| |
 |
|
|
| |
| ԹҊ : âä¹ÔèÇ |
| Թҍ âä¹ÔèÇ ã¹äµ ã¹»ÃÐà·Èä·Â
|
| Թ âä¹ÔèÇ ã¹äµ ã¹»ÃÐà·Èä·Â |
Kidney Stone in Thailand ¹ÔèÇã¹äµ ã¹ »ÃÐà·Èä·Â
º·¤ÇÒÁ¹Õé¤é¹ËÒáÅÐàÃÕºàÃÕ§â´Â ¹¾.¡ÔµµÔ³Ñ° ¡ÄÉ®ÒÀ¤ / Supervisor ¹¾.ÊÁªÒÂ à¨µÊØÃ¡Ò¹µì*
*¼ÙéàªÕèÂǪÒÊÒ¢ÒÍÒÂØÃ¡ÃÃÁ´éÒ¹âÃ¤äµ âç¾ÂÒºÒÅ àÅÔ´ÊÔ¹
âä¹ÔèÇ䵤×ÍÍÐäà [1]
¹ÔèÇà¡Ô´¨Ò¡ÊÒáè͹ÔèÇ·ÕèÁÕÍÂÙèµÒÁ»¡µÔã¹»ÑÊÊÒÇÐ ä´éá¡è á¤Åà«ÕèÂÁ ¿ÍÊ࿵ ÍÍ¡«Òàŵ ÂÙàõ ã¹ÀÒÇзÕèÁÕÊÒÃàËÅèÒ¹Õéã¹»ÃÔÁÒ³·Õè¼Ô´»¡µÔáÅÐÊÀÒ¾áÇ´ÅéÍÁ·ÕèàÍ×éÍÍӹǠÊÒÃàËÅèÒ¹ÕéÊÒÁÒöÃÇÁµÑǡѹ¨¹¡ÅÒÂà»ç¹¡é͹¼ÅÖ¡á¢ç§ áÅÐÁÕ¢¹Ò´ãËè¢Ö鹨¹¡ÅÒÂà»ç¹¹ÔèÇÍØ´µÑ¹·ÕèºÃÔàdzµèÒ§æ¢Í§·Ò§à´Ô¹»ÑÊÊÒÇÐ
ÍØºÑµÔ¡Òóì áÅФÇÒÁªØ¡ ( Epidemiology ) [2]
¤ÇÒÁªØ¡¢Í§âä¹ÔèÇÁÕá¹Çâ¹éÁÊÙ§¢Öé¹·ÑèÇ·Ø¡ÀÙÁÔÀÒ¤¢Í§âÅ¡ ã¹»ÃÐà·ÈÊËÃѰ ÍàÁÃÔ¡Ò㹪èǧ 10 »ÕËÅѧ ÍØºÑµÔ¡Òóìâä¹ÔèÇà¾ÔèÁ¢Ö鹨ҡ 3.8% à»ç¹ 5.2% (G.C. Curhan, USA) ã¹»ÃÐà·ÈàÂÍÃÁѹ¹Õà¾ÔèÁ¢Öé¹ ¨Ò¡ 4.0% à»ç¹ 4.7% ÊÒà˵ØÊӤѹèÒ¨ÐÁÒ¨Ò¡ÃٻẺ¡ÒôÓà¹Ô¹ªÕÇÔµ(lifestyle change) ÍÒËÒÃ(dietary habits) áÅÐÊÀÒÇÐáÇ´ÅéÍÁ(environments) ·Õèà»ÅÕè¹á»Å§ä»ÍÂèÒ§ÃÇ´àÃçÇ »ÑËÒÊÓ¤ÑÍÕ¡»ÃСÒâͧâä¹ÔèǤ×Í ¡ÒÃà¡Ô´¹ÔèÇ«éÓ ¾ºÊÙ§¶Ö§ 50% ÀÒÂã¹ 5 »Õ ÍÒËÒ÷Õèà¾ÔèÁ»Ñ¨¨ÑÂàÊÕ觢ͧ¡ÒÃà¡Ô´âä¹ÔèÇä´éá¡è animal proteins, sodium, sucrose áÅÐ calcium supplements ÊÓËÃѺ¡ÅØèÁ¢Í§ÍÒËÒà ·ÕèÊÒÁÒöŴ¤ÇÒÁàÊÕ觢ͧâä¹ÔèÇä´é àªè¹ potassium, phytate, citrate áÅÐ ¹éÓ à»ç¹µé¹ ªèǧÍÒÂØ·ÕèÁÕ¤ÇÒÁàÊÕè§㹡ÒÃà¡Ô´âä¹ÔèÇÊÙ§ ¤×Í ÃÐËÇèÒ§ 40-60 »Õ »Ñ¨¨ØºÑ¹¾ºÇèÒÍѵÃÒ¡ÒÃà¡Ô´âä¹ÔèÇã¹à¾ÈªÒÂáÅÐà¾ÈËÔ§ã¡Åéà¤Õ§¡Ñ¹
ÊÓËÃѺ㹻ÃÐà·Èä·Â¹Ñé¹ âä¹ÔèÇã¹Ãкº·Ò§à´Ô¹»ÑÊÊÒÇÐà»ç¹âä·Õ辺ä´éºèÍ áÅÐà»ç¹»ÑËÒÊÓ ¤Ñ·Ò§ÊÒ¸ÒÃ³ÊØ¢¢Í§ »ÃÐà·È áµè¡ÒÃÈÖ¡ÉÒÍÂèÒ§à»ç¹ÃкºÂѧäÁèÁÕà·èÒ·Õè¤Çà áÅÐÂѧ¢Ò´¢éÍÁÙž×é¹°Ò¹·ÕèÊÓ ¤ÑËÅÒ»ÃСÒà â´Ââä¹ÔèǾºÁÒ¡·ÕèÊØ´ã¹»ÃЪҡÃÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í ÃͧŧÁÒä´éá¡è»ÃЪҡÃÀÒ¤à˹×Í ÊèǹÀÒ¤ãµéÁÕ¤ÇÒÁªØ¡¢Í§âäµèÓ·ÕèÊØ´ âä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐáºè§ÍÍ¡à»ç¹ 2 ¡ÅØèÁµÒÁµÓá˹觷Õèà¡Ô´ ¤×Í âä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹº¹ (ä´éá¡è âä¹ÔèÇ·Õ辺ã¹äµáÅзèÍäµ) áÅÐâä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹÅèÒ§ (ä´éá¡èâä¹ÔèÇ·Õ辺㹡ÃÐà¾ÒлÑÊÊÒÇÐ áÅзèÍ»ÑÊÊÒÇÐ) ã¹»Õ ¾.È. 2514 ä´éÁÕÃÒ§ҹÇèÒ âä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹãËèà»ç¹âä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹÅèÒ§ »ÃÐÁÒ³ÃéÍÂÅÐ 90 ÊèǹãË辺ã¹à´ç¡ÍÒÂØµèÓ¡ÇèÒ 10 »Õ áÅÐÊèǹãËèà»ç¹à´ç¡ªÒÂ ã¹»Õ ¾.