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Diagnostik und Therapie der Nephrolithiasis

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Diagnosis and treatment of nephrolithiasis

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Zusammenfassung

Hintergrund

Nierensteine sind eine häufige und weltweit verbreitete Ursache von Nierenerkrankungen mit einem meist chronischen Verlauf und hoher Rezidivhäufigkeit.

Fragestellung

Im folgenden Beitrag werden für den Internisten die diagnostische Herangehensweise beim symptomatischen Nierenstein und die therapeutischen Optionen beleuchtet. Dabei werden sowohl die Akuttherapie als auch Möglichkeiten der Rezidivprävention thematisiert.

Methoden

Als Grundlage dieser Übersicht dienen eine selektive Literaturrecherche und eigene Arbeiten zum Thema.

Ergebnisse und Schlussfolgerungen

Die Diagnose Nierenstein wird über die Anamnese und Untersuchung gestellt. In der bildgebenden Diagnostik sind die Nativcomputertomographie und Sonographie gleichwertig. Die Wahl der Therapie hängt von Begleitumständen, wie Fieber, dem Ansprechen auf die Schmerztherapie oder einem relevanten Harnstau, sowie von der Größe, Lokalisation und Zusammensetzung des Steins ab. Ist eine invasive Therapie notwendig, sollte das weitere Vorgehen mit den Kollegen der Urologie abgestimmt werden. Angesichts der hohen Rezidivwahrscheinlichkeit sind die Steinanalyse und die Bestimmung lithogener und litholytischer Substanzen im 24-h-Sammelurin entscheidend für das weitere Vorgehen. Bei der Frage, inwieweit ein Patient nach symptomatischem Erstereignis von einer langfristigen medikamentösen Therapie zur Steinprophylaxe profitiert, kann das Recurrence-of-kidney-stone(ROKS)-Nomogramm helfen.

Abstract

Background

Kidney stones are a common and increasing problem worldwide. Nephrolithiasis is frequently a chronic disease given the risk of recurrence following passage of a first stone.

Objectives

In the present article, an update on the diagnosis and treatment of kidney stones relevant for internal medicine physicians is provided.

Methods

This review is based on a selective literature search and our own work.

Results and conclusion

The diagnosis of kidney stones is based on the clinical history and physical examination. Confirmatory radiologic tests include noncontrast computerized tomography or ultrasonography with both techniques having recently been shown to have equivalent overall outcomes. The therapy of kidney stones is based on the clinical presentation and diagnostic findings (e.g., fever, response to pain management, and demonstration of relevant obstruction) as well as location, size, and composition of the stone. If invasive treatment is being considered, the urology department should be consulted. Given the high risk of recurrence, stone analysis must be performed as well as the concentration of lithogenic and litholytic substances measured in a 24-h urine collection. The newly established recurrence of kidney stone nomogram (ROKS nomogram) identifies kidney stone formers at greatest risk for a second symptomatic episode who may benefit from medical intervention.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Pfau, K.-U. Eckardt und F. Knauf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen und Klinikum Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    A. Pfau, K.-U. Eckardt &  F. Knauf

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  1. A. Pfau
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  2. K.-U. Eckardt
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  3. F. Knauf
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Correspondence to F. Knauf.

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Pfau, A., Eckardt, KU. & Knauf, F. Diagnostik und Therapie der Nephrolithiasis. Internist 56, 1361–1368 (2015). https://doi.org/10.1007/s00108-015-3758-0

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