With the current development of technology, infrared spectrum stone analyzer can quickly and accurately analyze the composition of stones, so as to provide a series of preventive measures, do you know what kind of composition your stones belong to? Do you know what kind of stones you have? Do you know how to prevent recurrence?
Calcium oxalate stones
Comprehensive prevention program 1 drink plenty of water (3L/d) 2. normal calcium diet (recommended amount is 1000mg/d) 3. restrict the intake of na (2g/d) 4. restrict the intake of oxalic acid 5. restrict the intake of animal protein 6. increase the intake of fiber 7. increase citric acid rich fruits 8. appropriate physical activity 9. appropriate body mass index (BMI 18~25kg/m2). Consider the use of drugs only if lifestyle changes and diet modification are not effective.
Increase fluid intake: recommended intake of 2.5~3.0L or more, and keep the daily urine volume at 3.2~2.5L or more. Urine specific gravity below 1.010. type of fluid: non-dairy fluids are appropriate, try to avoid excessive dietary caffeine, black tea, grape and apple juices and colas. Orange juice, sour fruit vine juice and lemon juice are recommended.
Diet
Calcium content: normal calcium content. Recommend eating more dairy products (milk, cheese, yogurt, etc.), tofu, drizzle and other foods. The recommended calcium intake is 800~1000mg.
However, low calcium diet is suitable for patients with absorptive hypercalciuria.
Limit the intake of oxalic acid in the diet: intake such as kale, almonds, peanuts, beets, parsley, spinach, rhubarb, black tea, cocoa powder, etc. should be avoided, of which spinach has the highest oxalic acid content.
Limit the intake of sodium: less than 2g/d
Limit the excessive intake of protein: the intake of animal protein should be limited to 150g or less. The daily protein intake of patients with recurrent stones should not exceed 80g
Increase the intake of fruits and vegetables
Increase coarse grains and fiber diet: but avoid wheat bran, etc.
Decrease the intake of vitamin C
Limit high purine diet: less than 500mg. purine-rich foods include animal offal (thymus, liver, kidney), poultry skin, herring with skin, sardines, anchovies, etc.
Drug prevention
Hypercalciuria: mainly thiazide diuretics. Disadvantages are the production of citrulluria and hypokalemia, for which they can be applied together with potassium citrate. Hypercitraturia: alkalizing treatment. The main drug is potassium citrate ;
Hyperoxaluria: treatment of intestinal-derived hyperoxaluria: drinking more water, limiting the intake of a diet high in oxalic acid, oral calcium or a high-calcium diet, supplementation with phosphate or magnesium oxide helps to prevent the formation of stones. Primary hyperoxaluria: no specific prevention.
Hyperoxaluria: alkalinization of urine, usually oral potassium citrate taking potassium citrate 3-7 mmol or sodium potassium citrate 9 mmol, 2-3 times/d. Allopurinol: allopurinol 100 mg, 3 times/d for those whose diet cannot be controlled. calcium-lowering drugs, usually dihydrocotrimoxazole 50 mg, 2 times daily.
Prevention of cystine stones
1.Ensure that the daily fluid intake exceeds 3000ml is the key measure. To prevent high concentration of cystinuria at night, it is recommended to drink 500ml of water each at bedtime and morning 2, which is the urinary cystine concentration below 300mg/L.
2, alkalinize urine: use sodium citrate orally, sodium bicarbonate is not recommended, the goal is to keep urine PH at 7.0~7.5
3.Use thiol drugs to improve the solubility of cystine by thiol disulfide exchange reaction. Of these, captopril is the first, and those who cannot tolerate it are switched to thiopronine. For those who excrete more than 3 mmol of cystine in 24h, thiopronine 250~2000 mg/d or captopril must be given.
Infected stones
Effective stone prevention should start with control of urinary tract infections and dietary prevention. To control infection, if there is lumbar pain and discomfort, urinary tract irritation sign, hematuria, etc., you should go to the hospital to perform urine routine, urinary ultrasound, etc., if there is urinary leukocyte infection, etc., you should treat urinary tract infection in time, preferably by urine mid-phase urine culture and drug sensitivity test, select sensitive antibiotics according to drug sensitivity test, or select empirical drugs, if oral anti-inflammatory drugs are not good, you can switch to If oral anti-inflammatory drugs are not good, intravenous quinolones or cephalosporins can be used instead.
Drug prophylaxis
The purpose of oral medication is to acidify the urine and inhibit the production of urease. Aluminum hydroxide or aluminum carbonate gels can be administered orally, which bind to phosphorus ions in the small intestine to form insoluble aluminum phosphate, thereby reducing the absorption of phosphorus and excretion of urinary phosphorus. Acidified urine can improve the solubility of phosphate. 1g of ammonium chloride, 2-3 times/day orally or 500mg of methionine, 2-3 times/day orally can be used. In patients with recurrent infections, urease inhibitors, such as acetyl hydroxyurea, 250mg, 2 times/day, can be applied for 2-4 months.
Uric acid stones
The prevention of uric acid stones starts with reducing the intake of foods rich in nucleic acid, such as animal offal, lean meat, etc. It is also important to keep the daily urine volume over 2000 ml, and to take oral alkalizing agents for a long time to restore the urinary pH to the normal range, if the recurrence of stones cannot be controlled, allopurinol can be used in moderation to reduce the production of uric acid in the body.
It is recommended to adopt an alkaline diet, avoiding foods such as pork, beef, duck, goose, animal offal, salted or fried food, mackerel, sardines, white fish, Wu Guo fish, dried meat, gravy, clams, crabs, etc.; vegetables such as spinach, various beans, cauliflower, lobster and mushrooms; wine, strong tea, coffee, cocoa, etc.; strong spices and condiments. Avoid eating more sea cucumbers, sea fish, seaweed, sea vegetables and other seafood. It is not advisable to drink alcohol, drinking alcohol can increase the level of uric acid, alcohol is also easy to cause the concentration of urine.