È. 2528 ÁÕÃÒ§ҹÇèÒẺἹ¢Í§âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐà»ÅÕè¹令×Í à»ç¹âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹº¹»ÃÐÁÒ³ÃéÍÂÅÐ 80 â´Â¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹº¹ÁÑ¡¾ºã¹ÇÑÂáç§Ò¹ÍÒÂØµÑé§áµè 20 »Õ¢Öé¹ä» ¾ºÁÒ¡·ÕèÊØ´ã¹ªèǧÍÒÂØ 40 –50 »Õ ¾ºÁÒ¡ã¹¼ÙéªÒÂÁÒ¡¡ÇèÒ¼ÙéËÔ§ 2 à·èÒ ËÅѧ¼èҵѴËÃ×ÍÊÅÒ¹ÔèÇÍÍ¡áÅéÇÁÕÍѵÃÒà¡Ô´à»ç¹«éÓ ÊÙ§¶Ö§ÃéÍÂÅÐ 39 (ã¹ 10 ¤¹·Õèà¤Âà»ç¹ ¾ºÇèÒà»ç¹«éÓ¶Ö§ 4 ¤¹) ÀÒÂã¹ÃÐÂÐàÇÅÒ 2 »Õ áÅÐà»ç¹âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹÅèÒ§»ÃÐÁÒ³ÃéÍÂÅÐ 20 ¡ÒÃà»ÅÕè¹á»Å§¹Õ龺àªè¹à´ÕÂǡѺ㹵èÒ§»ÃÐà·È àªè¹ ÊËÃѰÍàÁÃÔ¡Ò ÂØâûáÅÐÕè»Øè¹ àª×èÍÇèÒ¡ÒÃà»ÅÕè¹á»Å§¹ÕéÁÕ¼ÅÁÒ¨Ò¡ÍÒËÒ÷Õèà»ÅÕè¹仵ÒÁÀÒÇÐàÈÃɰ¡Ô¨ Êѧ¤ÁáÅСÒÃÈÖ¡ÉÒ [3]
¨Ò¡º·¤ÇÒÁàÃ×èͧ ¡ÒÃÇÔ¨ÑÂâääµáÅСÒÃäËŵÒ ¢Í§ È.¾.. ÊØÁÒÅÕ ¹ÔÁÁÒ¹¹ÔµÂì áÅФ³Ð [4] ä´éÍéÒ§¶Ö§¡ÒÃÈÖ¡ÉÒ ¢Í§ ¾¨¹ì ÈÃÕºØÅ×Í áÅФ³Ð [5] ã¹ËÁÙèºéÒ¹ã¹ÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í â´Â¡ÒõÃǨÇèÒÁÕá¼Å ¨Ò¡¡ÒüèҵѴ¹ÔèÇã¹äµ áÅÐ/ËÃ×Íà¤Â·ÃÒºÇèÒà»ç¹¹ÔèǨҡÒõÃǨ·Ò§ÃѧÊÕÁÒ¡è͹ ËÃ×ÍäÁè ¾ºÇèÒ ÍØºÑµÔ¡ÒÃ³ì ¢Í§âä ¹ÔèÇã¹äµ¤×Í»ÃÐÁÒ³ 3.7 µèÍ 1,000 ¢Í§»ÃЪҡà áÅШҡ¡ÒÃÈÖ¡ÉҢͧ È.¾.. ÊØÁÒÅÕ ¹ÔÁÁÒ¹¹ÔµÂì áÅФ³Ð[6] ã¹»ÃЪҡ÷ÕèµÃǨ¾º¹ÔèÇã¹äµ ¨Ò¡¡ÒÃ·Ó ¡ÒõÃǨÀÒ¾ÃѧÊÕÇÔ·ÂÒ plain KUB ¨Ò¡ËÁÙèºéÒ¹ 5 áËè§ã¹¨Ñ§ËÇÑ´¢Í¹á¡è¹ ã¹¼Ùé»èÇ·Ñé§·ÕèÁÕáÅÐäÁèÁÕ ÍÒ¡Òà ¨Ó¹Ç¹ 550 ÃÒ ¾ºÇèÒ 442 ÃÒÂÁÕ «Ôà·Ãµã¹»ÑÊÊÒÇеíèÒ ¹Í¡¹Ñé¹ÁÕ«Ôà·Ãµã¹»ÑÊÊÒÇлáµÔ áÅоº ÍØºÑµÔ¡ÒÃ³ì ¢Í§ ¹ÔèÇã¹äµÃéÍÂÅÐ 2-16 ·Ñé§¹Õé¢Ö鹡ѺÊÀÒ¾¢Í§ËÁÙèºéÒ¹ ÊÓËÃѺ ÍØºÑµÔ¡ÒÃ³ì ¢Í§¹ÔèÇã¹äµ ã¹ÀÙÁÔÀÒ¤Í×è¹ÁÕ¡ÒÃÈÖ¡ÉÒäÁèÁÒ¡¹Ñ¡ áÅÐÁÕ¡ÒÃÈÖ¡ÉÒã¹á§è¢Í§ ¡Åä¡¡ÒÃà¡Ô´âä ÁÒ¡¡ÇèÒã¹á§è¢Í§ ÍØºÑµÔ¡Òóì áÅÐÂѧ¤§äÁè·ÃÒº¶Ö§¡Åä¡¡ÒÃà¡Ô´¢Í§âä¹ÔèÇ·ÕèªÑ´à¨¹ ÃÇÁ¶Ö§ÂѧäÁèÊÒÁÒöËÒá¹Ç·Ò§¡Òûéͧ¡Ñ¹áÅСÒÃÃÑ¡ÉÒ·Õèä´é¼Å ¹Í¡¨Ò¡¹ÕéÊèǹãËèÂѧà»ç¹ ¡ÒÃÈÖ¡ÉÒ´éҹ˹Öè§´éÒ¹ã´à·èÒ¹Ñé¹ äÁèä´éÈÖ¡ÉÒâ´Âàª×èÍÁ⧻Ѩ¨ÑµèÒ§æà¢éÒ´éÇ¡ѹ ¡ÒÃÈÖ¡ÉÒ·ÕèÁÕÊèǹãËè à»ç¹¡ÒÃÈÖ¡ÉÒ à¡ÕèÂǡѺº·ºÒ·¢Í§ÊÒÃâ»áµÊà«ÕèÂÁáÅЫÔà·Ãµã¹»ÑÊÊÒÇеèÍ¡ÒÃà¡Ô´¹ÔèÇ ÂѧäÁèÁÕ¡ÒÃÈÖ¡ÉһѨ¨ÑÂàÊÕè§µèÍ¡ÒÃà¡Ô´¹ÔèÇ«éÓ â´ÂÍÒÈÑ¡Òäӹdz¨Ò¡ ͧ¤ì»ÃСͺµèÒ§æã¹»ÑÊÊÒÇÐ ÍÂèÒ§·ÕèÁÕ¡ÒÃÈÖ¡ÉÒã¹µèÒ§»ÃÐà·È áÅÐÁÕ¢éͨӡѴ´éҹ෤¹Ô¤ã¹¡Ò÷ӡÒÃÇÔà¤ÃÒÐËì·Ò§ªÕÇà¤ÁÕ [7-18]
