Centre for Nephrology, UCL Medical School, Royal Free Campus, London, UK.
Nephron Clin Pract. 2010;116(3):c159-71. doi: 10.1159/000317196. Epub 2010 Jul 2.
Renal stone disease covers kidney and lower urinary tract stones caused by a variety of conditions, including metabolic and inherited disorders, and anatomical defects with or without chronic urinary infection. Most cases are idiopathic, in which there is undoubtedly a genetic predisposition, but where environmental and lifestyle factors play an important role. Indeed, it is becoming apparent that renal stone disease is often part of a larger 'metabolic picture' commonly associated with type 2 diabetes, obesity, dyslipidaemia, and hypertension. Renal stone disease is a growing problem in the UK (and other developed and developing populations) with a cross-sectional prevalence of ∼1.2%. This means that there are currently ∼720,000 individuals with a history of kidney stones in the UK. Almost 40% of first-time stone formers will form a second stone within 3 years of the first episode if no prophylactic measures are instituted to prevent stone recurrence, since removal or disintegration of the first stone does not treat the underlying cause of stones in the majority of patients. The age of onset is getting younger and the sex ratio (until recently more men than women) is becoming almost even. Metabolic screening remains an important part of investigating renal stone disease, but to the disappointment and frustration of many doctors, medical treatment is still essentially pragmatic, except perhaps in cystinuria, and to a limited extent in primary hyperoxaluria (if pyridoxine-sensitive); although newer treatments may be emerging. This review summarizes current thinking and provides a practical basis for the management of renal stone disease.
肾结石病涵盖了由多种情况引起的肾脏和下尿路结石，包括代谢和遗传紊乱，以及伴有或不伴有慢性尿路感染的解剖缺陷。大多数病例是特发性的，其中无疑存在遗传易感性，但环境和生活方式因素也起着重要作用。事实上，越来越明显的是，肾结石病通常是与 2 型糖尿病、肥胖症、血脂异常和高血压等更为广泛的“代谢图景”相关的一部分。肾结石病在英国（以及其他发达国家和发展中国家）是一个日益严重的问题，横断面患病率约为 1.2%。这意味着目前英国有大约 72 万人有肾结石病史。如果不采取预防措施来防止结石复发，首次结石形成者中有近 40%会在首次发作后 3 年内形成第二个结石，因为大多数患者的结石复发的根本原因并没有得到治疗，即使去除或分解了第一个结石。发病年龄越来越年轻，性别比例（直到最近男性多于女性）几乎持平。代谢筛查仍然是肾结石病研究的重要组成部分，但令许多医生失望和沮丧的是，除了胱氨酸尿症（在一定程度上还包括原发性高草酸尿症（如果对吡哆醇敏感））之外，医学治疗基本上仍然是实用主义的；尽管可能会出现新的治疗方法。这篇综述总结了当前的思维，并为肾结石病的管理提供了实用的基础。
