【AUA指南】肾结石的医疗管理(Medical manegement of kidney stones)
Evaluation
评估
1. A clinician should perform a screening evaluation consisting of a detailed medical and dietary history, serum chemistries and urinalysis on a patient newly diagnosed with kidney or ureteral stones. (Clinical Principle)
1. 临床医生应对新诊断为肾结石或输尿管结石的病人进行筛查评估，包括详细的病史和饮食史、血清化学成分和尿液分析。(临床原则)
2. Clinicians should obtain serum intact parathyroid hormone (PTH) level as part of the screening evaluation if primary hyperparathyroidism is suspected. (Clinical Principle)
2. 如果怀疑原发性甲状旁腺功能亢进，临床医生应获得血清完整甲状旁腺激素(PTH)水平作为筛查评估的一部分。(临床原则)
3. When a stone is available, clinicians should obtain a stone analysis at least once. (Clinical Principle)
3. 当结石可取得时，临床医生应至少进行一次结石分析。(临床原则)
4. Clinicians should obtain or review available imaging studies to quantify stone burden. (Clinical Principle)
4. 临床医生应获得或审阅取得的影像学资料，以量化结石负荷。（临床原则）
5. Clinicians should perform additional metabolic testing in high-risk or interested first-time stone formers and recurrent stone formers. (Standard; Evidence Strength: Grade B)
5. 临床医生应该对高危或感兴趣的初次结石患者和复发性结石患者进行另外的代谢检测。(标准；证据强度：B级)
6. Metabolic testing should consist of one or two 24-hour urine collections obtained on a random diet and analyzed at minimum for total volume, pH, calcium, oxalate, uric acid, citrate, sodium, potassium and creatinine. (Expert Opinion)
6. 代谢检测应包括随机饮食中获得的一个或两个24小时尿液收集，并至少分析总体积、pH、钙、草酸盐、尿酸、柠檬酸盐、钠、钾和肌酐。（专家意见）
7. Clinicians should not routinely perform “fast and calcium load” testing to distinguish among types of hypercalciuria. (Recommendation; Evidence Strength: Grade C)
7. 临床医生不应常规进行“快速钙负荷”测试以区分高钙尿的类型。（推荐；证据强度：C级）
Diet Therapies
饮食疗法
8. Clinicians should recommend to all stone formers a fluid intake that will achieve a urine volume of at least 2.5 liters daily. (Standard; Evidence Strength: Grade B)
8. 临床医生应该向所有结石形成者推荐一种液体摄入量以达到每天至少2.5升的尿量。(标准；证据强度：B级)
9. Clinicians should counsel patients with calcium stones and relatively high urinary calcium to limit sodium intake and consume 1,000-1,200 mg per day of dietary calcium. (Standard; Evidence Strength Grade: B)
9. 临床医生应建议患有钙结石和尿钙相对较高的患者限制钠的摄入量，每天摄入1000 - 1200毫克的膳食钙。(标准；证据强度：B级)
10. Clinicians should counsel patients with calcium oxalate stones and relatively high urinary oxalate to limit intake of oxalate-rich foods and maintain normal calcium consumption. (Expert Opinion)
10. 临床医生应建议有草酸钙结石和较高尿草酸盐的患者限制摄入富含草酸盐的食物，并保持正常的钙摄入量。(专家意见)
11. Clinicians should encourage patients with calcium stones and relatively low urinary citrate to increase their intake of fruits and vegetables and limit non-dairy animal protein. (Expert Opinion)
11. 临床医生应鼓励钙结石和相对较低的尿柠檬酸的患者增加水果和蔬菜的摄入量，并限制非乳制品动物蛋白。(专家意见)
12. Clinicians should counsel patients with uric acid stones or calcium stones and relatively high urinary uric acid to limit intake of non-dairy animal protein. (Expert Opinion)
12. 临床医生应建议尿酸结石或钙结石及尿酸较高的患者限制非乳制品动物蛋白的摄入量。(专家意见)
13. Clinicians should counsel patients with cystine stones to limit sodium and protein intake. (Expert Opinion)
13. 临床医生应建议胱氨酸结石患者限制钠和蛋白质的摄入量。(专家意见)
Pharmacologic Therapies
药物疗法
14. Clinicians should offer thiazide diuretics to patients with high or relatively high urine calcium and recurrent calcium stones. (Standard; Evidence Strength Grade B)
14. 临床医生应提供噻嗪类利尿剂给高或相对高尿钙和复发性钙结石的患者。(标准；证据强度：B级)