ª¹Ô´¢Í§¹ÔèÇ·Õ辺ã¹ä·Â [3,19-26]
¡é͹¹ÔèÇÁÕͧ¤ì»ÃСͺ 2 Êèǹ ¤×ÍÊèǹ·Õèà»ç¹áÃè¸ÒµØ (mineral composition) áÅÐÊèǹ·Õèà»ç¹ÊÒÃÍÔ¹·ÃÕÂì (organic matrix) «Öè§ÁÕ»ÃÐÁÒ³ 5-10% ÊÒÃÍÔ¹·ÃÕÂìàËÅèÒ¹Õéà»ç¹ÊÒÃâÁàÅ¡ØÅãËè·Õ辺㹻ÑÊÊÒÇÐ ä´éá¡è ¡ÅØèÁâ»ÃµÕ¹ ä¢Áѹ áÅФÒÃìâºäÎà´Ãµ à»ç¹µé¹ ͧ¤ì»ÃСͺ·Õèà»ç¹áÃè¸ÒµØà¡Ô´¨Ò¡¡Òõ¡¼ÅÖ¡¢Í§ÊÒáè͹ÔèÇã¹»ÑÊÊÒÇÐ ä´éá¡è á¤Åà«ÕèÂÁ ÍÍ¡«Òàŵ ¿ÍÊ࿵ áÅСôÂÙÃÔ¤ à»ç¹µé¹ «Öè§¼ÅÖ¡¹ÔèÇàËÅèÒ¹Õé¨Ðà¨ÃԾѲ¹Òà»ç¹¡é͹¹ÔèÇäÁèä´é ¶éÒäÁèÁÕ¡ÒÃÃÇÁµÑǡѺÊÒÃÍÔ¹·ÃÕÂìã¹»ÑÊÊÒÇÐ (ÊèǹãËè¤×Íâ»ÃµÕ¹) ´Ñ§¹Ñé¹àª×èÍÇèÒÊÒÃÍÔ¹·ÃÕÂìã¹»ÑÊÊÒÇÐ â´Â੾ÒÐâ»ÃµÕ¹áÅÐä¡Åâ¤â»ÃµÕ¹ ÁÕº·ºÒ·ÊÓ¤ÑÁҡ㹡Ãкǹ ¡ÒÃà¡Ô´¹ÔèÇ «Ö觨Óà»ç¹µéͧÁÕ¡ÒÃÈÖ¡ÉÒÇÔ¨ÑÂÇèÒÁÕª¹Ô´ã´ºéÒ§ ÁÕáËÅè§¡Óà¹Ô´¨Ò¡·Õèã´ áÅÐÁÕº·ºÒ·ÍÂèÒ§äõèÍ¡Òõ¡¼ÅÖ¡ ¡ÒÃà¡ÒÐ¡ÅØèÁ¢Í§¼ÅÖ¡àËÅèÒ¹Ñé¹ ÃÇÁ·Ñé§¡ÒÃà¡ÒеԴ¡Ñºà«ÅÅìºØ¼ÔǢͧÃкº·Ò§à´Ô¹»ÑÊÊÒÇÐ [1]
¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÁÕËÅÒª¹Ô´ ÁÕÊèǹ»ÃСͺᵡµèÒ§¡Ñ¹ä» ¹ÔèǺҧ»ÃÐàÀ· ÁÕÊÒûÃСͺà¾Õ§ÍÂèÒ§à´ÕÂÇ ¹ÔèǺҧ»ÃÐàÀ·ÁÕÊÒûÃСͺËÅÒª¹Ô´ »Ð»¹¡Ñ¹ÍÂÙè ¹ÔèÇÊèǹãËèÃéÍÂÅÐ 90 ·ÃÒºä´é¨Ò¡¡ÒöèÒÂÀÒ¾ÃѧÊÕ ¤×Íà»ç¹¹ÔèÇ·ÖºáʧÃѧÊÕä´éá¡è ¹ÔèǨӾǡ á¤Åà«ÕèÂÁÍÍ¡«ÒàÅ· á¤Åà«ÕèÂÁ¤ÒÃìºÍ๷ ËÃ×Íá¤Åà«ÕèÂÁ¿ÍÊ࿵ ¹ÔèÇ·ÕèàË繨ҧæã¹ÀÒ¾¶èÒÂÃѧÊÕ ä´éá¡è¹ÔèǨӾǡ«Õʵչ ¹ÔèÇâ»Ãè§áʧ«Öè§ÀÒ¾¶èÒÂÃѧÊÕÁͧäÁèàËç¹ä´éá¡è¹ÔèǨӾǡ¡Ã´ÂÙÃÔ¤ à»ç¹µé¹ [27-32] ÊÒÁÒöáºè§»ÃÐàÀ·¢Í§¹ÔèÇä´éà»ç¹
* ·ÕèÁÒ Nephrology : Last Minute Internal Medicine, McGrawHell 2008 [27]
1. à¡Å×Íá¤Åà«ÕèÂÁ Calcium stones (ã¹»ÃÐà·Èä·Â¾ººèÍÂÊØ´»ÃÐÁÒ³ 75-80 % ) «Öè§ÁÑ¡¨ÐÃÇÁ¡Ñº
ÍÍ¡«Òàŵ (oxalate) ¹ÔèǪ¹Ô´¹Õé¨ÐàËç¹ä´é ¨Ò¡ÀÒ¾¶èÒÂÃѧÊÕ à¡Ô´¨Ò¡¡ÒÃÁÕá¤Åà«ÕèÂÁã¹»ÑÊÊÒÇÐÊÙ§
2. à¡Å×ÍʵÃÙäÇ·ì Struvite (magnesium ammonium phosphate) stones (15%) ¹ÔèǪ¹Ô´¹ÕéàËç¹ä´é¨Ò¡ ÀÒ¾¶èÒÂÃѧÊÕ¸ÃÃÁ´Ò ¹ÔèǨÐÁÕÅѡɳÐàËÁ×͹à¢Ò¡ÇÒ§ staghorn à¡Ô´ã¹¼Ùé»èÇ·ÕèÁÕ·Ò§à´Ô¹»ÑÊÊÒÇÐÍÑ¡àʺàÃ×éÍÃѧ â´Âàª×éÍẤ·ÕàÃÕ¨ÐÊÅÒ urea ãËéà»ç¹ ammonia ¼Ùé»èÇÂàËÅèÒ¹ÕéÁÑ¡¨ÐÁÕ¡ÒõԴàª×éÍã¹·Ò§à´Ô¹»ÑÊÊÒÇÐàÃ×éÍÃѧ ¡ÒÃÃÑ¡ÉÒ¨ÐäÁèËÒ¢Ҵ ËÒ¡äÁèä´éàÍÒ¹ÔèÇÍÍ¡ â´Â»ÑÊÊÒÇТͧ¼Ùé»èǨÐà»ç¹´èÒ§ÁÑ¡¨ÐÁÕ¤èÒ pH ÁÒ¡¡ÇèÒ 7
3. à¡Å×ÍÂÙÃÔ¤ Uric acid stones (6%) à¡Ô´¨Ò¡ÃѺ»ÃзҹÍÒËÒ÷ÕèÁÕ purine ÊÙ§ä´éá¡è à¤Ã×èͧã¹ÊѵÇì»Õ¡ à»ç¹µé¹ »ÑÊÊÒÇТͧ¼Ùé»èÇÂÁÑ¡¨Ðà»ç¹¡Ã´ â´ÂÁÕ¤èÒ pH ¹éÍ¡ÇèÒ 5.5 ¹ÔèǪ¹Ô´¹ÕéäÁèÊÒÁÒöàËç¹ä´é¨Ò¡ ÀÒ¾¶èÒÂÃѧÊÕ¸ÃÃÁ´Ò
