuresis greater than 2 1/24 h), normoclacic diet (800-1000h mh/24 h) with meat but not dairy product restriction, oxalate salts, carbohydrate and alcohol restriction. These dietary recommendations should be controlled by measuring the above cited parameters in the 24 hour urine samples and by measuring urea excretion which should not exceed 0.33 g/kg of body weight. When diet fails, drugs may be added mainly allopurinol, thiazides and potassium citrate.
临床上可检测到的钙结石主要危险因素包括尿量减少、高钙尿症、高尿酸尿症、尿液pH值呈碱性、高草酸尿症、低镁尿症、低枸橼酸尿症。鉴于该疾病处于活动期，应从泌尿外科和代谢两个角度，通过在家中自由饮食并记录饮食情况后收集24小时尿液进行更精确的评估。在大多数情况下，钙结石是特发性的，即与继发性高钙尿症（如原发性甲状旁腺功能亢进）的病因无关，也与原发性或消化性或毒性来源的高草酸尿症无关。其治疗主要是饮食调整，包括大量饮水（尿量大于2.5升/24小时）、正常钙饮食（800 - 1000毫克/24小时），限制肉类但不限制乳制品，限制草酸盐、碳水化合物和酒精摄入。这些饮食建议应通过检测24小时尿液样本中的上述参数以及测量尿素排泄量（不应超过0.33克/千克体重）来进行控制。当饮食调整无效时，可添加药物，主要是别嘌醇、噻嗪类药物和枸橼酸钾。
