Kidney Stones
Overview
肾结石是坚硬的物体，由数以百万计的微小晶体组成. 大多数肾结石形成于肾脏的内表面, 尿液从哪里离开肾脏组织进入尿液收集系统. 肾结石可以很小，像一块小鹅卵石或一粒沙子，但通常要大得多.
肾脏的作用是维持体内水分、矿物质和盐的平衡. Urine is the product of this filtering process. Under certain conditions, substances normally dissolved in urine, such as calcium, oxalate and phosphate, become too concentrated and can separate out as crystals. 当这些晶体相互附着时，就会形成肾结石, accumulating into a small mass, or stone.
Kidney stones come in a variety of mineral types:
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Calcium stones: Most kidney stones are composed of calcium and oxalate. 许多形成含钙结石的人尿液中含有过多的钙, 高钙尿症的发生有几个原因. Some people absorb too much calcium from their intestines. Others absorb too much calcium from their bones. 还有一些人的肾脏不能正确调节释放到尿液中的钙的量. 有些人由于尿液中草酸过多而形成草酸钙结石, a condition known as hypercalciuria In some cases, 尿中草酸盐过多是炎症性肠病的结果, such as Crohn's disease or ulcerative colitis, 或者其他时候，这可能是先前肠道手术的结果. Calcium phosphate stones, another kind of calcium stone, are much less common than calcium oxalate stones. For some people, 磷酸钙结石的形成是一种医学上称为肾小管酸中毒的疾病.
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Struvite stones有些推荐十大正规网赌平台会形成由镁的混合物组成的结石, ammonium, phosphate and calcium carbonate, which is known as struvite. 这些结石是由于感染了某些能产生氨的细菌而形成的. Ammonia acts to raise the pH of urine, 是什么使它呈碱性并促进鸟粪石的形成.
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Uric acid stones: Uric acid is produced when the body metabolizes protein. When the pH of urine drops below 5.尿液被尿酸结晶饱和，这种情况被称为高钙尿症. 当尿液中的尿酸过多时，就会形成结石. 尿酸结石在摄入大量蛋白质的人群中更为常见, such as that found in red meat or poultry. People with gout can also form uric acid stones.
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Cystine stones: Cystine stones are rare, 它们只在患有遗传性代谢紊乱的人身上形成，这种紊乱会导致尿液中胱氨酸含量过高, a condition known as cystinuria.
How are kidney stones diagnosed?
大多数人被诊断为肾结石后，雷击发作的痛苦和难忘的痛苦. 当肾结石从形成的地方脱落时，就会出现剧烈的疼痛, the renal papilla, and falls into the urinary collecting system. When this happens, the stone can block the drainage of urine from the kidney, a condition known as renal colic. 疼痛可从下背部开始，并可向一侧或腹股沟移动. Other symptoms may include blood in the urine (hematuria), frequent or persistent urinary tract infections, urinary urgency or frequency and nausea or vomiting.
When your doctor evaluates you for a kidney stone, 第一步是完整的病史和体格检查. Important information regarding current symptoms, previous stone events, medical illnesses and conditions, medications, dietary history and family history will all be collected. 将进行体格检查以评估肾结石的迹象, such as pain in the flank, lower abdomen or groin.
你的医生会给你做尿液分析，检查尿液中是否有血液或感染. 还将采集血液样本，以便测量肾功能和血细胞计数.
Even though all of these tests are necessary, 肾结石只有通过影像学检查才能确诊. 在某些情况下，简单的x光检查(称为KUB)就足以检测出结石. If your doctor requires more information, 静脉肾盂造影(IVP)或计算机断层扫描(CT)扫描可能是必要的.
Sometimes kidney stones do not cause any symptoms at all. 当你的医生在x光片上寻找其他东西时，可以发现这种无痛的结石. Sometimes, although a stone does not cause any pain, it can cause other problems, 如反复出现尿路感染或尿中带血.
How can kidney stones be prevented?