4. à¡Å×Í«Õʵչ Cystine stones (2%) à¡Ô´¨Ò¡¤ÇÒÁ¼Ô´»¡µÔ¢Í§ÃèÒ§¡ÒÂ㹡Òôٴ«ÖÁÊÒëÕʵչ ÊÒÁÒöàËç¹ä´é ¨Ò§æ ¨Ò¡ÀÒ¾¶èÒÂÃѧÊÕ¸ÃÃÁ´Ò
ÊÒà˵آͧ¹ÔèÇ [3,20,27]
* ·ÕèÁÒ Nephrology : Last Minute Internal Medicine, McGrawHell 2008 [27]
¨Ò¡¡ÒÃÈÖ¡ÉÒ·Ò§ ÃкҴÇÔ·ÂÒ ¾ºÇèÒÊÒà˵طÕèà¡ÕèÂÇ¢éͧä´éá¡è »Ñ¨¨ÑÂÀÒÂã¹ÃèÒ§¡Ò¢ͧ¼Ùé»èÇÂàͧáÅÐÊÀÒ¾áÇ´ÅéÍÁ¢Í§¼Ùé»èÇ â´ÂËÅÑ¡æáÅéÇà¡Ô´¨Ò¡ ÀÒÇÐäÁèÊÁ´ØÅÂì ¢Í§à¡Å×ÍáÃèµèÒ§æã¹»ÑÊÊÒÇÐ àªè¹ ÀÒÇÐ Hypercalciuria , Hypocitraturia , Hyperoxalaturia áÅÐ Hyperuricosuria à»ç¹µé¹ [33-37]
ÊÓËÃѺÊÒà˵آͧ¡ÒÃà¡Ô´¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇйÑé¹ »Ñ¨¨ØºÑ¹ÂѧäÁè·ÃÒºá¹è¹Í¹ áµèàª×èÍÇèÒ ÊÀÒÇеèÍ仹ÕéÁÕÊèǹà¡ÕèÂÇ¢éͧ¡Ñº¡ÒÃà¡Ô´¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐ
Types and Causes of Hypercalciuria* : * Pathology of Kidney Stones ; Internal Medicine just the Fact , McGrawhill 2008 [38]
¡.ÊÒà˵ؤÇÒÁ¼Ô´»¡µÔ·Õèà¡ÕèÂǡѺ»Ñ¨¨ÑÂÀÒÂã¹µÑǼÙé»èÇÂàͧ [20]
1.¡ÃÃÁ¾Ñ¹¸Øì ¼Ùé»èÇ·ÕèÁÕ¾èÍáÁèà»ç¹âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÁÕâÍ¡ÒÊ·Õè¨Ðà»ç¹âä¹ÔèÇàªè¹à´ÕÂǡѹä´é
2.ÍÒÂØáÅÐà¾È ¹ÔèÇã¹äµ¾ºã¹ à¾ÈªÒÂÁÒ¡¡ÇèÒà¾ÈËÔ§ã¹ÍѵÃÒ 2 µèÍ1 ¾ºÁÒ¡ã¹¼ÙéãËèÁÒ¡¡ÇèÒã¹
à´ç¡ áÅйÔèÇ㹡ÃÐà¾ÒлÑÊÊÒÇоºÁÒ¡ã¹à¾ÈªÒÂÁÒ¡¡ÇèÒà¾ÈËÔ§ã¹ÍѵÃÒ 7 µèÍ 1 ¾ºÁÒ¡ã¹à´ç¡
ÍÒÂØ¹éÍ¡ÇèÒ 7 »Õ áÅÐã¹¼ÙéãË辺ä´éªèǧÍÒÂØÁÒ¡¡ÇèÒ 30 »Õ ¢Öé¹ä»
Types and Causes of Hypocitraturia* : Intracellular acidosis causing increased absorption of citrate in the proximal tubule
with resultant precipitation of calcium and oxalate in the collecting duct.
* Pathology of Kidney Stones ; Internal Medicine just the Fact , McGrawhill 2008[38]
Types and Causes of Hyperoxaluria* : * Pathology of Kidney Stones ; Internal Medicine just the Fact , McGrawhill 2008 [38]
3.¤ÇÒÁ¼Ô´»¡µÔ¢Í§ÃдѺá¤Åà«ÕèÂÁã¹àÅ×Í´ ËÃ×ÍÁÕÀÒÇÐá¤Åà«ÕèÂÁã¹»ÑÊÊÒÇÐÊÙ§à¡Ô¹ (Hypercalciuria)
ä´éá¡èÀÒÇдѧµèÍ仹Õé (µÒÃÒ§ Types and causes of Hypercalciuria ´éÒ¹º¹)
- ÀÒÇеèÍÁ¾ÒÃÒ¸ÑÂÃÍ´ì·Ó§Ò¹ÁÒ¡à¡Ô¹ Hyperparathyroidism
- ¡Òôٴ«ÖÁá¤Åà«ÕèÂÁÁÒ¡à¡Ô¹ ÍÒ¨à¡Ô´¨Ò¡ä´éÃѺÇÔµÒÁÔ¹´ÕÁÒ¡à¡Ô¹
- ¡ÒâѺÍÍ¡¢Í§á¤Åà«ÕèÂÁáÅпÍÊ࿵㹻ÑÊÊÒÇÐÁÒ¡à¡Ô¹
- ÁÕ¡ÒâѺ¡Ã´ÂÙÃԤ㹻ÑÊÊÒÇÐÁÒ¡
- ÁÕÃдѺáÁ¡¹Õà«ÕèÂÁáÅÐ/ËÃ×Íâ»áµÊà«ÕèÂÁ ã¹àÅ×Í´µèÓ
4.ÁÕ¡Òõպ᤺¢Í§Ãкº·Ò§à´Ô¹»ÑÊÊÒÇÐ ·ÓãËéÁÕ»ÑÊÊÒÇФÑ觤éÒ§ â´Â¡Òõպ᤺¹ÕéÍÒ¨ ÁÕÁÒáµè¡Óà¹Ô´
