Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A
Institute of Semeiotica Medica, University of Parma, Italy.
J Urol. 1996 Mar;155(3):839-43.
We define the role of urine volume as a stone risk factor in idiopathic calcium stone disease and test the actual preventive effectiveness of a high water intake.
We studied 101 controls and 199 patients from the first idiopathic calcium stone episode. After a baseline study period the stone formers were divided by randomization into 2 groups (1 and 2) and they were followed prospectively for 5 years. Followup in group 1 only involved a high intake of water without any dietetic change, while followup in group 2 did not involve any treatment. Each year clinical, laboratory and radiological evaluation was obtained to determine urinary stone risk profile (including relative supersaturations of calcium oxalate, brushite and uric acid by Equil 2), recurrence rate and mean time to relapse.
The original urine volume was lower in male and female stone formers compared to controls (men with calcium oxalate stones 1,057 +/- 238 ml./24 hours versus normal men 1,401 +/- 562 ml./24 hours, p < 0.0001 and women calcium oxalate stones 990 +/- 230 ml./24 hours versus normal women 1,239 +/- 440 ml./24 hours, p < 0.001). During followup recurrences were noted within 5 years in 12 of 99 group 1 patients and in 27 of 100 group 2 patients (p = 0.008). The average interval for recurrences was 38.7 +/- 13.2 months in group 1 and 25.1 +/- 16.4 months in group 2 (p = 0.016). The relative supersaturations for calcium oxalate, brushite and uric acid were much greater in baseline urine of the stone patients in both groups compared to controls. During followup, baseline values decreased sharply only in group 1. Finally the baseline urine in patients with recurrences was characterized by a higher calcium excretion compared to urine of the patients without recurrences in both groups.
We conclude that urine volume is a real stone risk factor in nephrolithiasis and that a large intake of water is the initial therapy for prevention of stone recurrences. In cases of hypercalciuria it is suitable to prescribe adjuvant specific diets or drug therapy.
我们确定尿量作为特发性钙结石病结石风险因素的作用，并测试高水摄入量的实际预防效果。
我们研究了101名对照者和199名首次发生特发性钙结石的患者。在基线研究期后，结石形成者被随机分为2组（1组和2组），并进行了5年的前瞻性随访。1组的随访仅包括高水摄入量且无任何饮食改变，而2组的随访不涉及任何治疗。每年进行临床、实验室和影像学评估，以确定尿路结石风险概况（包括通过Equil 2计算的草酸钙、透钙磷石和尿酸的相对过饱和度）、复发率和平均复发时间。
与对照组相比，男性和女性结石形成者的初始尿量较低（草酸钙结石男性1057±238毫升/24小时，正常男性1401±562毫升/24小时，p<0.0001；草酸钙结石女性990±230毫升/24小时，正常女性1239±440毫升/24小时，p<0.001）。随访期间，99名1组患者中有12名在5年内复发，100名2组患者中有27名复发（p=0.008）。1组复发的平均间隔时间为38.7±13.2个月，2组为25.1±16.4个月（p=0.016）。与对照组相比，两组结石患者基线尿液中草酸钙、透钙磷石和尿酸的相对过饱和度要高得多。随访期间，仅1组的基线值急剧下降。最后，复发患者的基线尿液与两组未复发患者的尿液相比，钙排泄量更高。
我们得出结论，尿量是肾结石的一个真正风险因素，大量饮水是预防结石复发的初始治疗方法。在高钙尿症病例中，适合开辅助性特殊饮食或药物治疗。
