Investigation and treatment of renal calculi

We have investigated and treated 176 patients who were suffering from renal calculi. The stones contained calcium in 87% of patients, predominantly urate in 11%, and rarely contained magnesium ammonium phosphate or cystine. Of the patients with calcium stones, hypercalciuria was present in 75% and was identified in 57% by the measurement of the 24-hour urinary calcium excretion, and in a further 18% by a standardization calcium "fast-and-load" test. Nine patients were found to have primary hyperparathyroidism and were treated surgically. A further 21% were suspected to have normocalcaemic hyperparathyroidism, and metabolic studies are being developed to clarify this. The treatment of hypercalciuria included a low-calcium diet, and various combinations of a thiazide diuretic, phosphate supplements and sodium cellulose phosphate. Hypercalciuria was controlled in all compliant patients, and only two developed further stones. Hyperuricosuria was rarely the sole metabolic abnormality in patients with calcium stones, though this might reflect the referral pattern of the Unit. Uric acid stones were frequently, but not invariably, associated with hyperuricosuria and acid urine, and even large uric acid calculi dissolved with a combined therapy of high fluid intake, allopurinol and an alkalinizing agent. Surgical treatment was rarely required in these patients. A stone in the renal pelvis of one patient was removed percutaneously and did not require ultrasonic fragmentation. Modern methods of investigation and treatment have greatly improved the outlook for patients with recurrent renal calculi.     

Urinary Excretion of Calcium and Citrate in Normal Individuals and Stone Formers with Variation in Calcium Intake

The changes which occur in both calcium and citrate excretion in normal persons, in idiopathic calcium stone formers and in persons with hyperparathyroidism have been measured at high and low levels of dietary calcium intake. The findings suggested a difference in the renal handling of calcium between normal subjects and stone formers. There was a greater increase in the urinary excretion of calcium with increased intake of calcium in individuals with renal calculi than in normals. Increasing the calcium intake shifted the mole ratio of calcium to citrate unfavourably for the chelation of calcium by citrate, and this unfavourable shift was more marked in the stone formers than in normal individuals. These findings support the concept that urinary citrate may be of importance in the prevention of calcium precipitation and hence in the pathogenesis of kidney stones.     

延边地区100例泌尿系统结石成分分析及代谢评价

[目的]了解延边地区泌尿系统结石的化学成分及与尿代谢异常、性别和民族差异性的关系,探讨其在泌尿系统结石预防和治疗中的临床价值.[方法]收集长期居住在延边地区的上尿路结石100例,利用化学试剂方法对其结石中的草酸盐、磷酸盐、尿酸及尿酸盐、胱氨酸、碳酸盐、铵、钙、镁等主要成分进行测定,结合患者临床资料中的尿酸、尿比重、尿pH值、尿钙水平等进行分析.[结果]100例上尿路结石中含有草酸盐成分的为92例(92%),磷酸盐成分为49例(49%),尿酸及尿酸盐为20例(20%),碳酸盐成分为27例(27%),铵成分为13例(13%),钙成分为92例(92%),镁成分为42例(42%),无含有胱氨酸成分结石.100例中含有1种成分的结石为35例(35%),2种成分为44例(44%),3种成分为19例(19%),4种成分为2例(2%).24h尿分析结果示代谢异常为43例(43%),其中高尿酸尿症为13例,高尿比重为21例,pH值低于5.5的为7例,高尿钙症为2例.汉族与朝鲜族泌尿系统结石成分中尿酸及尿酸盐差异明显(P<0.05).[结论]延边地区泌尿系统结石成分以草酸盐和磷酸盐为主;不同尿代谢异常、不同民族及性别人群的生活习惯及饮食方法不同导致结石成分不同.     

Urinary Pyrophosphate in Normal Subjects and in Stone Formers

The urinary excretion of inorganic pyrophosphate was determined in nine normal subjects and also in eight patients with recurrent calcium-containing renal stones during varied levels of phosphate intake. The excretion of pyrophosphate and orthophosphate is virtually the same in the two groups at all levels of phosphate intake. It appears unlikely that a consistently reduced urinary excretion of pyrophosphate is a factor in the formation of urinary calculi. Pyrophosphate excretion rose and calcium excretion fell with increasing phosphate intake; this might be expected to have a beneficial effect in patients with recurrent calcium stones.     