ËÃ×Í à¡Ô´¢Öé¹ÀÒÂËÅѧ
5.¤ÇÒÁà¢éÁ¢é¹¢Í§¹éÓ»ÑÊÊÒÇÐ à¡Ô´à¹×èͧ¨Ò¡ÁÕÊÒõèÒ§æ¶Ù¡¢ÑºÍÍ¡ÁÒã¹»ÑÊÊÒÇÐÁÒ¡¡ÇèÒ»¡µÔ ËÃ×Íà¡Ô´
¨Ò¡¼Ùé»èÇ´×èÁ¹éÓ¹éÍ¡ÇèÒ»¡µÔ ËÃ×ÍÊÙàÊÕ¹éÓÍÍ¡¨Ò¡ÃèÒ§¡Ò·ҧ´éÒ¹Í×è¹ÁÒ¡¡ÇèһáµÔ àÁ×èÍ»ÑÊÊÒÇÐÁÕ
¤ÇÒÁà¢éÁ¢é¹ÊÙ§ âÍ¡ÒÊ·ÕèÊÒÃÅÐÅÒÂã¹»ÑÊÊÒÇШе¡¼ÅÖ¡ ¨Ö§ÁÕÁÒ¡¢Öé¹
6.¤ÇÒÁà»ç¹¡Ã´-´èÒ§¢Í§»ÑÊÊÒÇÐ »ÑÊÊÒÇзÕèÁÕÄ·¸Ôìà»ç¹¡Ã´ÁÒ¡ÍÒ¨à¡Ô´¡Òõ¡¼ÅÖ¡¢Í§ ¡Ã´ÂÙÃÔ¤ «Õʵչ
ä´é Êèǹ»ÑÊÊÒÇзÕèÁÕÄ·¸Ôìà»ç¹´èÒ§ ÍÒ¨à¡Ô´¡Òõ¡µÐ¡Í¹¢Í§¼ÅÖ¡ÊÒèӾǡ ÍÍ¡«Òàŵ ¿ÍÊà¿Ê áÅÐ
¤ÒºÍ๵ä´é ¨Ò¡¡ÒÃÈÖ¡ÉҢͧ W.G. Robertson, UK.[2] ÁÕËÅÑ¡°Ò¹Â×¹ÂѹªÑ´à¨¹ÇèÒ¤¹»¡µÔáÅмÙé»èÇÂ
âä¹ÔèÇÁÕ¤ÇÒÁà»ç¹¡Ã´-´èÒ§¢Í§»ÑÊÊÒÇзÕèᵡµèÒ§¡Ñ¹ â´Â·ÑèÇ令ÇÒÁà»ç¹¡Ã´´èÒ§ã¹»ÑÊÊÒÇÐ ÁÕ¡ÒÃ
à»ÅÕè¹á»Å§ã¹ÃÐËÇèÒ§Çѹ »¡µÔ¤ÇÒÁà»ç¹¡Ã´-´èÒ§¢Í§»ÑÊÊÒÇÐ ÍÂÙè㹪èǧµÑé§áµèÁÕ¤ÇÒÁà»ç¹¡Ã´·Õè pH
5.2 㹵͹ˡâÁ§àªéÒ ¶Ö§ÁÕ¤ÇÒÁà»ç¹¡ÅÒ§ pH 7.0 㹵͹ˡâÁ§àÂç¹ ¨Ö§ÁÕâÍ¡ÒÊà¡Ô´¼ÅÖ¡ ä´é·Ñé§¼ÅÖ¡
¡Ã´ÂÙÃÔ¤ áÅмÅÖ¡á¤Åà«ÕèÂÁ áµè¼ÅÖ¡àËÅèÒ¹Õé¨ÐÅÐÅÒÂàÁ×èÍ pH à»ÅÕè¹ä»ËÅѧ¨Ò¡¹Ñ鹨֧ÁÕ ¡ÒâѺÍÍ¡ÁҡѺ
»ÑÊÊÒÇÐ ã¹¼Ùé»èÇ·Õèà»ç¹¹ÔèǡôÂÙÃÔ¤ÁÑ¡¨ÐÁÕ »ÑÊÊÒÇзÕèÁÕ¤ÇÒÁà»ç¹¡Ã´ (pH 5.0-5.5) «Ö觤ÇÒÁà»ç¹¡Ã´-
´èÒ§äÁèÊÙ§¾Í·Õè¨ÐÅÐÅÒ¼ÅÖ¡ä´é ¨Ö§à¡Ô´¼ÅÖ¡ÊÐÊÁÁÒ¡¢Öé¹áÅÐÃÇÁµÑǡѹ ·ÓÅÒÂà«ÅÅìºØ·èÍ·Ò§à´Ô¹
»ÑÊÊÒÇÐ à¡Ô´¡ÒÃà¡ÒеԴáÅФ§¤éÒ§ã¹·èÍ·Ò§à´Ô¹»ÑÊÊÒÇÐ ¨¹à¨ÃÔà»ç¹¡é͹¹ÔèÇã¹·ÕèÊØ´
7.¡ÒÃÍÑ¡àʺµÔ´àª×éÍã¹Ãкº·Ò§à´Ô¹»ÑÊÊÒÇÐ à¡Ô´¨Ò¡¡ÒõԴàª×é;ǡ Klebsiella ,Pseudomonas à»ç¹µé¹
8.Çѵ¶Øá»Å¡»ÅÍÁ·ÕèËÅØ´à¢éÒä»ã¹·Ò§à´Ô¹»ÑÊÊÒÇÐ
9.ÂÒºÒ§ª¹Ô´ [38-44] ·ÓãËéà¡Ô´¹ÔèÇä´é àªè¹ ÂҢѺ»ÑÊÊÒÇÐ, ÂÒ¡ÅØèÁ Carbonic anhydrase inhibitors ,ÂÒÃкÒ ËÃ×Í ÂÒÅ´¡Ã´·Õè¡Ô¹ÍÂÙèà»ç¹àÇÅÒ¹Ò¹æ ·ÓãËéà¡Ô´¹ÔèÇ´éÇ¡Å䡼èÒ¹·Ò§àÁµÒºÍÅÔ¤ ÊèǹÂÒ¡ÅØèÁMagnesium trisilicate , Ciprofloxacin , Sulfa medications , Triamterene , Indinavir áÅÐ Ephedrine (alone or in combination with guaifenesin) ·ÓãËéà¡Ô´¹ÔèǼèÒ¹¡Åä¡ Drug crystallize and urinary supersaturation ËÃ×ÍÂÒ Probenecid, Salicylates, áÅÐ Ablative chemotherapies ¡çÊÒÁÒö·ÓãËéà¡Ô´ ÀÒÇСôÂÙÃԤ㹻ÑÊÊÒÇÐÊÙ§ áÅÐà¡Ô´¹ÔèÇẺ¡Ã´ÂÙÃÔ¤ ä´éàªè¹à´ÕÂǡѹ
10.¤ÇÒÁÍéǹ ¨Ò¡¡ÒÃÈÖ¡ÉҢͧ B. Hess, CH [2] áÅÐÍÕ¡ËÅÒ§ҹÇÔ¨ÑÂÃÒ§ҹÇèÒ ÀÒÇÐ metabolic syndrome áÅÐ obesity ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸ì¡Ñºâä¹ÔèÇ áÅÐÂѧ¾ºÇèÒ¼Ùé»èÇÂâä¹ÔèǡôÂÙÃÔ¤ÁÑ¡ÁÕâäàºÒËÇÒ¹ÃèÇÁ´éÇ ¡Åä¡àª×èÍÇèÒ¹èÒ¨Ðà¡ÕèÂÇ¢éͧ¡ÑºÀÒÇÐ insulin resistance â´ÂÀÒÇÐÍéǹáÅСÒô×é͵èÍÍÔ¹«ØÅÔ¹Êè§ ¼Å·ÓãËé»ÑÊÊÒÊÐÁÕ¤ÇÒÁà»ç¹¡Ã´ÁÒ¡¢Öé¹ áÅÐàÊÕè§µèÍ¡ÒÃà¡Ô´¹ÔèǡôÂÙÃÔ¤ ÊÓËÃѺ¡Åä¡¡ÒÃà¡Ô´ÀÒÇлÑÊÊÒÇÐà»ç¹¡Ã´ ¹èÒ¨Ðà»ç¹¼ÅÁÒ¨Ò¡ÀÒÇÐ impaired ammonia genesis response à¹×èͧ¨Ò¡¡ÒÃÊÃéÒ§áÍÁâÁà¹ÕµéͧÍÒÈÑ¡ÒáÃеØé¹â´ÂÍÔ¹«ØÅÔ¹
