Asplin John R
Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois, USA.
Curr Opin Nephrol Hypertens. 2022 Mar 1;31(2):168-174. doi: 10.1097/MNH.0000000000000766.
Evaluation of the kidney stone patient includes measurement of 24 h urine chemistries. This review summarizes the application of physiologic principles to the interpretation of urine chemistries, using sulfate and ammonium to estimate diet acid load, and the renal response.
There has been increased recognition of the need to measure urine ammonium excretion in the clinical setting in order to understand renal acid excretion. Some 24 h urine kidney stone panels include ammonium measurements, providing an opportunity to apply this measurement to clinical practice. In order to better interpret ammonium excretion, one needs an estimate of dietary acid load to understand the driving forces for ammonium excretion. Sulfate is also included in some kidney stone panels and functions as an estimate of diet acid load. Combining these analytes with urine pH, the clinician can quickly estimate dietary stone risk as well as potential bowel disease, acidification disorders, and the presence of urease producing bacteria; all of which can affect stone risk.
Measurement of ammonium and sulfate excretion along with urine pH provide important insights into the acid/alkali content of diet, presence and severity of bowel disease, presence of renal acidification disorders, and urinary infection.
对肾结石患者的评估包括测定24小时尿化学成分。本综述总结了生理原理在尿化学成分解读中的应用，利用硫酸盐和铵来估计饮食酸负荷以及肾脏的反应。
人们越来越认识到在临床环境中测量尿铵排泄量对于了解肾脏酸排泄的必要性。一些24小时尿肾结石检测项目包括铵测量，这为将该测量应用于临床实践提供了机会。为了更好地解读铵排泄情况，需要估计饮食酸负荷以了解铵排泄的驱动因素。一些肾结石检测项目中也包括硫酸盐，它可作为饮食酸负荷的估计指标。将这些分析物与尿液pH值相结合，临床医生可以快速估计饮食性结石风险以及潜在的肠道疾病、酸化障碍和产脲酶细菌的存在情况；所有这些都可能影响结石风险。
测量铵和硫酸盐排泄量以及尿液pH值可提供关于饮食酸/碱含量、肠道疾病的存在及严重程度、肾脏酸化障碍的存在情况以及泌尿系统感染的重要信息。
