小结
定义
病史和体格检查
关键诊断因素
- 急性重度腰部疼痛
其他诊断因素
- 危险因素
- 既往发生过肾结石
- 恶心和呕吐
- 尿频/尿急
- 血尿
- 睾丸痛
- 肥胖
- 肾结石家族史
- 促结石形成药物
- 腹股沟痛
- 发热
- 心动过速
- 低血压
- 肋脊角和同侧腰部压痛
危险因素
- 脱水
- 高盐摄入
- 白人血统
- 男性
- 肥胖
- 晶体尿
- 职业暴露导致的脱水
- 温暖的气候
- 肾结石家族史
- 促结石形成药物
诊断性检查
首要检查
- 螺旋 CT 平扫（非妊娠成人）
- 超声检查（孕妇或儿童）
- 尿液分析
- 全血细胞计数 (FBC) 和分类计数
- 血清电解质、尿素和肌酐
- 尿妊娠试验
需考虑的检查
- 结石分析
- 腹部平片 (KUB)
- 磁共振成像 (MRI)
- 随机尿胱氨酸测试
治疗流程
非妊娠患者急性肾绞痛
确诊肾或输尿管结石：有梗阻证据，非妊娠
已确诊肾结石：无梗阻证据，非妊娠
已确诊输尿管结石：无梗阻证据，非妊娠
妊娠
非妊娠患者结石急性发作后
撰稿人
专家顾问
Jodi Antonelli, MD
Assistant Professor
Department of Urology
University of Texas Southwestern Medical Center
Dallas
TX
利益声明
JA is a member of the Scientific Advisory Board for Boston Scientific. JA has received a research grant from the US National Institutes of Health to study strategies to reduce recurrence of nephrolithiasis and reduce stent-associated pain.
Naim Maalouf, MD
Associate Program Director
Associate Professor
University of Texas Southwestern Medical Center
Dallas
TX
利益声明
NM has received a research grant from the US National Institutes of Health to study strategies to reduce recurrence of nephrolithiasis and reduce stent-associated pain.
同行评议者
Andrew Dickinson, MBBS, FRCS, FRCSEd, MD, FRCS(Urol)
Consultant Urologist
Derriford Hospital
University Hospitals Plymouth NHS Trust
Plymouth
UK
利益声明
AD was Chair of the NICE guidelines committee on renal and ureteric stones: assessment and management, 2017-2019.
编辑
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
利益声明
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
鉴别诊断
- 急性阑尾炎
- 异位妊娠
- 卵巢囊肿
更多 鉴别诊断指南
- 尿石症
- 肾结石和输尿管结石的评估和管理
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肾脏感染
肾结石
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