Stepanova Natalia
State Institution "O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine", 03680 Kyiv, Ukraine.
Dialysis Medical Center LLC "Nephrocenter", 03057 Kyiv, Ukraine.
J Clin Med. 2025 May 23;14(11):3678. doi: 10.3390/jcm14113678.
Managing nephrolithiasis in chronic kidney disease (CKD) poses a therapeutic challenge: preventing stone recurrence while preserving kidney function. Standard urological interventions and preventive strategies, such as high fluid intake, thiazides, and potassium citrate, cut recurrence by 50-60% in healthy kidneys but risk fluid overload, hyperkalemia, and diminished efficacy in CKD as glomerular filtration rate (GFR) declines. Often, stone prevention and CKD care are addressed separately, leaving clinicians without unified guidance for this rising patient group. This review explores the bidirectional relationship between nephrolithiasis and CKD, integrating pathophysiology and therapeutic strategies into a practical, decision-oriented framework. It offers tailored interventions based on GFR category, stone type, and comorbid conditions, emphasizing the potential for dual-purpose therapies. Going beyond previous reviews, it connects clinical practice with existing research gaps, offering tools to balance outcomes and guide future studies.
在慢性肾脏病（CKD）中管理肾结石是一项治疗挑战：既要预防结石复发，又要保护肾功能。标准的泌尿外科干预措施和预防策略，如大量饮水、使用噻嗪类药物和枸橼酸钾，可使健康肾脏的结石复发率降低50%至60%，但随着肾小球滤过率（GFR）下降，在CKD患者中存在液体超负荷、高钾血症和疗效降低的风险。通常，结石预防和CKD护理是分开处理的，这使得临床医生对于这一不断增加的患者群体缺乏统一的指导。本综述探讨了肾结石与CKD之间的双向关系，将病理生理学和治疗策略整合到一个实用的、以决策为导向的框架中。它根据GFR类别、结石类型和合并症提供量身定制的干预措施，强调双重目的治疗的潜力。与以往的综述不同，它将临床实践与现有的研究差距联系起来，提供平衡结果的工具并指导未来的研究。
