US Army - 20th Chemical, Biological, Radiological, Nuclear, Explosives Command, 2201 Aberdeen Blvd, Aberdeen Proving Ground, MD 21005.
Madigan Army Medical Center - Internal Medicine, 9040 Jackson Ave, Tacoma, WA 98431.
FP Essent. 2021 Oct;509:33-38.
Kidney stones have a prevalence of 8.8% in the United States, with men affected more than women (10.6% versus 7.1%). Most stones are composed of calcium oxalate (61%). Calcium phosphate (15%) and uric acid (12%) stones are the second and third most common types. Risk factors include renal and ureteral anatomic abnormalities, family history, previous stones, older age, and various drugs. Factors that increase the risk of stone development include obesity, older age, metabolic syndrome, diabetes, and hypertension. Symptoms include renal colic, dysuria, urinary frequency, hematuria, fever, flank pain, and groin pain. Renal ultrasonography is the recommended first-line imaging modality, and is preferred in pregnant patients. Metabolic testing is recommended in high-risk patients (eg, with a family history of stones, one kidney, malabsorption or intestinal disease). A nonsteroidal anti-inflammatory drug is the first drug of choice for pain management. Medical expulsive therapy (MET) is considered first-line therapy if stones do not resolve with observation. MET is recommended for patients with uncomplicated distal ureteral stones 10 mm in diameter or less. If a stone fails to pass, other interventions (eg, extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, ureteroscopy, ureteral stents, nephrostomy tubes) can be considered, depending on the situation. Increased fluid intake and dietary interventions can reduce the risk of recurrence.
在美国，肾结石的患病率为 8.8%，男性比女性更容易患病（10.6%对 7.1%）。大多数结石由草酸钙（61%）组成。磷酸钙（15%）和尿酸（12%）结石是第二和第三常见类型。危险因素包括肾脏和输尿管解剖异常、家族史、既往结石、年龄较大和各种药物。增加结石形成风险的因素包括肥胖、年龄较大、代谢综合征、糖尿病和高血压。症状包括肾绞痛、尿痛、尿频、血尿、发热、侧腹痛和腹股沟痛。肾脏超声检查是推荐的一线影像学检查方法，在孕妇中首选。建议对高危患者（例如，有结石家族史、单肾、吸收不良或肠道疾病）进行代谢检查。对于疼痛管理，非甾体抗炎药是首选药物。如果观察后结石未溶解，将考虑采用医疗排石疗法（MET）作为一线治疗。对于直径不超过 10 毫米的单纯远端输尿管结石患者推荐采用 MET。如果结石无法排出，可以根据情况考虑其他干预措施（例如体外冲击波碎石术、经皮肾镜取石术、输尿管镜检查、输尿管支架、肾造口管）。增加液体摄入和饮食干预可以降低复发风险。
