Pfau A, Eckardt K-U, Knauf F
Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen und Klinikum Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland.
Internist (Berl). 2015 Dec;56(12):1361-8. doi: 10.1007/s00108-015-3758-0.
Kidney stones are a common and increasing problem worldwide. Nephrolithiasis is frequently a chronic disease given the risk of recurrence following passage of a first stone.
In the present article, an update on the diagnosis and treatment of kidney stones relevant for internal medicine physicians is provided.
This review is based on a selective literature search and our own work.
The diagnosis of kidney stones is based on the clinical history and physical examination. Confirmatory radiologic tests include noncontrast computerized tomography or ultrasonography with both techniques having recently been shown to have equivalent overall outcomes. The therapy of kidney stones is based on the clinical presentation and diagnostic findings (e.g., fever, response to pain management, and demonstration of relevant obstruction) as well as location, size, and composition of the stone. If invasive treatment is being considered, the urology department should be consulted. Given the high risk of recurrence, stone analysis must be performed as well as the concentration of lithogenic and litholytic substances measured in a 24-h urine collection. The newly established recurrence of kidney stone nomogram (ROKS nomogram) identifies kidney stone formers at greatest risk for a second symptomatic episode who may benefit from medical intervention.
肾结石是全球范围内常见且日益严重的问题。鉴于首次结石排出后存在复发风险，肾结石病通常是一种慢性疾病。
在本文中，为内科医生提供有关肾结石诊断和治疗的最新信息。
本综述基于选择性文献检索和我们自己的工作。
肾结石的诊断基于临床病史和体格检查。确诊的影像学检查包括非增强计算机断层扫描或超声检查，最近已证明这两种技术的总体结果相当。肾结石的治疗基于临床表现和诊断结果（如发热、疼痛管理反应以及相关梗阻的表现）以及结石的位置、大小和成分。如果考虑进行侵入性治疗，应咨询泌尿外科。鉴于复发风险高，必须进行结石分析，并在24小时尿液收集样本中测量致石和溶石物质的浓度。新建立的肾结石复发列线图（ROKS列线图）可识别出发生第二次症状性发作风险最高的肾结石患者，这些患者可能从药物干预中获益。
