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. Kidney stones can be small, like a tiny pebble or grain of sand, but are often much larger.

肾脏的作用是维持体内水分、矿物质和盐的平衡. 尿液就是这种过滤过程的产物. Under certain conditions, 通常溶解在尿液中的物质, such as calcium, oxalate and phosphate, 变得过于浓缩，可以分离成晶体. 当这些晶体相互附着时，就会形成肾结石, 积聚成小质量的, or stone.

肾结石有多种矿物质类型:

1. Calcium stones大多数肾结石是由钙和草酸盐组成的. 许多形成含钙结石的人尿液中含有过多的钙, a condition known as hypercalciuria There are several reasons why hypercalciuria may occur. 有些人从肠道中吸收了过多的钙. 还有一些人从骨骼中吸收了过多的钙. Still others have kidneys that do not correctly regulate the amount of calcium they release into their urine. There are some people who form calcium oxalate stones as a result of too much oxalate in the urine, 在某些情况下被称为高钙尿症, 尿中草酸盐过多是炎症性肠病的结果, 比如克罗恩病或溃疡性结肠炎, 或者其他时候，这可能是先前肠道手术的结果. Calcium phosphate stones, 另一种钙石, 比草酸钙结石少得多吗. For some people, calcium phosphate stones form as a result of a medical condition known as renal tubular acidosis.

2. 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, 磷酸盐和碳酸钙, which is known as struvite. These stones form as a result of infection with certain types of bacteria that can produce ammonia. 氨的作用是提高尿液的pH值, 是什么使它呈碱性并促进鸟粪石的形成.

3. Uric acid stones尿酸是人体代谢蛋白质时产生的. 当尿液pH值低于5时.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, 比如在红肉或家禽中发现的. 痛风患者也会形成尿酸结石.

4. Cystine stones: Cystine stones are rare, and they form only in persons with an inherited metabolic disorder that causes high levels of cystine in the urine, 这种情况被称为胱氨酸尿症.

如何诊断肾结石?

Most people are diagnosed with kidney stones after the thunderclap onset of excruciating and unforgettable pain. This severe pain occurs when the kidney stone breaks loose from the place that it formed, the renal papilla, 然后进入尿液收集系统. When this happens, 结石会阻碍尿液从肾脏排出, 这种情况被称为肾绞痛. 疼痛可从下背部开始，并可向一侧或腹股沟移动. 其他症状包括尿中带血(血尿), 频繁或持续的尿路感染, 尿急或尿频，恶心或呕吐.

当你的医生检查你是否有肾结石时, 第一步是完整的病史和体格检查. 有关当前症状的重要信息, previous stone events, 医疗疾病和状况, medications, 饮食史和家族史都将被收集. 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. A blood sample will also be collected so that kidney function and blood counts can be measured.

尽管所有这些测试都是必要的, 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. 如果你的医生需要更多的信息, 静脉肾盂造影(IVP)或计算机断层扫描(CT)扫描可能是必要的.

有时肾结石根本不会引起任何症状. Such painless stones can be discovered when your doctor is looking for other things on X-rays. Sometimes, 虽然结石不会引起任何疼痛, 它会导致其他问题, 如反复出现尿路感染或尿中带血.

如何预防肾结石?

如果你有一个肾结石，你很可能会形成另一个. 减少你形成另一颗结石的机会, 第一步是首先确定你原来的石头形成的原因. 在布雷迪泌尿研究所, we believe in the adage, 一盎司的预防胜过十分的治疗,“所以我们非常重视全面的代谢评估, so that therapies can be appropriately directed towards reducing the risk of recurrent stone disease.

如果你自己排出的结石还在, 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, 如果你的结石是通过输尿管镜检查或PERC取出的 , 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, 因为治疗是针对结石类型的.

Because we know that kidney stones form when the urine has too high a concentration of crystals and/or not enough substances that protect against the crystals, 详细分析结石的新陈代谢是很重要的. Typically, the metabolic evaluation of a stone former consists of a simple blood test and two 24-hour urine collections.

The results of these metabolic studies will provide an assessment of the risk of future stone formation. One or more of the following diagnoses and treatments may be made based on these metabolic data.

诊断:尿量少

Treatment:

Increase fluid intake

预防结石形成最基本的方法就是多喝水, 从而稀释你的尿液. 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.

诊断:尿中钙过多(高钙尿症)

Possible treatments:

Thiazide diuretics

这些药物有助于减少尿钙排泄. 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, so in many cases your doctor will prescribe a potassium supplement to go along with the thiazide diuretic.

Lower sodium intake

人体会小心地调节钠含量. 当过量的钠随尿液排出时，钙也按比例排出. In other words, the more sodium you consume, the more calcium that will be in your urine. Your goal should be to reduce your sodium intake so that you consume less than 2 grams of sodium per day. 小心盐的“无声来源”, such as fast foods, packaged or canned foods, 软化水和运动饮料.

