AMBULATORY EVALUATION OF NEPHROLITHIASIS - CLASSIFICATION, CLINICAL PRESENTATION AND DIAGNOSTIC-CRITERIA
AMBULATORY EVALUATION OF NEPHROLITHIASIS - CLASSIFICATION, CLINICAL PRESENTATION AND DIAGNOSTIC-CRITERIA
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DOI：
10.1016/0002-9343(80)90495-7
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发表时间：
1980-01-01
影响因子：
5.9
通讯作者：
PETERS, P
中科院分区：
文献类型：
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作者：
PAK, CYC;BRITTON, F;PETERS, P
使用前面描述的门诊方案，对241名肾结石患者进行了评估。根据实验结果，可将其分为10组。吸收性高钙尿症I型(87%男性)占24.5%，其特征为正常血钙、正常的空腹尿钙(0.11 mg/100ml肾小球滤过)、口服钙负荷后尿钙过高(>；0.20 mg/mg肌酐)、正常的尿环[c]AMP(<；5.4nmol/100ml肾小球滤过)和血清甲状旁腺激素(PTH)，以及高钙尿(>；200 mg/天，在限制钙和钠的饮食中)。吸收性高钙尿症II型(男性占58%)占29.8%，其生化特征与吸收性高钙尿症I型相同，但限制饮食和低尿量(1.42±-)时血钙正常。L 0.55SD/天)。肾性高钙尿症(男性56%)，占8.3%，表现为正常的血钙和高的空腹尿钙(0.160.+-)。0.054 mg/100ml肾小球滤过率)，尿cAMP(6.80±-)。2.10nmol/100ml肾小球滤过率)和血清甲状旁腺素。原发性甲状旁腺功能亢进症(女性占57%)占5.8%，主要表现为高钙血症、低磷血症、高钙尿和高尿cAMP。高尿酸尿钙尿石症(100%男性)占8.7%，以高尿酸尿症(776.+-)为特征。164 mg/d)，尿酸pH>PK(5.91+-)。0.33)。在肠源性高草酸尿症(女性占60%)中，2.1%的病例尿草酸升高(6.29±-)。13.2毫克/天)。尿酸结石患者中非含钙结石的发生率为2.1%(100%男性)，感染性结石患者中为2.1%(60%女性)。这些情况的典型表现是尿液pH值低(5.29。+-)。0.12)和较高的尿液pH(6.69+-)。1.16)。肾小管性酸中毒1例(男性，0.4%)。10.8%的患者(81%男性)虽然尿量低(1.41.+-)，但未发现代谢异常。L/天)。5.4%的患者无法区分高钙尿症和肾性高钙尿症。这一动态协议揭示了近90%的病例存在生理障碍，并在95%的患者中提供了明确的诊断。
Using the ambulatory protocol previously described, 241 patients with nephrolithiasis were evaluated. They could be categorized into 10 groups from the results obtained. Absorptive hypercalciuria type I (87% male) comprised 24.5% and was characterized by normocalcemia, normal fasting urinary Ca (< 0.11 mg/100 ml glomerular filtration), an exaggerated urinary Ca following an oral Ca load (> 0.20 mg/mg creatinine), normal urinary cyclic[c]AMP (< 5.4 nmol/100 ml glomerular filtration) and serum parathyroid hormone (PTH), and hypercalciuria (> 200 mg/day during a calcium- and sodium-restricted diet). Absorptive hypercalciuria type II (58% male) accounted for 29.8%; its biochemical features were the same as those for absorptive hypercalciuria type I, except for normocalciruia during a restricted diet and low urine volume (1.42 .+-. 0.55 SD l/day). Renal hypercalciuria (56% male), disclosed in 8.3%, was represented by normocalcemia and high values for fasting urinary Ca (0.160 .+-. 0.054 mg/100 ml glomerular filtration), urinary cAMP (6.80 .+-. 2.10 nmol/100 ml glomerular filtration) and serum PTH. Primary hyperparathyroidism (57% female), accounted for 5.8%, typically included hypercalcemia, hypophosphatemia, hypercalciuria and high urinary cAMP. Hyperuricosuric calcium urolithiasis (100% male)comprised 8.7%, and was characterized by hyperuricosuria (776 .+-. 164 mg/day) and urinary pH exceeding pK for uric acid (5.91 .+-. 0.33). In enteric hyperoxaluria (60% female), encountered in 2.1% of cases, urinary oxalate was increased (6.29 .+-. 13.2 mg/day). Noncalcium-containing stones were found in 2.1% of the patients with uric acid lithiasis (100% male) and in another 2.1% of the patients with infection lithiasis (60% female). These conditions were typified by low urinary pH (5.29 .+-. 0.12) and high urinary pH (6.69 .+-. 1.16), respectively. Renal tubular acidosis was found in one patient (male, 0.4%). In 10.8% of the patients (81% male), no metabolic abnormality could be found, although urine volume was low (1.41 .+-. 0.51 l/day). Hypercalciuria could not be differentiated between absorptive hypercalciuria and renal hypercalciuria in 5.4% of the patients. This ambulatory protococol disclosed a physiologic disturbance in nearly 90% of the cases and provided a definitive diagnosis in 95% of the patients.