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a urinary stone
the presence of kidney stones (calculi) in the kidney (同)renal lithiasis

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/02/19 22:54:54」(JST)

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Urolithiasis (from Greek oûron, "urine" and lithos, "stone") is the condition where urinary stones are formed or located anywhere in the urinary system.^[1] The term nephrolithiasis (or "renal calculus") refers to stones that are in the kidney, while ureterolithiasis refers to stones that are in the ureter. The term cystolithiasis (or vesical calculi) refers to stones which form or have passed into the urinary bladder.^[2]

Urinary stones are typically classified by their location or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). In humans, calcium oxalate is a major constituent of most urinary stones. About 80% of those with kidney stones are men. Men most commonly experience their first episode between 20-30 years of age, while for women the age at first presentation is somewhat later.

Nephrolithiasis and ureterolithiasis[edit]

Main article: Kidney stone

Kidneys, ureters, and bladder x-ray with bilateral kidney stones

A kidney stone, also known as a renal calculuoos is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters (0.12 in)) they can cause obstruction of the ureter. Ureteral obstruction causes postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well as spasm of the ureter. This leads to pain, most commonly felt in the flank (the area between the ribs and hip), lower abdomen, and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic typically comes in waves lasting 20 to 60 minutes, beginning in the flank or lower back and often radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Ultrasound examination and blood tests may also aid in the diagnosis.

When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs or opioids. More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.

Cystolithiasis[edit]

Main article: Bladder stone

A star-shaped stone can be seen in the urinary bladder on this radiograph of the pelvis

Cystolithiasis refers to stones which form or have passed into the urinary bladder, which are also referred to as vesical calculi.^[2]

Signs and symptoms[edit]

In the kidney, fixed renal pain (flank pain) is common. In the ureter (according to localisation of stone): If in the upper one-third of the ureter - pain radiates to the perineum, if at the pelvic brim - pain radiates to the inner aspect of the thigh, if present in the middle one-third of ureter - pain radiates to the iliac fossa. If the stone is localised in the bladder neck or urethra - pain may present as tip of penis pain. Frequency of urination, oliguria, dribbling of urine, and hematuria may increase.

Causes[edit]

The development of urinary stones is most commonly related to:

Decreased urine volume
Increased excretion of stone-forming components
Inadequate urine drainage, which may lead to stasis
Decrease in urinary citrate levels leading to deposition of calcium
Deficiency of vitamins A or C - these conditions can also lead to the "hyper triad": hyperparathyroidism, hypercalcaemia, and hyperuricosuria.

In ruminants[edit]

Among ruminants, uroliths more commonly cause problems in males than in females; the sigmoid flexure of the ruminant male urinary tract is more likely to obstruct passage. Early-castrated males are at greater risk, because of lesser urethral diameter.^[3]

Low Ca:P intake ratio is conducive to phosphatic (e.g. struvite) urolith formation.^[3] Incidence among wether lambs can be minimized by maintaining a dietary Ca:P intake ratio of 2:1.^[4]^[3]

Alkaline pH favors formation of carbonate and phosphate calculi. For domestic ruminants, dietary cation:anion balance is sometimes adjusted to assure a slightly acidic urine pH, for prevention of calculus formation^[3]

Differing generalizations regarding effects of pH on formation of silicate uroliths may be found. ^[5]^[3] In this connection, it may be noted that under some circumstances, calcium carbonate accompanies silica in siliceous uroliths.^[6]

Pelleted feeds may be conducive to formation of phosphate uroliths, because of increased urinary phosphorus excretion. This is attributable to lower saliva production where pelleted rations containing finely ground constituents are fed. With less blood phosphate partitioned into saliva, more tends to be excreted in urine.^[7] (Most saliva phosphate is fecally excreted.^[8])

