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儿童肾结石的临床特点和诊断

Authors
Jodi Smith, MD, MPH
F Bruder Stapleton, MD
Section Editor
Laurence S Baskin, MD, FAAP
Deputy Editor
Melanie S Kim, MD
Translators
杨屹, 主任医师，教授

引言

对儿童肾结石的认识日益增多。肾结石的临床表现各异，并且肾结石患儿，特别是年幼儿童，通常并不出现常见于成人的典型急性腰痛。因此，在做出肾结石的诊断前，通常会对患儿是否存在其他疾病进行评估。有关儿童期肾结石的临床特点和诊断将总结在此。儿童肾结石的流行病学、危险因素、紧急处理及预防复发将单独讨论。 (参见“儿童肾结石的流行病学和危险因素”和“Acute management of nephrolithiasis in children”和“儿童复发性肾结石的预防”)

临床表现

大多数肾结石患儿都有临床症状，通常表现为腰痛或腹痛。大约15%-20%的患儿无临床症状，这主要见于因其他原因行腹部影像学检查时发现结石，进而诊断为肾结石的年幼儿童[1-3]。

在那些有临床症状的患儿中，最常见的症状为疼痛[1-4]。其他可能的临床表现包括：肉眼血尿、排尿困难和尿急，以及恶心/呕吐。

疼痛 — 疼痛可被定位为腹痛或腰痛(被称为肾绞痛)。在数项病例系列研究中，50%-75%患者的主诉为疼痛[1-5]。

疼痛频率因年龄而异。例如，在一项报告中，疼痛在青少年、学龄儿童和5岁以下儿童中的发生率分别为60%、40%和20%[2]。与年龄相关的疼痛差异可能与就诊时的结石部位有关。幼儿(即<5岁)比学龄儿童及青少年更不易发生输尿管结石(发生率分别为32%、64%和82%)[6]。输尿管结石通常会出现疼痛，因为它可导致输尿管梗阻；而肾结石常常没有症状，并可能在做腹部影像学检查时被偶然发现而得以诊断。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-08.
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