Influence of urinary sodium on calcium excretion in normal individuals. A redefinition of hypercalciuria

The twenty-four hour urinary excretion of calcium and sodium was measured in 38 normal volunteers after a week on a diet containing 400 mg of calcium per day. There was a significant correlation (P less than 0.001) between calcium and sodium excretion. The normal range of calcium excretion as a function of sodium excretion has been determined. This approach sharpens the definition of hypercalciuria by taking into account the influence of dietary sodium intake. It also removes the necessity of regulating dietary sodium as well as calcium intake before measuring calcium excretion in patients who form recurrent renal stones.     

单中心3760例泌尿系结石成分及其相关因素分析

目的探讨本地区泌尿系结石疾病患者利用泌尿系结石红外光线自动分析仪分析的结石成分构成及其临床意义。方法回顾性分析我院2014年5月至2020年5月3760例泌尿系结石疾病患者资料,采用泌尿系结石红外光线自动分析仪（LIIR-20型）分析结石成分组成。结果泌尿系结石以肾结石为主（2932例,77.98%）。从结石成分看,草酸钙结石最常见2999例（79.76%）、其次分别是无水尿酸结石229例（6.09%）、碳酸磷灰石187例（4.97%）。从性别来看,男性泌尿系结石发病率明显高于女性[男2659例（70.72%）,女1101例（29.28%）],其中男性一水草酸钙结石较女性明显多发（男71.86%,2155/2999;女28.14%,844/2999）,女性六水磷酸铵镁类感染性结石明显多于男性（男36.36%,52/143;女63.64%,91/143）。从年龄上看,成年患者多表现为一水草酸钙结石,而小儿患者（10岁及以下）多表现为尿酸胺（30.43%,56/184）及胱氨酸结石（3.80%,7/184）。结论本医疗中心泌尿系结石成分以草酸钙类结石为主,存在着年龄及性别等的差异;泌尿系结石红外光线自动分析仪作为新技术可以很好地分析泌尿系结石成分,为针对结石成分的特点采取相应的预防和诊疗措施提供了依据。     

Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases

Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13 - 70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.     

Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases

Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13-70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.     

肾鹿角形结石患者结石成分的红外光谱分析

目的 通过红外光谱分析法分析肾鹿角形结石的化学成分,探讨其与泌尿系统感染的关系,为肾结石的治疗和预防提供帮助.方法 回顾性分析北京大学人民医院泌尿外科2009年8月至2010年2月共51例肾鹿角形结石病例,以红外光谱法分析结石的化学成分,并对尿/结石细菌培养等临床资料进行总结.结果 共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、六水磷酸镁铵、尿酸、L-胱氨酸等6种化学成分.结石以混合成分为主,单一成分结石15例(29.4%).含钙结石41例(80.4%),含尿酸结石10例(19.6%).感染石26例(51.0%).术前尿常规阳性率78.4%(40/51),尿/结石细菌学培养阳性率64.7%(33/51).结论 肾鹿角形结石成分多样,病因复杂,与泌尿系统感染密切相关.     

黑龙江省870例尿石症患者结石成分分析

目的 探讨黑龙江省尿石症患者的尿路结石化学成分,为临床防治提供帮助.方法 收集哈尔滨医科大学附属第一医院2011年9月～2013年9月住院患者体外碎石排出后和手术取出的结石标本870例,应用红外光谱法进行分析.结果 尿石症发生率男性高于女性,男、女性别之比为1.85：1,上尿路结石发生率高于下尿路结石.结石成分检出率最高的为草酸钙（占84.77％）,其次是碳酸磷灰石（占52.18％）,其他成分结石所占比例较低.结论 黑龙江省尿石症患者的尿路结石化学成分以草酸钙为主,掌握尿路结石的成分对于了解结石的成因,指导治疗及预防复发有重要的临床意义.     

泌尿系结石成分分析与预防复发健康指导

目的通过对泌尿系结石成分分析,以期对预防其复发进行健康指导。方法收集本院泌尿外科最近234例患者的结石,并对其成分进行分析。结果结石成分含有草酸盐、磷酸盐、尿酸盐、钙盐、镁盐的患者为108例（46.2%）;含有草酸盐、尿酸盐、钙盐、镁盐的患者为63例（26.9%）;含有磷酸盐、钙盐、镁盐的患者为45例（19.2%）;含有草酸盐、尿酸盐、钙盐的患者为18例（7.7%）。另外,分析的结石全部为含钙结石;92.3%的结石含镁盐;草酸盐和尿酸盐均为80.8%;磷酸盐为65.4%。结论泌尿系结石成分分析是代谢评估的一项主要内容,可以为预防结石的复发提供针对性的治疗依据。     