Oxalate uroliths can occur in ruminants, although such problems from oxalate ingestion may be relatively uncommon. Ruminant urolithiasis associated with oxalate ingestion has been reported.^[9] However, no renal tubular damage or visible deposition of calcium oxalate crystals in kidneys was found in yearling wether sheep fed diets containing soluble oxalate at 6.5 percent of dietary dry matter for about 100 days.^[10]

Conditions limiting water intake can be conducive to urolith formation.^[11]

Various surgical interventions, e.g. amputation of the urethral process at its base near the glans penis in male ruminants, perineal urethrostomy, or tube cystostomy may be considered for relief of obstructive urolithiasis.^[11]

References[edit]

Wikimedia Commons has media related to Kidney stone.

^ Pearle MS, Calhoun EA and Curhan GC (2007). "Chapter 8: Urolithiasis". In Litwin, MS; Saigal, CS. Urologic Diseases in America (NIH Publication No. 07–5512). Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. pp. 283–319. Retrieved 2011-06-04.
^ ^a ^b McNutt, WF (1893). "Chapter VII: Vesical Calculi (Cysto-lithiasis)". Diseases of the kidneys and bladder: a text-book for students of medicine. IV: Diseases of the Bladder. Philadelphia: J.B. Lippincott Company. pp. 185–6. Retrieved 2011-06-04.
^ ^a ^b ^c ^d ^e Pugh, D. G. 2002. Sheep and goat medicine. Saunders, Philadelphia. 468 pp.
^ Bushman, D. H., R. J. Emerick and L. B. Embry. 1965. Urolithiasis: relationships involving dietary calcium, phosphorus and magnesium. J. Nutr. 87: 499-504.
^ Stewart, S. R., R. J. Emerick and R. H. Pritchard. 1991. Effects of dietary ammonium chloride and variations in calcium to phosphorus ratio on silica urolithiasis in sheep. J. Anim. Sci. 69: 2225-2229.
^ Forman, S. A., F. Whiting and R. Connell. 1959. Silica urolithiasis in beef cattle. 3. Chemical and physical composition of the uroliths. Can. J. Compar. Med. 23(4):157-162.
^ Scott, D. and W. Buchan. 1988. The effects of feeding pelleted diets made from either coarsely or finely ground hay on phosphorus balance and on the partition of phosphorus excretion between urine and faeces in the sheep. Q. J. Exp. Physiol. 73: 315-322.
^ Bravo, D., D. Sauvant, C. Bogaert and F. Meschy. 2003. III. Quantitative aspects of phosphorus excretion in ruminants. Reprod. Nutr. Dev. 43: 285-300.
^ Waltner-Toews, D. andD. H. Meadows. 1980. Case report: Urolithiasis in a herd of beef cattle associated with oxalate ingestion. Can. Vet. J. 21: 61-62
^ James, L. F. and J. E. Butcher. 1972. Halogeton poisoning of sheep: effect of high level oxalate intake. J. Anim. Sci. 35: 1233-1238
^ ^a ^b Kahn, C. M. (ed.) 2005. Merck veterinary manual. 9th Ed. Merck & Co., Inc., Whitehouse Station.

UpToDate Contents

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1. 成人における腎結石症が疑われた場合の診断および急性期マネージメント diagnosis and acute management of suspected nephrolithiasis in adults
2. 成人における腎尿管結石症マネージメントのオプション options in the management of renal and ureteral stones in adults
3. 腎結石分析の解釈 interpretation of kidney stone analysis
4. 尿管結石のマネージメント management of ureteral calculi
5. 腎結石が確認された成人患者の評価および結石形成の有無が不明の患者の治療 evaluation of the adult patient with established nephrolithiasis and treatment if stone composition is unknown

English Journal

EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.