Normal calcium diet

People who form stones sometimes think that because there is too much calcium in their urine, 他们应该限制钙的摄入量. 没有研究支持这种做法. 你的身体需要膳食钙来支撑骨骼. 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.

对于形成草酸钙结石的推荐十大正规网赌平台, 摄取足够的膳食钙是加倍重要的, because under normal circumstances calcium and oxalate bind together in the intestine and are eliminated from the body. 如果没有钙加入草酸盐, the oxalate will be reabsorbed by your body and passed into the urine where it may increase the risk of calcium oxalate stones.

Increase fluid intake

不管你的诊断是什么, 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

柠檬酸盐是一种与尿液中的钙结合的分子, 防止钙与草酸盐或磷酸盐结合而形成结石的. If your potassium level is low or normal, your doctor may prescribe potassium citrate supplement. 如果你的血钾水平高, 医生可能会给你开柠檬酸钠补充剂, 比如比西特拉或碳酸氢钠.

有证据表明柑橘类果汁, 比如橙汁或柠檬水, 可能会增加尿中的柠檬酸水平, 所以这些液体对低尿症患者特别有效.

诊断:高草酸尿(尿中草酸过多)

Possible treatments:

Low oxalate diet

If you form calcium oxalate stones, it is important that you limit your intake of dietary oxalates. 许多健康食品都含有草酸盐, 所以与其完全不吃这些食物, 我们要求你限制那些草酸含量特别高的食物. 如果你确实食用草酸含量高的食物, 一定要用一杯或两杯水把多余的草酸冲走.

Normal calcium diet

Oxalate and calcium bind together in the intestine and leave the body together in the stool. 如果没有足够的钙, 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, 哪里会形成草酸钙结石.

Increase fluid intake

不管你的诊断是什么, 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

大多数美国人远远超过了必需的蛋白质摄入量, 哪一种会导致尿液中尿酸过多. 作为一般建议, 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. 这将是足够的蛋白质，以满足你的身体需要.

Allopurinol

If you have tried a low-protein diet and you still have too much uric acid in your urine, 医生可能会给你开别嘌呤醇. This drug acts to reduce the uric acid levels in the urine by blocking the conversion of purines to uric acid.

Increase fluid intake

不管你的诊断是什么, 你应该每天喝足够的水来产生至少2升的尿液.

诊断:尿pH值过低(尿酸过多)

Possible treatments:

Citrate supplementation

Citrate supplements, such as potassium citrate, 会提高你尿液的pH值吗, making stones, 比如那些由尿酸组成的, less likely to form. If your blood potassium level is high, your doctor may prescribe sodium bicarbonate or Bicitra.

Lower protein intake

高蛋白饮食会降低尿液pH值. 作为一般建议, 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. 这将是足够的蛋白质，以满足你的身体需要.

Increase fluid intake

不管你的诊断是什么, 你应该每天喝足够的水来产生至少2升的尿液.

什么时候应该治疗肾结石?

When a kidney stone causes pain to the extent that the pain cannot be controlled with oral pain medication, 这块石头应该处理一下. 同样，伴有严重恶心或呕吐的结石也应接受治疗. Some stones are associated with infection or fever — such situations can be life threatening and demand prompt attention. 与单肾有关的结石, poor overall kidney function or complete blockage of urine flow should also all be treated.

Sometimes, 当结石与令人烦恼的症状有关时, 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, stones larger in size than 5 mm are unlikely to pass on their own and should be considered for treatment.

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. 这样的石头之后可能会有“观察等待”.“这意味着结石没有得到积极的治疗, but instead your doctor keeps a check on the stone to be sure that it is not growing or changing. 这可以用周期x射线来完成.

There are a number of reasons to treat a kidney stone even if it is not causing any painful symptoms.

复发性尿路感染

有些肾结石可能会感染, and in many cases, 尽管进行了适当的抗生素治疗, 感染不能从结石中清除. 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, the Federal Aviation Administration will not allow a pilot to fly until all stones have been cleared from his or her kidney. 其他职业也不允许肾结石的意外通过.

Extensive travel

The patient who, 无论是商务还是其他, travels to locales where medical care is not reliable may wish to consider preventive treatment.

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.

我的肾结石应该怎样治疗?

Historically, the treatment of kidney stones required major surgery and was associated with long hospitalization and recovery periods. However, 近年来，人们对肾结石疾病的认识有所提高, 随着外科技术的进步, has led to the development of minimally invasive and even noninvasive treatments for people with kidney stones.

At Johns Hopkins, we believe that the treatment of a patient’s stones requires an approach that is unique to that individual. 我们提供一系列最先进的治疗方案，包括 ESWL , ureteroscopy and PERC, and we will discuss with you the advantages and disadvantages of each therapy as they apply to your situation. Our goal is to provide each patient with a clear understanding of the nature of their stone burden as well as the most appropriate course of treatment.