小结
定义
病史和体格检查
关键诊断因素
- 急性重度胁腹痛
其他诊断因素
- 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
- 高蛋白摄入
- 高盐摄入
- 白人血统
- 男性
- 脱水
- 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
- 尿液分析
- FBC 分类计数
- 血清电解质、尿素和肌酐
- 尿妊娠试验
- 非增强螺旋 CT 扫描
- 结石分析
需考虑的检查
- 腹部平片 (KUB)
- 肾脏超声
- 静脉肾盂造影 (IVP)
- 磁共振成像 (MRI)
- 24 小时尿液监测
- 随机尿胱氨酸测试
Algoritmo de tratamento
非妊娠急性肾绞痛
确诊结石：无梗阻证据且非妊娠
确诊结石：存在梗阻证据且非妊娠
妊娠
非妊娠患者结石急性发作后
Colaboradores
Autores
Jodi Antonelli, MD
Assistant Professor
Department of Urology
University of Texas Southwestern Medical Center
Dallas
TX
Declarações
JA has received a grant for being a member of the Scientific Advisory Board for Boston Scientific, a company that manufactures products for kidney stone surgery. 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
Declarações
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.
Agradecimentos
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 monograph. 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.
Revisores
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Declarações
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
Declarações
LF declares that she has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Declarações
IM declares that he has no competing interests.
Nagaraja Rao, MBBS, ChM, FRCS
Consultant Urological Surgeon
Spire Manchester Hospital
Manchester
UK
Declarações
NR declares no competing interests.
Referências
Principais artigos
Khan SR, Pearle MS, Robertson WG, et al. Kidney stones. Nat Rev Dis Primers. 2016 Feb 25;2:16008.Texto completo Resumo
Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014 Aug;192(2):316-24.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- 急性阑尾炎
- 异位妊娠
- 卵巢囊肿
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- 小儿泌尿科学指南
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