天津地区泌尿系结石成分分析

目的:了解天津地区泌尿系结石化学成分构成。比较上下尿路结石成分的特点,年龄、性别构成比例及城市居住人群与郊区居住人群的尿路结石成分的异同,为泌尿系结石的治疗及预防提供参考。方法:收集天津医科大学第二医院2005年1月-2009年12月门诊体外冲击波碎石后排出和住院患者手术取出的泌尿系结石标本420例,使用红外光谱法进行定量和定性分析。结果:420例泌尿系结石中单纯草酸钙结石占26.4%(111/420),草酸钙+磷酸钙结石占31.4%(132/420),草酸钙+羟基磷灰石结石占17.4%(73/420),尿酸结石占12.4%(52/420),碳酸磷灰石结石占8.8%(37/420),磷酸镁铵结石占3.1%(13/420),胱氨酸结石占0.5%(2/420),磷酸氢钙结石为0,其中含钙结石占75.2%(316/420);尿酸结石比例高于国内文献报道;男女患病比例为2.75∶1,发病高峰在25～65岁之间,老年泌尿系结石的发病率有增加的趋势;上尿路结石占94.5%(397/420),下尿路结石占5.5%(23/420),比例为17.3∶1;郊区下尿路结石所占比例9.0%(12/134)高于市区3.8%(11/286),结石成分无明显差异;5年间结石成分无明显差异。结论:(1)本组含钙结石上尿路比下尿路多,含尿酸结石及磷酸镁铵结石下尿路比上尿路多。(2)尿酸结石所占结石总数百分比高于国内外文献报道。这对于本地区治疗及预防尿石有一定的参考价值。(3)泌尿系结石发病年龄高峰延迟,说明老年泌尿系结石的发病率增加。(4)郊区下尿路结石比例高于市区,考虑与生活条件及医疗水平有关。(5)本地区5年内结石成分构成无明显变化。     

南疆地区197例患者泌尿系结石成份分析

目的探讨南疆地区泌尿系结石患者的结石成份及防治方法。方法搜集新疆南部地区与三聚氰胺奶粉相关尿路结石病例197例。手术取石,采用红外光谱自动分析仪定性检测。结果除外8例资料不全,纳入统计189例,共检测出8种成份,其中单纯成份结石51.85%（98例）,混合成份结石48.15%（91例）。按结石主要成份分为含钙结石72例（38%）,非钙结石66例（34.8%）,混合型结石51例（28%）。各种成份的结石病例的构成比从高到低依次为尿酸铵结石44例（44.9%）,一水草酸钙和尿酸铵28例（28.5%）,一水草酸钙24例（26.3%）。三种结石的临床特点是67%为维吾尔族患者,男性占71%,且52.8%为3岁以下婴幼儿;肾结石占61.4%;尿酸铵是主要的结石成份,草酸钙结石具一定比例。结论新疆南部地区维吾尔族男性肾结石发病率明显高于汉族男性;同时发现三聚氰胺奶粉易诱导维族男性婴幼儿患尿酸铵结石,应进一步探讨诱因,及早治疗。     

尿石形成的尿危险因素分析

本实验证实含钙尿石形成的尿危险因素是24小时尿高pH、钙、尿酸、草酸和低镁、钠/肌酐、渗透压/肌酐。本组测定值不宜计算形成结石的相对概率,宜采用判别分析。判别值为—22.620,正常人符合率为100.00％,病人为80.56％,两者判别能力有极显著性意义。其中钙、尿酸和草酸对尿石形成的贡献率较高,因此,尿石防治的重点应控制这3个因素。此外还讨论了各危险因素的作用机制及用雷达图形象地表示尿石形成的危险因素。     

红外光谱法测定大连地区1761例泌尿系结石成分分析

目的 探讨大连地区泌尿系结石的成分组成,为临床防治提供依据。方法 收集2017年3月至2019年12月共1761例结石标本,包括男性1140例,女性621例,年龄7个月~93岁,上尿路结石1626例,下尿路结石135例。采用红外光谱分析法分析结石成分,比较不同年龄段患者在性别及结石位置上的差异。结果 男性高发;高发年龄段为51~70岁,该年龄段患者占所有患者的60%以上;一水草酸钙检出率最高为75.87%,其次为碳酸磷灰石45.26%;单纯型结石761例（43.21%）,混合型结石1000例（56.79%）。结论 大连地区泌尿系结石成分以草酸钙为主,混合结石多于单纯结石,给予个体化生活指导建议有利于本地泌尿系结石的防治。     