15. Clinicians should offer potassium citrate therapy to patients with recurrent calcium stones and low or relatively low urinary citrate. (Standard; Evidence Strength Grade B)
15. 临床医生应该为患有复发性钙结石和低尿酸或相对低的尿柠檬酸盐的患者提供柠檬酸钾治疗。(标准；证据强度：B级)
16. Clinicians should offer allopurinol to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium. (Standard; Evidence Strength Grade B)
16. 临床医生应向患有高尿酸尿症和正常尿钙的复发草酸钙结石患者提供别嘌呤醇。(标准；证据强度：B级)
17. Clinicians should offer thiazide diuretics and/or potassium citrate to patients with recurrent calcium stones in whom other metabolic abnormalities are absent or have been appropriately addressed and stone formation persists. (Standard; Evidence Strength Grade B)
17. 对于其他代谢异常不存在或已得到适当治疗，结石仍持续形成的复发性钙结石患者，临床医师应提供噻嗪类利尿剂和/或柠檬酸钾。(标准；证据强度：B级)
18. Clinicians should offer potassium citrate to patients with uric acid and cystine stones to raise urinary pH to an optimal level. (Expert Opinion)
18. 临床医生应向患有尿酸和胱氨酸结石的患者提供柠檬酸钾治疗，以将尿液pH值提高到最佳水平。（专家意见）
19. Clinicians should not routinely offer allopurinol as first-line therapy to patients with uric acid stones. (Expert Opinion)
19. 临床医生不应常规提供别嘌呤醇作为尿酸结石患者的一线治疗。（专家意见）
20. Clinicians should offer cystine-binding thiol drugs, such as alpha-mercaptopropionylglycine (tiopronin), to patients with cystine stones who are unresponsive to dietary modifications and urinary alkalinization, or have large recurrent stone burdens. (Expert Opinion)
20. 临床医生应向不进行饮食调整和尿碱化或有大量复发性结石的胱氨酸结石患者提供与胱氨酸结合的硫醇类药物，如巯基丙酰甘氨酸(硫普罗宁)。(专家意见)
21. Clinicians may offer acetohydroxamic acid (AHA) to patients with residual or recurrent struvite stones only after surgical options have been exhausted. (Option; Evidence Strength Grade B)
21. 只有在手术方案用尽后，临床医生才能向患有残留或复发性鸟粪石的患者提供乙酰氧肟酸（AHA）。(标准；证据强度：B级)
Follow-up
随访
22. Clinicians should obtain a single 24-hour urine specimen for stone risk factors within six months of the initiation of treatment to assess response to dietary and/or medical therapy. (Expert Opinion)
22. 临床医生应在开始治疗后6个月内获得一个24小时的结石危险因素尿液样本，以评估饮食和/或药物治疗的反应。(专家意见)
23. After the initial follow-up, clinicians should obtain a single 24-hour urine specimen annually or with greater frequency, depending on stone activity, to assess patient adherence and metabolic response. (Expert Opinion)
23. 在最初的随访之后，临床医生应该每年获得一个24小时的尿样，或者根据结石的活动，更频繁地获得尿样，以评估患者的依从性和代谢反应。(专家意见)
24. Clinicians should obtain periodic blood testing to assess for adverse effects in patients on pharmacological therapy. (Standard; Evidence Strength Grade: A)
24. 临床医生应定期进行血液检测，以评估患者在药物治疗方面的不良反应。(标准；证据强度：A级)
25. Clinicians should obtain a repeat stone analysis, when available, especially in patients not responding to treatment. (Expert Opinion)
25. 临床医生应在可能的情况下进行重复结石分析，尤其是对治疗无效的患者。(专家意见)
26. Clinicians should monitor patients with struvite stones for reinfection with urease-producing organisms and utilize strategies to prevent such occurrences. (Expert Opinion)
26. 临床医生应监测鸟粪石患者是否再次感染产生脲酶的微生物，并采取策略预防此类事件的发生。(专家意见)
27. Clinicians should periodically obtain follow-up imaging studies to assess for stone growth or new stone formation based on stone activity (plain abdominal imaging, renal ultrasonography or low dose computed tomography [CT]). (Expert Opinion)
27. 临床医生应定期进行影像学随访研究，以评估结石生长或基于结石活动的新结石形成(腹部平扫、肾超声或低剂量计算机断层扫描[CT])。(专家意见)
*翻译仅供学习交流，不作为临床实践标准
编译：刘刚(黄石市中心医院)
编辑：榭小仙
审核：刘刚 李升