Gratzke C1, Bachmann A2, Descazeaud A3, Drake MJ4, Madersbacher S5, Mamoulakis C6, Oelke M7, Tikkinen KA8, Gravas S9.
European urology.Eur Urol.2015 Jun;67(6):1099-1109. doi: 10.1016/j.eururo.2014.12.038. Epub 2015 Jan 19.
CONTEXT: Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology.OBJECTIVE: To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS.EVIDENCE ACQUISITION: A structured
PMID 25613154

The visceral fat compartment is independently associated with changes in urine constituent excretion in a stone forming population.

Fram EB1, Agalliu I, DiVito J, Hoenig DM, Stern JM.
Urolithiasis.Urolithiasis.2015 Jun;43(3):213-20. doi: 10.1007/s00240-015-0770-8. Epub 2015 Apr 23.
The objective of this study was to identify the independent effect of visceral fat on urine constituent excretion in a stone forming population. Using a database of 382 kidney stone patients with available visceral fat quantification, we created multiple linear regression models predicting changes i
PMID 25903669

A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study.

Karakoyunlu N1, Goktug G, Şener NC, Zengin K, Nalbant I, Ozturk U, Ozok U, Imamoglu A.
Urolithiasis.Urolithiasis.2015 Jun;43(3):283-7. doi: 10.1007/s00240-015-0768-2. Epub 2015 Apr 3.
The aim of the study was to compare percutaneous nephrolithotomy (PCNL) and staged retrograde flexible ureteroscopy (FURS) methods used in the treatment of kidney stones of 2 cm or more in diameter. The study comprised a total of 60 patients with a diagnosis of kidney pelvic stones more than 2 cm
PMID 25838180

Japanese Journal

Silica urolithiasis in dogs

Tasaki Yumi,Ito Genta,Momoi Yasuyuki,タサキユミ,イトウゲンタ,モモイヤスユキ,田崎由実,三浦直樹,桃井康行
2013-04-00
… -Silica urolithiasis in dogs is mainly caused by silica-rich drinking water. … -Specific brands of pet food are also associated with silica urolithiasis. …
NAID 120005231947

結石による尿路閉塞を伴った重症腎盂腎炎の治療経験

高本篤,那須良次,杉本盛人 [他]
西日本泌尿器科 = The Nishinihon journal of urology 75(1), 12-16, 2013-01-00
NAID 40019549070

シンポジウム4「尿路結石ガイドライン : 改訂版の概要と上手な使い方｣ : 座長の言葉<第61回日本泌尿器科学会中部総会>

郡健二郎,鈴木孝治
泌尿器科紀要 58(12), 695-696, 2012-12-00
… Progress has been made in the diagnosis and treatment of urolithiasis over the last 10 years, after the first version of the Guidelines on Urolithiasis was published in December 2002. … It may be possible to further promote the medical treatment of urolithiasis by effectively using this in combination with the relatively textbook-like first version. …
NAID 120005147831

Related Pictures

of urolithiasis Urolithiasis (urinary stones disease) presentation Urolithiasis in Large Animals - Urinary System - Merck Veterinary Manual Urolithiasis (Renal Calculi) Nursing Management & Interventions - Nurseslabs Urolithiasis Signs And Symptoms | MIMS Malaysia 4 Urolithiasis (Renal Calculi) Nursing Care Plans - Nurseslabs What is Urolithiasis? (with pictures)

★リンクテーブル★

リンク元	「尿路結石」「尿路結石症」「病理学」「renal calculi」「calculi」

「尿路結石」

Urolithiasis
	Classification and external resources
ICD-10	N21.0-N21.9
ICD-9	594.0, 594.1, 594.2, 594.8, 594.9
DiseasesDB	31859
eMedicine	ped/2371
MeSH	D001744

　　[★]

英: urolithiasis
関: 尿路結石症、尿管結石症尿管結石

疫学

男女比=2.4:1

まとめ

CBT QB vol2 p.382改

結石の種類	X線での描写	形成されやすい尿pH	酸解離定数
リン酸カルシウム	＋	アルカリ性	pKa1=2.12 pKa2=7.21 pKa3=12.67
シュウ酸カルシウム	＋	酸性	pKa1=1.27 pKa2=4.27
シスチン	－	酸性	pKCOOH<1 pKCOOH<2.1 pKNH3+=8.02 pKNH3+=8.71 pI=5.03
尿酸	－	酸性	pK1=5.8 pK2=10.3
キサンチン	－	酸性