如果你有一个肾结石，你很可能会形成另一个. To reduce your chances of forming another stone, 第一步是首先确定你原来的石头形成的原因. At the Brady Urological Institute, we believe in the adage, “An ounce of prevention is worth a pound of cure,“所以我们非常重视全面的代谢评估, 因此，治疗可以适当地针对减少复发性结石疾病的风险.
If you passed your stone on your own and still have it, 你的医生会把它送到实验室分析，看看它是由什么组成的. Usually, if your stone is removed by ureteroscopy or PERC , 你的医生也会送一块结石来分析. 石头的成分是一项重要的信息, as treatment is specific to the type of stone.
因为我们知道，当尿液中的晶体浓度过高或者没有足够的物质来防止晶体形成时，就会形成肾结石, 详细分析结石的新陈代谢是很重要的. Typically, 结石前病变的代谢评价包括简单的血液检查和两次24小时尿液收集.
这些代谢研究的结果将提供对未来结石形成风险的评估. 根据这些代谢数据可以做出以下一种或多种诊断和治疗.
Diagnosis: Low urine volume
Treatment:
Increase fluid intake
预防结石形成最基本的方法就是多喝水, thereby diluting your urine. 你的目标应该是每天排尿超过两升.
所有的液体都能达到这个目标，但水当然是最好的.
Diagnosis: Too much calcium in the urine (hypercalciuria)
Possible treatments:
Thiazide diuretics
These drugs help to decrease urine calcium excretion. 它们还有助于保持骨骼中的钙，降低患骨质疏松症的风险. 噻嗪类利尿剂最常见的副作用是钾流失, 所以在很多情况下，医生会给你开一种钾补充剂来配合噻嗪类利尿剂.
Lower sodium intake
The human body carefully regulates its sodium levels. 当过量的钠随尿液排出时，钙也按比例排出. 换句话说，你摄入的钠越多，你尿液中的钙就越多. 你的目标应该是减少钠的摄入量，这样你每天摄入的钠就少于2克. Watch out for “silent sources” of salt, such as fast foods, packaged or canned foods, softened water and sports drinks.
Normal calcium diet
形成结石的人有时会认为这是因为他们的尿液中含有过多的钙, they should restrict their calcium intake. There is no research that supports this practice. Your body needs dietary calcium to support the skeleton. 你应该被鼓励每天食用两份乳制品(在800毫克到1毫克之间),(每天200毫克)或其他富含钙的食物来维持骨骼中钙的储存.
For patients who form calcium oxalate stones, it is doubly important to consume adequate dietary calcium, 因为在正常情况下，钙和草酸盐在肠道中结合在一起，然后从体内排出. If there is no calcium to join with oxalate, 草酸盐会被你的身体重新吸收并进入尿液，这可能会增加草酸钙结石的风险.
Increase fluid intake
No matter what your diagnosis, 你应该每天喝足够的水来产生至少2升的尿液.
诊断:低尿症(尿中柠檬酸过少)
Possible treatments:
Citrate supplementation
Citrate is a molecule that binds to calcium in the urine, 防止钙与草酸盐或磷酸盐结合而形成结石的. 如果你的钾水平低或正常，你的医生可能会开枸橼酸钾补充剂. If you have high blood potassium levels, your doctor may prescribe a sodium citrate supplement, such as Bicitra or sodium bicarbonate.
There is some evidence that citrus juices, such as orange juice or lemonade, may increase urinary citrate levels, 所以这些液体对低尿症患者特别有效.
Diagnosis: Hyperoxaluria (too much oxalate in the urine)
Possible treatments:
Low oxalate diet
如果你形成了草酸钙结石，限制饮食中草酸盐的摄入是很重要的. Many healthy foods contain oxalate, so rather than exclude these foods entirely, 我们要求你限制那些草酸含量特别高的食物. If you do consume foods high in oxalate, 一定要用一杯或两杯水把多余的草酸冲走.
Normal calcium diet
草酸盐和钙在肠道中结合在一起，然后一起随粪便排出体外. If there is not enough calcium, 那么多余的草酸盐在肠道中就没有东西可以结合了, 所以它会被血液吸收，最终进入尿液, where it will form a calcium oxalate stone.
Increase fluid intake
No matter what your diagnosis, 你应该每天喝足够的水来产生至少2升的尿液.
