Levy F L, Adams-Huet B, Pak C Y
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Am J Med. 1995 Jan;98(1):50-9. doi: 10.1016/S0002-9343(99)80080-1.
Evaluations of 1,270 patients with recurrent nephrolithiasis in an outpatient setting were analyzed for the purpose of updating the classification of nephrolithiasis. All but 4% had abnormal urinary biochemistry that placed them into one or more of 20 etiologic categories. A single diagnosis was documented in 41.3% of patients. The remaining 58.7% had more than one diagnosis. Hypercalciuric calcium (Ca) nephrolithiasis, encountered in 60.9% of patients, comprised six variants--absorptive hypercalciuria Type I and II, renal hypercalciuria, primary hyperparathyroidism, and unclassified hypercalciuria (renal phosphate leak and fasting hypercalciuria). Hyperuricosuria Ca nephrolithiasis (HUCN) and gouty diathesis (GD) accounted for 35.8% and 10.0% of patients, respectively. Distinguishing features were hyperuricosuria and normal urinary pH in HUCN, and normal urinary uric acid and low urinary pH (< 5.5) in GD. Hyperoxaluric Ca nephrolithiasis, occurring in 8.1% of patients, was subdivided into enteric, primary, and dietary variants. Hypocitraturic Ca nephrolithiasis affected 28% of patients in its idiopathic variant. Many of these patients' problems were probably dietary in origin, while some could have had incomplete renal tubular acidosis. Hypocitraturia due to renal tubular acidosis or chronic diarrheal syndrome affected only 3.3% of patients. Hypomagnesiuric Ca nephrolithiasis, infection stones, and cystinuria were uncommon, accounting for 6.8%, 5.9%, and 0.9% of patients, respectively. The acquired problem of low urine volume (< 1 L/d) was found in 15.3% of patients. The remaining 3.5% of patients were difficult to classify despite the presence of abnormal urinary biochemistry.
为更新肾结石的分类，对门诊环境中1270例复发性肾结石患者的评估进行了分析。除4%外，所有患者的尿液生化指标均异常，使其归入20种病因类别中的一种或多种。41.3%的患者记录有单一诊断。其余58.7%有不止一种诊断。60.9%的患者患有高钙尿性钙肾结石，包括六种变体——I型和II型吸收性高钙尿症、肾性高钙尿症、原发性甲状旁腺功能亢进症和未分类的高钙尿症（肾磷酸盐泄漏和空腹高钙尿症）。高尿酸尿性钙肾结石（HUCN）和痛风素质（GD）分别占患者的35.8%和10.0%。其区别特征是HUCN中高尿酸尿症和正常尿液pH值，以及GD中正常尿液尿酸和低尿液pH值（<5.5）。8.1%的患者患有高草酸尿性钙肾结石，可细分为肠道型、原发性和饮食型变体。特发性变体的低枸橼酸尿性钙肾结石影响了28%的患者。这些患者的许多问题可能源于饮食，而有些患者可能患有不完全肾小管酸中毒。由肾小管酸中毒或慢性腹泻综合征引起的低枸橼酸尿症仅影响3.3%的患者。低镁尿性钙肾结石、感染性结石和胱氨酸尿症不常见，分别占患者的6.8%、5.9%和0.9%。在15.3%的患者中发现了尿量低（<1L/天）这一后天问题。其余3.5%的患者尽管尿液生化指标异常，但难以分类。
