Nephrolithiasis

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最后审阅: 13 Sep 2026
最后更新: 30 Jan 2026

小结

定义

病史和体格检查

关键诊断因素

  • acute, severe flank pain
完整详情

其他诊断因素

  • previous episodes of nephrolithiasis
  • nausea and vomiting
  • urinary frequency/urgency
  • hematuria
  • testicular pain
  • obesity
  • family history of nephrolithiasis
  • precipitant medications
  • groin pain
  • fever
  • tachycardia
  • hypotension
  • costovertebral angle and ipsilateral flank tenderness
完整详情

危险因素

  • dehydration
  • high salt intake
  • white ancestry
  • male sex
  • obesity and metabolic syndrome
  • crystalluria
  • gastrointestinal surgery
  • occupational exposure to dehydration
  • warm climate
  • family history of nephrolithiasis
  • precipitant medications
  • dietary animal protein intake
  • ascorbic acid supplementation
完整详情

诊断性检查

首要检查

  • urinalysis
  • CBC and differential
  • serum electrolytes, BUN, and creatinine
  • urine pregnancy test
  • noncontrast helical CT scan
  • stone analysis
完整详情

需考虑的检查

  • plain abdominal radiograph (KUB)
  • renal ultrasound
  • intravenous pyelogram (IVP)
  • magnetic resonance imaging (MRI)
  • 24-hour urine monitoring
  • spot urine for cystine
完整详情

新兴检查

  • dual-energy CT
完整详情

治疗流程

初步治疗

acute renal colic nonpregnant

急症处理

confirmed stone: no evidence of obstruction nonpregnant

confirmed stone: with evidence of obstruction nonpregnant

pregnant

持续性治疗

following an acute episode nonpregnant

撰稿人

专家顾问

Russell Terry, MD

Assistant Professor of Urology

University of Florida College of Medicine

Gainesville, FL

利益声明

RT declares that he has no competing interests.

鸣谢

Dr Jodi Antonelli and Dr Naim Maalouf would like to gratefully acknowledge Dr Brian Eisner, Dr Michael E. Lipkin, Dr Muhammad Iqbal, Dr Keith Xavier, and Dr Mantu Gupta, previous contributors to this topic.

利益声明

BE has received fees for consulting from Boston Scientific, Olympus/Gyrus ACMI, PercSys, and The Ravine Group. MEL declares that he is a consultant for Boston Scientific Corporation. MI, KX, and MG declare that they have no competing interests.

同行评议者

Robert Tompkins, MD

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler, TX

利益声明

RT declares that he has no competing interests.

Lynda Frassetto, MD

Associate Professor of Medicine

Division of Nephrology

University of California at San Francisco, CA

利益声明

LF declares that she has no competing interests.

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard, IL

利益声明

IM declares that he has no competing interests.

Nagaraja Rao, MBBS, ChM, FRCS

Consultant Urological Surgeon

Spire Manchester Hospital

Manchester

UK

利益声明

NR declares no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.全文  摘要

European Association of Urology. Urolithiasis. Mar 2025 [internet publication].全文

Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline. 2016 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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