Frequently Asked Questions |概述
In recent years, there has been a steep and steady increase in the incidence of肾结石在小儿人群中。基于这一增长，波士顿儿童医院于2007年建立了一项小儿肾结石计划，以帮助管理这种涌入。
Co-directors医学博士Caleb Nelson，MPH;Bartley Cilento, MD, MPH; and米歇尔·鲍姆;医学博士, answer question about why kidney stones are becoming more common in children, treatment options and prevention tips.
How many patients are seen in the Kidney Stone Clinic?
尼尔森博士: A few years ago, we'd see a new patient about once a month. Now it seems like we see new cases every week. We now have four Kidney Stone Clinics each month in several locations: two in Boston, one in Waltham and one in Weymouth. We plan to expand to our North Dartmouth satellite in the near future.
What do you think is causing this increase?
尼尔森博士: There may be a number of reasons. Children are becoming less physically active, which is contributing to an increased incidence of obesity. Obese people are more likely to get stones, although both obese and non-obese children and adults can get them. We don’t know if obesity itself causes stones, or is just a marker for other factors that cause stones. Diet is a factor, as many children get too much salt, eat highly processed foods and don't drink enough water. Kidney stones form when there's too much of the stone-forming material and not enough water in the urine, so dehydration is a major contributor.
什么是典型的肾结石症状？
Cilento博士：在“静音石头”的情况下，症状可能与没有任何不同之处，这是由于尿阻塞引起的疼痛。大多数阻塞石头会导致疼痛，恶心和呕吐。在大孩子中，侧面或背痛是典型的。在年幼的孩子中，症状可能含糊不清，他们可能无法确定疼痛的位置。对于所有儿童，尿液中的血液都是关键的小费，任何患有疼痛的儿童伴有尿液中的血液。
What are the treatment options for patients with kidney stones?
Cilento博士:治疗is determined based on the size, location, number and composition of the kidney stone(s). In many cases, they can be passed spontaneously without any surgical treatment, since children can pass stones that are relatively large, compared with adults. Other times, it is necessary to remove them. The most common treatment is extracorporeal shock wave lithotripsy, where a noninvasive device is used to send shock waves through the skin into the body and fragment the stone.
Dr. Baum: We also do a metabolic evaluation and take a urine sample to assess for factors that contribute to stone formation, such as increased levels of calcium in the urine. We perform blood tests to look for other risk factors. Once the stone is passed or removed, we perform a chemical analysis to identify its type. This can provide important clues about why it formed. We perform 24-hour urine-stone risk profiles to understand fully the risks for kidney stones, and we can use these profiles to follow the impact of our medical treatments and the reduction of risk as a result of treatment.
防止肾结石复发的最佳方法是什么？
Dr. Baum: We prescribe individualized treatment plans for all our patients, including high-fluid intake and a no-added-salt diet. Medications may be prescribed to help prevent crystals from forming in the urine and to help substances dissolve in the urine. After a child has his first stone and we complete our initial evaluation, we like to see the child twice a year. We check to see how much fluid the child is drinking compared to our set goals, monitor symptoms and do follow-up urine and blood tests. We assess for development of new stones by follow-up ultrasound or, where indicated, low-dose, non-contrast CT.
在不久的将来，重要的预防性成分将是鉴定出肾结石疾病的遗传原因。
孩子什么时候应该看专家？
尼尔森博士: All children with proven or suspected kidney stones should be seen by urology and nephrology. This is a potentially life-long condition that needs thorough investigation to reduce the risk of long-term issues.