成分による区分

シュウ酸結石：（15-30%）
リン酸結石　：（約20%）
尿酸結石　　：（約10%）

組成

有機基質：2.5%
結晶質：97.5%

頻度を%で示す。

1. シュウ酸カルシウム　　　　　　　：単独では最多で30%、混合で70%に含有
2. リン酸カルシウム　　　　　　　　：1%
3. リン酸マグネシウムアンモニウム　：5%　：感染結石に多い
4. 尿酸　　　　　　　　　　　　　　：5%　：痛風に高確率で合併、高尿酸結晶合併
5. シスチン　　　　　　　　　　　　：1%　：酸性状態でできる
6. キサンチン　　　　　　　　　　　：まれ

成因

尿の性状と結石形成

a. 結石を構成する晶質の尿中排泄増加

1. カルシウム　←　高Ca尿症
2. シュウ酸　←　原発性高蓚酸尿症
3. 尿酸　←　痛風、悪性腫瘍
4. シスチン　←　シスチン尿症

b. 尿のpH

酸性化 →　尿酸・シスチンの溶解度↓
アルカリ化　→　リン酸カルシウムの溶解度↓

c. 尿停滞と濃縮 ←　長期臥床・尿路通過障害・海綿腎

長期臥床⇒骨吸収↑⇒尿中Ca濃度↑⇒尿路結石

d. 阻止因子　…　クエン酸(低分子物質)

⇒閉経前の女性は男性より尿中クエン酸量が3倍ほど多い

その他の結石形成因子

a. ホルモン　←　原発性副甲状腺機能亢進症(PHPT)・クッシング症候群・1型腎尿細管アシドーシス(RTA type I)
b. 薬物性結石　←　ダイアモックス・ステロイド
c. 環境要因　←　暑いところで発汗
d. その他：ビタミンB6、食事

大きさと排石

5-6mm程度の大きさの場合、自己での排石は不能らしい。

治療

ESWL
経尿道的採石術
自然排石

予防

飲水
クエン酸製剤：ウラリット配合

「尿路結石症」

　　[★]

英: urolithiasis, urinary calculus, urinary tract stone disease
同: 尿石症
関: 結石、尿路結石

疫学

40-50歳代

病因

尿の酸性度の変動、尿中成分の溶解度の低下

尿路の炎症、尿流のうっ滞

部位による区分

尿路結石

症状

尿管の狭窄部
結石疼痛

検査

血尿(肉眼的～顕微鏡的)

鑑別診断

腹部大動脈瘤(腹部腫瘤触知, 腹部CT(単純～造影))、腎梗塞(塞栓を来す基礎疾患の有無(IE,Af,弁膜症), 側腹部痛, 血尿, 血圧↑, LDH･ALP･AST↑, 腹部CT(確定は造影するしかない))

治療

経過観察：6-7割は自然に排石される。腹部単純XPで1.0×0.6cm以下 / 短径5mm以下なら自然排石期待。
対症療法：疝痛に対しインドメタシン座薬、ボルタレン座薬、ソセゴン＋アタラックスP
排石促進：尿管蠕動運動促進、利尿
内視鏡的療法

経皮的腎切石術 PNL

珊瑚状結石やUPJ狭窄合併例で実施。経皮的に腎ろうを作成し、内視鏡を挿入する

経尿道的尿管結石摘出術 TUL

中下部尿管結石症例に対して尿管鏡を使用し、超音波、レーザー等で砕石。全尿路の結石に対応可能

ESWL

骨盤骨部以外の尿路結石ではfirst choice。体外からの衝撃により破砕された石がstone streetを作る。合併症として血尿、腎皮膜下出血、発熱、疼痛。妊婦、下大動脈瘤患者などでは禁忌。