220例尿石标本化学成分分析

对220例泌尿系结石标本进行化学成分分析。结果:混合成分结石占61.4％,单纯成分结石占38.6％。其中含钙结石最多,占89.6％。另对上、下尿路结石,合并感染与非感染结石,多发与单发结石,复发与初发结石的成分分别进行比较。上尿路结石含钙和草酸盐多于下尿路结石,而下尿路结石含铵高于上尿路结石。合并感染的结石含磷酸盐和碳酸盐比非感染结石高,而非感染结石含草酸盐高。单发结石含磷酸盐、铵、镁及碳酸盐高于多发结石。初发结石含钙高于复发结石。     

1 849例泌尿系结石种类及其与患者临床特征的关系

目的：分析湖南省泌尿系结石种类与患者临床特征的关系,探讨泌尿系结石防治策略。方法：收集中南 大学湘雅三医院泌尿外科收治的1 849例来自湖南省14个州市的泌尿系结石患者的结石,使用红外光谱分析技术分析 结石成分。根据患者的临床特征分析结石种类与临床参数的关系。结果：所有结石分为6类,男性中草酸钙结石和 尿酸结石分别占84.1%和7.7%;女性中草酸钙结石和尿酸结石分别占78.4%和4.2%,男性草酸钙结石、尿酸结石所占比 例高于女性(P<0.05)。年龄越大尿酸结石所占比例越高(<18岁为0.0%;18~<41岁为1.6%;41~<66岁为6.6%;≥66岁为 12.4%)。不同BMI结石种类构成比差异无统计学意义(P>0.05)。是否合并有尿路感染、高血压、糖尿病对结石种类构 成无明显影响(P>0.05)。尿液pH值呈正常、酸性、碱性的患者尿酸结石比例分别为 0.3%,13.8%和10.3%,尿液呈酸性 患者中尿酸结石比例较高。肌酐升高患者中含尿酸结石的比例高于肌酐正常患者(12.1% vs 4.5%,P<0.05)。结论：老 年患者、尿液呈酸性和肾功能不全患者较易发生尿酸结石,而改变尿液pH可能是防治湖南省泌尿系结石的重要策略。     

枳椇皮提取物对肾结石大鼠的治疗作用

研究枳椇皮中药灌胃给药后对肾结石大鼠的治疗作用。方法采用乙二醇加氯化铵法复制肾结石病理模型,观察枳椇皮提取物对肾结石大鼠的治疗作用。结果枳椇皮提取物能恢复肾结石大鼠的体重,增加24 h排尿量,促进血液中钙的排泄和代谢,减少肾组织中结石的形成,降低血清尿素氮、肌酐水平,减缓大鼠肾组织因结石引起的损伤和病变。结论枳椇皮提取物对大鼠肾结石有一定的治疗作用,但其确切机制有待进一步研究。     

尿石元素成分的原子吸收光谱分析

本文采用火焰原子吸收光谱法定量测定了24例尿石的钾、钠、钙、镁,锌和铁的含量,并对其中的20例结石进行了表层和内层的分层分析。结果显示原子吸收光谱法能满意地测定这些元素,含量分别为0.33、0.329、20.765、0.216、0.094和0.088％,以草酸盐,磷酸盐及尿酸盐为主的三类混合结石的元素含量无明显差异,表层和内层亦无明显差异。     

红外光谱自动分析系统在尿路结石成分分析中的应用

目的评价红外光谱自动分析系统检测尿路结石成分的临床应用价值。方法应用LIIR型红外光谱自动分析系统对110例尿路结石的结石标本进行成分分析。结石标本分别取自患者自排、冲击波碎石、输尿管镜取石和经皮肾镜碎石。在结石患者中,男性71例,女性39例,男：女：2．6：1。结果在结石的构成比中,草酸钙结石最多,其次是碳酸磷灰石,再次为尿酸类结石;感染石少见。在构成比中,碳酸磷灰石存在性别差异（P〈0．05）。在不同成分的检出率中,男性依次是一水草酸钙、碳酸磷灰石、二水草酸钙、尿酸和六水磷酸铵镁;女性依次是碳酸磷灰石、一水草酸钙、二水草酸钙和六水磷酸铵镁。在不同成分的检出率中碳酸磷灰石存在性别差异（P〈0．05）。此外,在110例结石中,单一结石成分占26．36％（29／110）;二种结石成分占43．36％（48／110）;三种石成分占30．00％（33／110）。最常见的混合性结石成分为-水草酸钙＋二水草酸钙＋碳酸磷灰石。结论红外光谱自动分析系统在临床使用过程中具有自动、准确、快捷、方便等诸多优点．值得临床推广使用。