如何防止肾结石复发

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共同创作者是 Scott Tobis, MD

参考

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肾结石是肾脏内部形成的硬质晶体，由矿物质和酸性盐组成。当它的体积变得足够大的时候，会很难排出体内，并造成极大的痛苦。60-80%的肾结石会复发。如果你曾经患过肾结石，就需要知道如何来预防它的复发。 [1]

方法 1
方法 1 的 3:

确定肾结石类型

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    让医生来辨别你体内的肾结石属于哪一类。只有了解了具体的结石类型后，才能用专门的方法来预防它的复发。一定要让医生检查你的甲状旁腺，将它排除出肾结石的形成原因。 [2]
    • 钙结石的形成是由于未被吸收的草酸钙堆积于肾脏，没有随着尿液排出，然后和其它废弃物混合成结石。钙结石中最典型的为草酸钙结石，它也是所有结石中最普遍的类型。磷酸钙结石虽不如草酸钙结石常见，但是更加棘手，因为它的质地更硬体积更大，治疗难度更高。
    • 感染性结石一般是在尿路感染后形成的，成分为镁和氨。
    • 尿酸结石是由于体内酸性过多而造成的。减少肉类的食用有助于阻止此类结石的形成。这种结石一般和痛风相关，治疗方法相似。
    • 胱氨酸结石不常见，容易发生在家庭成员之间。胱氨酸是一种氨基酸，有些人会大量遗传。
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    确定将来的复发风险。因为你有过肾结石，所以复发风险会很大。看看是否有一些你之前没有注意到的危险因素。可以在http://www.qxmd.com/calculate-online/nephrology/recurrence-of-kidney-stone-roks上下载应用软件，这个软件可以很快估算出你的风险。你也应该多和医生讨论自身的危险因素。
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    根据之前的肾结石类型、年龄、性别和家族病史，医生可以帮你制定计划来降低肾结石复发的风险。一般会包括改变饮食、多喝水，有时还会需要吃药甚至进行手术（只有极个别案例需要手术）。 [3]
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方法 2
方法 2 的 3:

通过饮食来预防肾结石

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    液体有利于将构成肾结石的物质排出体内。其中水是最好的选择，它可以排除肾脏中的杂质，同时也不会增加糖、钠等其他饮品中所含的成分，有利于预防肾结石。每天至少喝10杯227克的水。不要喝含咖啡因的饮料，它不仅不能补水，还会让身体脱水。每天的排尿量应在1.9升以上，尿液呈淡黄色。 [4]
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    浓缩尿是造成肾结石的主要因素。盐会让身体脱水，促进浓缩尿的形成。如果你吃盐的话，需要在摄入盐分后喝一大杯水来缓解。 [5]
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    动物蛋白也会导致浓缩尿。蛋白质中的杂质会进入尿液，增加肾结石形成的风险。 [6]
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    有研究表明不溶性纤维会和尿液中的钙质结合并和大便一起排出，有利于减少尿液中的钙残留。比较好的膳食纤维来源包括： [7]
    • 全谷物如燕麦、米糠和藜麦
    • 西梅和西梅汁
    • 绿叶菜如菠菜、甜菜和甘蓝菜
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    最好一餐同时摄入钙和草酸，这样两者就能在胃中粘合，无需等待肾脏去处理并可能转化为肾结石。 [8]
    • 菠菜、巧克力、甜菜和大黄的草酸含量都很高。豆类、青椒、茶叶和花生也含有草酸。
    • 牛奶、奶酪、富含钙质的橙汁和酸奶都是比较适合与富含草酸的食物一起食用的钙质来源。
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方法 3
方法 3 的 3:

通过药物和手术来预防肾结石

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    最常见的处方药是噻嗪类利尿剂或含磷制剂。氢氯噻嗪（一种利尿剂）能够将钙质保留在骨头里，进而减少流入尿液中的钙含量，降低钙结石的风险。在减少盐摄入量的同时服用这种药物效果会最好。 [9]
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    别嘌呤醇能让尿液呈碱性，降低血液和尿液内的尿酸水平。有时候别嘌呤醇和碱化剂可以配合使用来彻底溶解尿酸结石。 [10]
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    短期服用抗生素可以阻止造成感染性结石的细菌在尿液中形成。医生一般不会让你长期服用抗生素，但短期服用作用很大。 [11]
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    这种疗法会用到导管，并往肾脏里注射碱化剂。此法对胱氨酸结石的疗效很好，配合每天大量饮水效果会更佳。 [12]
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    只有当你有甲状旁腺功能亢进或甲状旁腺引起的肾结石时，才能选择这个疗法。这种钙结石是有危险的。可以通过移除颈部两个甲状旁腺中的一个腺体来治疗，消除患肾结石的风险。 [13]
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小提示

  • 并不是每个人都能知道自己之前有过什么类型的结石，它可能在没注意的时候就被过滤掉或排出体内了，或者之前的检查报告已经不存在了。即便如此，结石还是可以治疗的，只是疗法的针对性会更小，疗效更弱。 [14]
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参考

  1. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC99277/
  2. ↑ http://parathyroid.com/kidney-stones.htm
  3. ↑ http://www.nytimes.com/health/guides/disease/kidney-stones/prevention.html
  4. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC99277/
  5. ↑ https://www.kidney.org/atoz/content/kidneystones
  6. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC99277/
  7. ↑ http://www.nytimes.com/health/guides/disease/kidney-stones/prevention.html
  8. ↑ https://www.kidney.org/atoz/content/kidneystones_prevent
  9. ↑ http://www.mayoclinic.org/diseases-conditions/kidney-stones/basics/prevention/con-20024829
  1. ↑ http://www.mayoclinic.org/diseases-conditions/kidney-stones/basics/prevention/con-20024829
  2. ↑ http://www.mayoclinic.org/diseases-conditions/kidney-stones/basics/prevention/con-20024829
  3. ↑ http://www.cystinuria.com/articles/treatment-of-cystine-stones/
  4. ↑ http://parathyroid.com/kidney-stones.htm
  5. ↑ http://kidneystones.uchicago.edu/types-of-stones/

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