¢.ÊÒà˵ØÃèÇÁ·Õèà¡ÕèÂÇ¢éͧ¡ÑºÊÀÒ¾áÇ´ÅéÍÁ¢Í§¼Ùé»èÇ [20]
1.ÊÀÒ¾ÀÙÁÔÈÒʵÃì
¼Ùé»èÇ·Õèà»ç¹âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÁÑ¡ÍÂÙè㹺ÃÔàdz·ÕèÃÒºÊÙ§ »ÃÐà·Èä·ÂàÃÒ ¾ºÁÒ¡ã¹ÀÒ¤µÐÇѹÍÍ¡
à©Õ§à˹×ÍáÅÐÀÒ¤à˹×Í
2.ÊÀÒÇÐÍÒ¡ÒÈáÅÐÄ´Ù¡ÒÅ
ã¹Ä´ÙÃé͹¨Ð¾ºÇèÒ¼Ùé»èÇÂà»ç¹âä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÁÒâç¾ÂÒºÒšѹÁÒ¡ ÍÒ¨à¹×èͧ¨Ò¡àÊÕÂà˧×èÍÁÒ¡·ÓãËé»ÑÊÊÒÇÐà¢éÁ¢é¹¢Öé¹ ·ÓãËé¹ÔèÇâµàÃçÇ¢Ö鹨֧à¡Ô´ÍÒ¡ÒâÖé¹ áµèã¹Ä´Ù˹ÒÇàÊÕÂà˧×è͹éÍ »ÑÊÊÒÇÐà¨×ͨҧ áÅлÑÊÊÒÇÐÁÕ»ÃÔÁÒ³ÁÒ¡
3.»ÃÔÁÒ³¹éÓ´×èÁ
«Ö觨ÐÁÕÊèǹà¡ÕèÂÇ¢éͧ¡Ñº¤ÇÒÁà¢éÁ¢é¹¢Í§»ÑÊÊÒÇÐ áÅÐÍÒ¨à¡ÕèÂÇ¢éͧ¡Ñº à¡Å×ÍáÃè·ÕèÅÐÅÒÂÍÂÙèã¹¹éÓ·Õèãªé´×èÁ
«Öè§¢Ö鹡ѺáµèÅзéͧ¶Ôè¹
4.âÀª¹Ò¡Òà áÅÐÇÔ¶Õ¡ÒôÓà¹Ô¹ªÕÇÔµ [3,45-46]
¡ÒúÃÔâÀ¤ÍÒËÒùҹҪ¹Ô´ áÅСÒô×èÁ¹éÓÁÕ¼ÅãËéÁÕ¡ÒÃà¾ÔèÁËÃ×ÍÅ´ ¢Í§ÊÒõèÒ§æ ·Õèà»ç¹Êèǹ»ÃСͺ
¢Í§¡é͹¹ÔèÇ àªè¹ ¡ÒáԹÍÒËÒÃà¤Ã×èͧã¹ÊѵÇì ÂÍ´¼Ñ¡ ÊÒËÃèÒ ¨Ð·ÓãËéà¡Ô´¡Ã´ÂÙÃÔ¤ÊÙ§ä´é ¨Ò¡¡ÒÃÈÖ¡ÉҢͧ R. Siener, DE [2] ¾ºÇèÒ ÃٻẺ¡ÒôÓà¹Ô¹ªÕÇÔµáÅÐÍÒËÒà ÁռŵèÍ¡ÒÃà¡Ô´¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐ
¾ºÇèÒ ¤èÒ¤ÇÒÁÍÔèÁµÑÇÂÇ´ÂÔ觢ͧ á¤Åà«ÕèÂÁÍÍ¡«Òàŵ㹻ÑÊÊÒÇÐá»Ã¼Ñ¹µÃ§¡Ñº¤èÒ body mass index (BMI) ã¹¢³Ð·Õè¤ÇÒÁà»ç¹¡Ã´-´èÒ§¢Í§»ÑÊÊÒÇÐ á»Ã¼¡¼Ñ¹¡Ñº¤èÒ BMI â´Â¾º¤ÇÒÁªØ¡¢Í§âäÍéǹÊÙ§ã¹¼Ùé»èÇ·Õèà»ç¹âä¹ÔèÇã¹à¾ÈªÒ áµè¾ºä´é¹éÍÂã¹¼Ùé»èÇÂËÔ§ §Ò¹ÇÔ¨ÑÂÃÒ§ҹÇèÒ¡Òô×èÁà¤Ã×èͧ´×èÁâ¤ÅÒà»ç¹ÊÒà˵ØãËéÃдѺ«Ôà·ÃµáÅÐáÁ¡¹Õà«ÕèÂÁã¹»ÑÊÊÒÇеèÓ áÅÐÂѧ·ÓãËé»ÑÊÊÒÇÐÁÕ¤ÇÒÁà»ç¹¡Ã´ÊÙ§ÁÒ¡¢Öé¹ ¡ÒúÃÔâÀ¤¼Ñ¡áÅмÅäÁé¨Ð·ÓãËé »ÃÔÁÒ³»ÑÊÊÒÇÐ ¤ÇÒÁà»ç¹´èÒ§áÅЫÔà·Ãµã¹»ÑÊÊÒÇÐÊÙ§¢Öé¹ ¢³Ð·ÕèÃдѺ
á¤Åà«ÕèÂÁã¹»ÑÊÊÒÇÐŴŧ ¡ÒÃÍÍ¡¡ÓÅѧ¡ÒÂÍÂèҧ˹ѡÊè§¼ÅãËé»ÃÔÁÒ³»ÑÊÒÇÐŴŧ ¡ÒÃÊÙººØËÃÕèà¾ÔèÁ¤ÇÒÁàÊÕè§µèÍ¡ÒÃà¡Ô´¹ÔèÇá¤Åà«ÕèÂÁÍÍ¡«Òàŵ «Öè§ÍÒ¨¼èÒ¹·Ò§¡ÒÃŴŧ¢Í§ÃдѺ vasopressin ÁռŷÓãËé»ÃÔÁÒ³»ÑÊÊÒÇÐŴŧ ¤ÇÒÁà¤ÃÕ´Êè§¼ÅãËé»ÃÔÁÒ³»ÑÊÊÒÇÐáÅÐáÁ¡¹Ôà«ÕèÂÁã¹»ÑÊÊÒÇеèÓŧ áÅÐÃдѺá¤Åà«ÕèÂÁã¹»ÑÊÊÒÇÐÊÙ§¢Öé¹ â´Â¡Åä¡ã´ÂѧäÁè·ÃÒºá¹èªÑ´
¡ÒáԹÍÒËÒèӾǡ¼Ñ¡·ÕèÁÕÊÒà ÍÍ¡«ÒàŵÊÙ§ àªè¹ ¼Ñ¡áÁéÇ ªÒ ¼Ñ¡â¢Á ¼Ñ¡Ë¹ÒÁ ¼Ñ¡µÔéÇ Ë¹èÍäÁéªçÍ¡â¡áŵ ¶ÑèÇ ÊµÍàºÍÃìÃÕè ªÐ¾ÅÙ ¨ÐÁÕâÍ¡ÒÊà¡Ô´¹ÔèÇ ¾Ç¡ÍÍ¡«Òàŵ à´ç¡àÅç¡·Õè¢Ò´ÍÒËÒèӾǡâ»ÃµÕ¹¨Ðà¡Ô´¹ÔèÇ㹡ÃÐà¾ÒлÑÊÊÒÇÐÁÒ¡
