Ferraro Pietro Manuel, Curhan Gary C, D'Addessi Alessandro, Gambaro Giovanni
Division of Nephrology, Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Via Moscati 31-33, 00168, Rome, Italy.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Nephrol. 2017 Apr;30(2):227-233. doi: 10.1007/s40620-016-0283-8. Epub 2016 Mar 11.
Nephrolithiasis is a frequent condition. While it is generally accepted that such condition carries a risk of recurrence over time, the exact risk and its predictors have been rarely quantitated. We aimed to estimate recurrence of kidney stones, overall and in specific subgroups, from randomized controlled trials (RCTs) of calcium stone formers.
Systematic review of RCTs of adult patients with idiopathic calcium kidney stones. Recurrence rates analyzed in subgroups based on type of intervention and other characteristics, using Poisson regression models.
The analysis included 21 RCTs with 2168 participants over a median follow-up of 3.2 years (range 0.5-9.7). The median recurrence of kidney stones was 15 per 100 person-years (range 0-110). Recurrence was higher in those with two or more previous stone episodes compared to those with a single episode at enrolment (16 vs. 6 per 100 person-years, p < 0.001) and in those untreated or treated with dietary changes compared to those treated with drugs (26 vs. 23 vs. 9 per 100 person-years, p < 0.001). The effect of drugs on recurrence seemed to be beneficial only among those with two or more previous stone episodes.
The overall recurrence rate of stones depends on factors such as previous stone history and type of treatment. Dietary approaches seem to be more effective among single stone formers, whereas drugs seem to be more effective among recurrent stone formers.
肾结石是一种常见病症。虽然人们普遍认为这种病症随着时间推移有复发风险，但确切风险及其预测因素很少被量化。我们旨在通过对钙结石形成者的随机对照试验（RCT）来估计肾结石的复发情况，包括总体复发情况以及特定亚组的复发情况。
对成年特发性钙肾结石患者的随机对照试验进行系统评价。使用泊松回归模型，根据干预类型和其他特征在亚组中分析复发率。
分析纳入了21项随机对照试验，共2168名参与者，中位随访时间为3.2年（范围0.5 - 9.7年）。肾结石的中位复发率为每100人年15例（范围0 - 110例）。与入组时仅有一次结石发作的患者相比，既往有两次或更多次结石发作的患者复发率更高（每100人年分别为16例和6例，p < 0.001）；与接受药物治疗的患者相比，未接受治疗或接受饮食改变治疗的患者复发率更高（每100人年分别为26例、23例和9例，p < 0.001）。药物对复发的影响似乎仅在既往有两次或更多次结石发作的患者中有益。
结石的总体复发率取决于既往结石病史和治疗类型等因素。饮食方法似乎对单发结石形成者更有效，而药物似乎对复发结石形成者更有效。
