Tracy Chad R, Pearle Margaret S
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
Curr Opin Urol. 2009 Mar;19(2):200-4. doi: 10.1097/MOU.0b013e328323a81d.
Recurrent nephrolithiasis is a burden to the individual patient as well as the healthcare system. A lack of new medications for treatment of stone disease and continued poor compliance with drug therapy has led to a growing interest in dietary manipulation and novel therapies aimed at preventing recurrent stone formation.
Despite initial enthusiasm for lemonade therapy, recent metabolic studies suggest that beverages with a high potassium citrate content, rather than citric acid, may be more effective in reducing stone risk because of the alkali load and citraturic response. In addition, there is increasing epidemiologic and metabolic evidence that obesity and dietary excess, including fructose-rich and purine-rich foods, are associated with increased stone risk. Finally, alternative measures for reducing urinary risk factors, such as probiotics, show promise in reducing urinary oxalate and may be effective in the treatment of primary and enteric hyperoxaluria or even idiopathic calcium oxalate nephrolithiasis. Although changes in urinary stone risk factors may reduce the need for surgical treatment of stone disease, the best management for recurrent nephrolithiasis is likely a combination of surgical and medical therapy.
Dietary measures and novel probiotic therapy are promising adjuncts for preventing recurrent nephrolithiasis.
复发性肾结石对个体患者以及医疗系统来说都是一项负担。用于治疗结石病的新药物匮乏，且药物治疗的依从性持续不佳，这使得人们越来越关注饮食调控以及旨在预防结石复发的新疗法。
尽管最初对柠檬水疗法充满热情，但近期的代谢研究表明，由于碱负荷和枸橼酸尿反应，富含柠檬酸钾而非柠檬酸的饮料可能在降低结石风险方面更有效。此外，越来越多的流行病学和代谢证据表明，肥胖和饮食过量，包括富含果糖和嘌呤的食物，与结石风险增加有关。最后，减少尿液风险因素的替代措施，如益生菌，在降低尿草酸方面显示出前景，可能对原发性和肠道高草酸尿症甚至特发性草酸钙肾结石有效。虽然尿液结石风险因素的改变可能减少结石病手术治疗的需求，但复发性肾结石的最佳管理可能是手术和药物治疗相结合。
饮食措施和新型益生菌疗法有望成为预防复发性肾结石的辅助手段。
