Wróblewski Tomasz, Wystrychowski Antoni
Oddział Nefrologiczny i Chorób Wewnetrznych, Szpital Powiatowy w Chrzanowie.
Przegl Lek. 2011;68(2):107-13.
Hypercalciuria is the most common metabolic abnormality that causes urolithiasis. The pathogenetic mechanisms responsible for hypercalciuria include enhanced gastrointestinal absorption of calcium, increased bone resorption and/or decreased renal reabsorption of calcium; the main dietary factors promoting hypercalciuria are high dietary sodium intake and protein-rich diet. The authors discuss pathophysiology of hypercalciuria and genetic factors behind 'idiopathic hypercalciuria'. The simplified diagnostic approach to hypercalciuria is outlined herein, and available therapeutic interventions of proven efficacy in idiopathic hypercalciuria are presented as well. Dietary intervention for hypercalciuria should include reduced sodium, protein and oxalate intake. Thiazide diuretics, in conjunction with a low-sodium diet, tend to reduce urinary calcium excretion and ameliorate idiopathic hypercalciuria. Potassium citrate acts as an inhibitor of calcium stone formation in the urinary tract. A low-calcium diet should generally be avoided, as it may increase urinary oxalate excretion and actually promote stone formation. In addition, a low-calcium diet may lead to negative calcium balance in subjects with hypercalciuria, and therefore increases the risk of osteopenia.
高钙尿症是导致尿路结石最常见的代谢异常情况。引起高钙尿症的发病机制包括胃肠道对钙的吸收增强、骨吸收增加和/或肾脏对钙的重吸收减少；促进高钙尿症的主要饮食因素是高钠饮食和富含蛋白质的饮食。作者讨论了高钙尿症的病理生理学以及“特发性高钙尿症”背后的遗传因素。本文概述了高钙尿症的简化诊断方法，并介绍了对特发性高钙尿症已证实有效的现有治疗干预措施。针对高钙尿症的饮食干预应包括减少钠、蛋白质和草酸盐的摄入。噻嗪类利尿剂与低钠饮食相结合，往往会减少尿钙排泄并改善特发性高钙尿症。柠檬酸钾可作为尿路中钙结石形成的抑制剂。一般应避免低钙饮食，因为它可能会增加尿草酸盐排泄，实际上促进结石形成。此外，低钙饮食可能会导致高钙尿症患者出现负钙平衡，从而增加骨质减少的风险。