外科的療法

腎盂切石術、腎切石術、腎摘出術、尿管切石

「病理学」

　　[★]

英: pathology
関

画像はまだありません

細胞障害

炎症

創傷治癒

循環障害

免疫異常

遺伝性疾患

腫瘍

代謝障害

蛋白質および核酸代謝障害

脂質代謝障害

糖代謝障害

無機質代謝障害

カルシウム代謝障害

病的石灰化 pathologic calcification

結石 calculi

色素代謝障害

ヘモクロマトーシス hemochromatosis

ビリルビン bilirubin

黄疸

環境と疾患

参考

東大病理学教室　病理標本が多い
http://pathol.umin.ac.jp/gakubu.shtml

「renal calculi」

　　[★] 腎結石、腎臓結石

関: kidney calculi、kidney stone、nephrolith、nephrolithiasis、renal calculus、renal stone; urolithiasis

「calculi」

　　[★]

np.

結石、歯石

関: calculus、dental calculi、dental calculus、lithogenous、scale、stone、tartar、urolithiasis

[Litwin2007-1] Pearle MS, Calhoun EA and Curhan GC (2007). "Chapter 8: Urolithiasis". In Litwin, MS; Saigal, CS. Urologic Diseases in America (NIH Publication No. 07–5512). Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. pp. 283–319. Retrieved 2011-06-04.

[McNutt1893-2] McNutt, WF (1893). "Chapter VII: Vesical Calculi (Cysto-lithiasis)". Diseases of the kidneys and bladder: a text-book for students of medicine. IV: Diseases of the Bladder. Philadelphia: J.B. Lippincott Company. pp. 185–6. Retrieved 2011-06-04.

[Pugh2002-3] Pugh, D. G. 2002. Sheep and goat medicine. Saunders, Philadelphia. 468 pp.

[4] Bushman, D. H., R. J. Emerick and L. B. Embry. 1965. Urolithiasis: relationships involving dietary calcium, phosphorus and magnesium. J. Nutr. 87: 499-504.

[5] Stewart, S. R., R. J. Emerick and R. H. Pritchard. 1991. Effects of dietary ammonium chloride and variations in calcium to phosphorus ratio on silica urolithiasis in sheep. J. Anim. Sci. 69: 2225-2229.

[6] Forman, S. A., F. Whiting and R. Connell. 1959. Silica urolithiasis in beef cattle. 3. Chemical and physical composition of the uroliths. Can. J. Compar. Med. 23(4):157-162.

[7] Scott, D. and W. Buchan. 1988. The effects of feeding pelleted diets made from either coarsely or finely ground hay on phosphorus balance and on the partition of phosphorus excretion between urine and faeces in the sheep. Q. J. Exp. Physiol. 73: 315-322.

[8] Bravo, D., D. Sauvant, C. Bogaert and F. Meschy. 2003. III. Quantitative aspects of phosphorus excretion in ruminants. Reprod. Nutr. Dev. 43: 285-300.

[9] Waltner-Toews, D. andD. H. Meadows. 1980. Case report: Urolithiasis in a herd of beef cattle associated with oxalate ingestion. Can. Vet. J. 21: 61-62

[10] James, L. F. and J. E. Butcher. 1972. Halogeton poisoning of sheep: effect of high level oxalate intake. J. Anim. Sci. 35: 1233-1238

[Kahn2005-11] Kahn, C. M. (ed.) 2005. Merck veterinary manual. 9th Ed. Merck & Co., Inc., Whitehouse Station.

Urolithiasis
Classification and external resources
ICD-10	N21.0-N21.9
ICD-9	594.0, 594.1, 594.2, 594.8, 594.9
DiseasesDB	31859
eMedicine	ped/2371
MeSH	D001744

匿名

検索

案内

urolithiasis