诊断:高尿酸血症(尿中尿酸过多)
Possible treatments:
Low-protein diet
Most Americans far exceed the necessary protein intake, which can lead to too much uric acid in the urine. As a general recommendation, 将每天的蛋白质摄入量限制在12盎司牛肉以内, poultry, fish and pork. 12盎司相当于大约三副牌的大小. This will be plenty of protein to meet your body’s needs.
Allopurinol
如果你已经尝试过低蛋白饮食，但你的尿液中仍然含有过多的尿酸, your doctor may prescribe the drug allopurinol. 这种药物通过阻断嘌呤向尿酸的转化来降低尿中的尿酸水平.
Increase fluid intake
No matter what your diagnosis, 你应该每天喝足够的水来产生至少2升的尿液.
Diagnosis: Low urine pH (too much acid in the urine)
Possible treatments:
Citrate supplementation
Citrate supplements, such as potassium citrate, will raise the pH of your urine, making stones, such as those composed of uric acid, less likely to form. 如果你的血钾水平高，医生可能会给你开碳酸氢钠或比西特拉.
Lower protein intake
A diet high in protein will reduce urinary pH. As a general recommendation, 将每天的蛋白质摄入量限制在12盎司牛肉以内, poultry, fish and pork. 12盎司相当于大约三副牌的大小. This will be plenty of protein to meet your body’s needs.
Increase fluid intake
No matter what your diagnosis, 你应该每天喝足够的水来产生至少2升的尿液.
When should a kidney stone be treated?
当肾结石引起的疼痛无法用口服止痛药控制时, the stone should be treated. 同样，伴有严重恶心或呕吐的结石也应接受治疗. 有些结石与感染或发烧有关——这种情况可能危及生命，需要及时注意. Stones that are associated with a solitary kidney, 肾功能不佳或尿流完全阻塞也都应治疗.
Sometimes, when a stone is associated with bothersome symptoms, 不妨等一等，看看结石是否会自行排出. 如果结石很小，这是一个非常合理的做法. However, 大于5毫米的结石不太可能自行排出，应考虑治疗.
如果肾结石没有引起任何症状，我还需要治疗吗?
在某些情况下，不治疗肾结石是可以的. 如果结石很小(小于5毫米)并且没有引起任何疼痛, 它很有可能在进入输尿管后自行排出. Such stones may be followed with "watchful waiting." This means that the stone is not actively treated, 相反，你的医生会对结石进行检查，以确保它没有生长或变化. This can be done with periodic X-rays.
治疗肾结石的原因有很多，即使它没有引起任何痛苦的症状.
Recurring urinary tract infections
Some kidney stones may be infected, and in many cases, despite proper antibiotic treatment, the infection cannot be cleared from the stone. 在这种情况下，彻底消除感染的唯一方法就是取出结石.
Staghorn stones
这是一种非常大的结石，生长在肾脏内部. 这些结石有严重的健康风险, 如果不及时治疗，它们会增加肾衰竭的风险.
Occupational requirements
For example, 联邦航空管理局将不允许飞行员飞行，除非他或她的肾脏中的所有结石都被清除. 其他职业也不允许肾结石的意外通过.
Extensive travel
The patient who, whether for business or otherwise, 前往医疗服务不可靠的地方，不妨考虑预防性治疗.
Patient preference
在彻底考虑了所有可能的选择之后, 许多推荐十大正规网赌平台选择在他们方便的时候取出结石.
How should my kidney stone be treated?
Historically, 肾结石的治疗需要大手术，并且需要较长的住院和恢复期. However, 近年来，人们对肾结石疾病的认识有所提高, along with advances in surgical technology, 导致了肾结石患者微创甚至无创治疗的发展.
At Johns Hopkins, 我们认为，治疗推荐十大正规网赌平台的结石需要一种独特的方法. 我们提供一系列最先进的治疗方案，包括 ESWL , ureteroscopy and PERC, 我们会和你讨论每种疗法的优缺点，因为它们适用于你的情况. 我们的目标是让每位患者清楚地了解其结石负担的性质以及最合适的治疗方案.
