Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Clin J Am Soc Nephrol. 2011 Aug;6(8):2069-75. doi: 10.2215/CJN.10651110. Epub 2011 Jul 22.
Recent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed.
最近的人口研究发现，有症状的肾结石患者患慢性肾脏病（CKD）的风险增加。尽管肾结石通常不作为终末期肾病（ESRD）的主要病因，但它们仍然可能是重要的致病因素。具有讽刺意味的是，由于尿钙排泄大量减少，CKD 可以起到预防肾结石形成的作用。在肾结石患者中，那些患有罕见遗传性疾病（胱氨酸尿症、原发性高草酸尿症、Dent 病和 2,8 二羟腺嘌呤结石）、复发性尿路感染、鸟粪石结石、高血压和糖尿病的患者，似乎患 CKD 的风险最高。肾结石导致 CKD 的主要机制通常归因于尿路梗阻或肾盂肾炎，但来自冲击波碎石术的晶体栓子和来自肾实质损伤的晶体栓子也可能起作用。肾结石的微创手术治疗的历史转变可能对 CKD 的风险产生了有益的影响。在潜在的肾脏供体中，过去有症状的肾结石，但 CT 扫描上未发现的结石与白蛋白尿有关。在普通人群中，通过超声筛查发现的肾结石也与 CKD 有关。需要进一步的研究，更好地对 CKD 进行分类，更好地描述肾结石患者的特征，更彻底地解决潜在的合并症混杂因素，并进行积极而不是被动的随访，以避免检测偏倚。