¡ÒâҴ ÇÔµÒÁÔ¹ àÍ ËÃ×Í ä´éÃѺ ÇÔµÒÁÔ¹´Õ ÁÒ¡à¡Ô¹ä» ¡ç·ÓãËéà¡Ô´¹ÔèÇä´é ËÃ×Í ¡ÒáԹ ¾Ç¡ ¼Ñ¡ ËÃ×Í ¼ÅäÁé ÃÊà»ÃÕéÂÇàªè¹ ÁйÒÇ ·ÕèÁÕâ»áµÊà«ÕèÂÁ«Ôà·ÃµÊÙ§ ÊÒÁÒöÂѺÂÑé§¡ÒÃà¡Ô´¹ÔèÇ ËÃ×͹ÔèÇà¡Ô´«éÓä´é ¤¹·Õè¢Ò´ÇÔµÒÁÔ¹ B6 ·ÓãËéÁÕ oxalate ÊÙ§ä´é (à¾ÃÒÐ glyoxalate à»ÅÕè¹à»ç¹ glycine ¹éÍÂŧ ¨Ö§à»ÅÕè¹ à»ç¹ oxalate ÁÒ¡¢Öé¹)
¶éÒ¡Ô¹á¤Åà«ÕèÂÁ·Õèà»ç¹àÁç´¤ÇáԹ¾ÃéÍÁ¡ÑºÁ×éÍÍÒËÒà à¾ÃÒÐá¤Åà«ÕÂÁÊÒÁÒö¨Ñº¡ÑºÍÍ¡«Òàŵ㹷ҧà´Ô¹ÍÒËÒÃáÅéǶ١¢ÑºÍÍ¡·Ò§Íب¨ÒÃÐä´é ËÒ¡¡Ô¹á¤Åà«ÕèÂÁàÁç´¡è͹¹Í¹·ÓãËéá¤Åà«ÕèÂÁ¶Ù¡´Ù´«ÖÁâ´Â µÃ§ áÅÐÁÕ¤ÇÒÁà¢éÁ¢é¹¢Í§á¤Åà«ÕèÂÁã¹»ÑÊÊÒÇÐÊÙ§¢Öé¹ ·ÓãËéÁÕâÍ¡ÒÊà»ç¹¹ÔèÇÁÒ¡¢Öé¹
5.ÍÒªÕ¾ [3,47-51]
¼ÙéÁÕÍÒªÕ¾à¡ÉµÃ¡Ã ·Ó§Ò¹¡ÅÒ§á¨é§ ¨ÐÁÕ¡ÒÃàÊÕÂà˧×èÍÁÒ¡ ·ÓãËé»ÑÊÊÒÇÐÁÕ¤ÇÒÁà¢éÁ¢é¹ ÍÒ¨·ÓãËéÁÕ¡Òõ¡¼ÅÖ¡ ¢Í§ÊÒÃÅÐÅÒÂã¹»ÑÊÊÒÇÐ à¡Ô´à»ç¹¹ÔèÇ¢Öé¹ä´é ËÃ×Í ¼Ùé·ÕèÁÕÃÒÂä´é¹éÍ ¨ÐºÃÔâÀ¤ÍÒËÒèӾǡá»é§áÅмѡÁÒ¡ â»ÃµÕ¹¹éÍ ·ÓãËéà¡Ô´¹ÔèǨӾǡÍÍ¡«Òàŵä´é§èÒ ¼Ô´¡Ñ¹¡Ñº¼Ùé·ÕèÁÕÃÒÂä´éÊÙ§ÁÕ¡ÒúÃÔâÀ¤ ÍÒËÒà â»ÃµÕ¹ ä¢Áѹ ÁÒ¡¡ÇèÒ»¡µÔ ·ÓãËéà¡Ô´ à»ç¹¹ÔèǾǡ¡Ã´ÂÙÃÔ¤ áÅÐ ¹ÔèÇá¤Åà«ÕèÂÁÊÙ§ ÊÓËÃѺÊÒà˵ØÍ×è¹æ[3] ¹Ñé¹ à·èÒ·ÕèÁÕ¡ÒÃÈÖ¡ÉÒã¹»ÃÐà·Èä·Â ¾ºÇèÒ ÊÒà˵آͧâä¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹÅèÒ§ ã¹à´ç¡ã¹ÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í à¢éÒã¨ÇèÒà¡Ô´¨Ò¡ÊÒà˵ØËÅÒ»ÃСÒÃÃèÇÁ¡Ñ¹ä´éá¡è ¡ÒÃàÅÕé§´Ù·Òáâ´Â¡ÒÃãËéÍÒËÒÃàÊÃÔÁ·Õè¼Ô´ÇÔ¸Õ àªè¹ ¡ÒÃãËé¢éÒÇÂéÓ (ÁÒôÒà¤ÕéÂÇ¢éÒÇà˹ÕÂÇãËéÅÐàÍÕ´áÅéÇãËéÅÙ¡ÃѺ»Ãзҹ) µÑé§áµèÊÑ»´ÒËìááËÅѧ¤ÅÍ´·ÓãËéà´ç¡·Òá¢Ò´â»ÃµÕ¹áÅÐáÃè¸ÒµØºÒ§ª¹Ô´ àªè¹ ¿ÍÊ࿵ ¡ÒÃÃѺ»Ãзҹ¼Ñ¡·éͧ¶Ô蹺ҧª¹Ô´·ÕèÁÕÍÍ¡«Òàŵ (oxalate) ã¹»ÃÔÁÒ³ÊÙ§ àªè¹ ¼Ñ¡àÁç¡ ¼Ñ¡µÔéÇ ¼Ñ¡¡ÃÐâ´¹ ·ÓãËéÁÕ»ÃÔÁÒ³ÍÍ¡«Òàŵ (oxalate) »ÃÔÁÒ³ÁÒ¡¶Ù¡¢ÑºÍÍ¡ÁÒã¹»ÑÊÊÒÇÐ ¨Ö§¾º¼ÅÖ¡á¤Åà«ÕèÂÁÍÍ¡«Òàŵ¨Ó¹Ç¹ÁÒ¡ ÃèÇÁ¡Ñº ¡Òô×èÁ¹éÓã¹»ÃÔÁÒ³¹éÍ»ÃСͺ¡ÑºÁÕ¡ÒÃÊÙàÊÕ¹éӨӹǹÁÒ¡·Ò§à˧×èÍà¹×èͧ¨Ò¡ÍÒ¡ÒÈÃé͹
ÊÒà˵آͧâä¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹº¹ ¢Í§»ÃЪҡÒÃÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í㹪¹º·ÊèǹãËèà¡Ô´¨Ò¡ ¡ÒÃä´éÃѺà¡Å×Íâ»áµÊà«ÕèÂÁã¹ÍÒËÒùéÍ ÃèÇÁ¡ÑºÁÕ¡ÒÃÊÙàÊÕÂà¡Å×Íâ»áµÊà«ÕèÂÁ»ÃÔÁÒ³ÁÒ¡ 仡Ѻà˧×èÍâ´Â੾ÒСѺ¤¹ã¹ÇÑ·ӧҹ ÃèÇÁ¡Ñºä´éÃѺáÁ¡¹Õà«ÕèÂÁ¹éÍ ¾ºÇèÒ㹤¹·Õè¢Ò´áÁ¡¹Õà«ÕèÂÁÁÑ¡ÁÕÀÒÇÐâ»áµÊà«ÕèÂÁã¹ÃèÒ§¡ÒµèÓÃèÇÁ´éÇ áÅлÑÊÊÒÇТͧ¼Ùé»èÇÂâä¹ÔèÇã¹äµÁÕ»ÃÔÁÒ³«Ôà·Ãµ (citrate) µèÓ «Öè§«Ôà·Ãµà»ç¹ÊÒ÷ÕèªèÇÂÂѺÂÑé§¡ÒÃà¡Ô´¹ÔèÇä ´éâ´Â«Ôà·Ãµ¨ÐÃÇÁ¡Ñºá¤Åà«ÕèÂÁà»ç¹á¤Åà«ÕèÂÁ«Ôà·Ãµ«Öè§ÊÒÁÒöÅÐÅÒ¹éÓä´é´Õ ¡ÒâҴ«Ôà·Ãµ·ÓãËéá¤Åà«ÕèÂÁÃÇÁ¡ÑºÍÍ¡«Òàŵà»ç¹á¤Åà«ÕèÂÁÍÍ¡«Òàŵ «Öè§ÅÐÅÒ¹éÓä´éäÁè´Õ ËÃ×Íá¤Åà«ÕèÂÁÃÇÁ¡Ñº¿ÍÊ࿵à»ç¹á¤Åà«ÕèÂÁ¿ÍÊ࿵ «Öè§¡çÅÐÅÒ¹éÓä´éäÁè´Õàªè¹à´ÕÂǡѹ ¹Í¡¨Ò¡¹Õéà¡Ô´¨Ò¡¡Òô×èÁ¹éÓ¹éÍÂáÅÐÁÕ¡ÒÃÊÙàÊÕ¹éÓ仡Ѻà˧×èÍÁÒ¡ à¹×èͧ¨Ò¡·Ó§Ò¹Ë¹Ñ¡ áÅÐÂѧÁÕÁÕÊÒà˵ØÍ×è¹æ ÍÕ¡·ÕèÂѧäÁè·ÃÒºá¹èªÑ´
¡ÒÃÇÔ¹Ô¨©Ñ ËÒ¹ÔèÇ [2,38]
Imaging for stones : (G.A. Bradley, UK) »Ñ¨¨ØºÑ¹à»ç¹·ÕèÂÍÁÃѺÇèÒ CT Urography à»ç¹ the new gold standard imaging technique ÊÓËÃѺµÃǨÇÔ¹Ô¨©Ñ¡é͹¹ÔèÇ â´Â CT (63%) ÊÒÁÒöµÃǨÊͺ¡é͹¹ÔèÇá¤Åà«ÕèÂÁä´éÊÙ§¡ÇèÒ Plain KUB (45%) ÍÂèÒ§ÁÕ¹ÑÂÊÓ¤Ñ áÅÐÍÒ¨ãªéªèÇ·ӹÒ¡ÒÃà¡Ô´¹ÔèÇ«éÓä´é ¹Í¡¨Ò¡¹Õé CT ÂѧÁÕ»ÃÐ⪹ì㹡ÒÃÇÑ´ËÃ×ͺ͡ÃдѺ¤ÇÒÁá¢ç§¢Í§¡é͹¹ÔèÇä´é «Ö觨Ðà»ç¹»ÃÐ⪹ìÍÂèÒ§ÁÒ¡µèÍ¡ÒÃàÅ×Í¡ÇÔ¸Õ¡ÒüèҵѴÃÑ¡ÉÒ áÅÐ 3-D CT ÂѧªèÇÂ㹡ÒÃÇÒ§á¼¹¡ÒÃ·Ó Percutaneous surgery ´éÇ ÍÂèÒ§äáçµÒÁ Plain KUB Âѧãªé»ÃÐ⪹ìä´é´ÕÊÓËÃѺ¡ÒõԴµÒÁ¡ÒÃÃÑ¡ÉҢͧ¹ÔèǪ¹Ô´·Öºáʧ
ÊÓËÃѺã¹Êèǹ¢Í§ Noncontrast helical CT ÁÕ¤ÇÒÁäÇáÅФÇÒÁ¨Óà¾ÒÐÊÙ§ 95-100% ÊÓËÃѺ¡ÒÃËÒ ¹ÔèÇã¹äµ ´Ñ§¹Ñé¹ã¹·Õè·Õè ÊÒÁÒö·Óä´é ¡ç¨Ñ´à»ç¹ Imaging modality of choice ÍÂèҧ˹Öè§
ÊÓËÃѺ Renal ultrasonography ¶Ö§áÁéÇèÒ¨ÐÁÕ¤ÇÒÁ¨Óà¾ÒÐÊÙ§ áµèÁÕ¤ÇÒÁäÇà¾Õ§ 25- 50% à·èÒ¹Ñé¹ÊÓËÃѺ¡ÒÃËÒ¹ÔèǪ¹Ô´·ÕèäÁèÁÕ¡ÒÃÍØ´¡Ñé¹·Ò§à´Ô¹»ÑÊÊÒÇÐ â´Â੾ÒÐ ºÃÔàdz Ureter
ÍÒ¡ÒÃáÊ´§¢Í§¼Ùéà»ç¹¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐ [19,20,38]
ÍÒ¡Òâͧ¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇШТÖ鹡Ѻ¢¹Ò´¢Í§¹ÔèÇ µÓá˹觷Õè¹ÔèǹÑé¹ÍØ´ÍÂÙè ¹ÔèǹÑé¹ÍØ´·Ò§à´Ô¹»ÑÊÊÒÇÐÁÒ¡¹éÍÂá¤èä˹
- ¹ÔèÇ·ÕèÍØ´µÑ¹ã¹ºÃÔàdzÃ͵èÍ·èÍ䵡Ѻ¡ÃÇÂäµ ureteropelvic junction [UPJ] ¼Ùé»èÇ·ÕèÁÕ¹ÔèÇã¹äµÍÒ¨äÁèÁÕÍÒ¡ÒÃÍÐäÃàÅ¡çä´é ¼Ùé»èÇÂÍÒ¨¨ÐÁÕÍÒ¡ÒûǴàÍÇ »ÑÊÊÒÇТØè¹ »ÑÊÊÒÇÐà»ç¹àÅ×Í´ ËÃ×Í ÊÕ¹éÓÅéÒ§à¹×éÍ ËÒ¡ÁÕ¡Òà ÍÑ¡àʺ µÔ´àª×éÍÃèÇÁ´éÇ¡ç¨ÐÁÕä¢éÊÙ§ ˹ÒÇÊÑè¹ »ÑÊÊÒÇÐà»ç¹Ë¹Í§¡ÅÔè¹àËÁ繤ÒÇ ËÒ¡ÁÕ¡ÒÃÍØ´µÑ¹ÃèÇÁ´éÇÂÍÒ¨µÃǨ¾º¡é͹㹷éͧÊèǹº¹ ¢éÒ§à´ÕÂǡѺ·ÕèÁÕ¹ÔèÇÍÂÙè ËÒ¡ÁÕ¹ÔèÇ·Õèäµ·Ñé§Êͧ¢éÒ§áÅÐÁÕ¡Ò÷ӧҹ¢Í§äµàÊ×èÍÁŧ ¼Ùé»èÇÂÍÒ¨ÁÕÍÒ¡Òà »ÑÊÊÒÇйéÍÂŧ ºÇÁ âÅËÔµ¨Ò§ ¤Å×è¹äÊé ÍÒà¨Õ¹ ¼ÔÇ˹ѧáË駤ÅéÓáÅФѹ ¼Ùé»èÇÂÍÒ¨¨Ð«ÖÁ ËÃ×Í äÁèÃÙéÊÖ¡µÑÇ ¶éÒÁբͧàÊÕ¤Ñ觤éÒ§ÍÂÙè㹡ÃÐáÊàÅ×Í´ÁÒ¡
- ¹ÔèÇÍØ´µÑ¹·Õè·èÍäµ ureter ¼Ùé»èǨÐÁÕÍÒ¡ÒûǴàÍÇ »Ç´à»ç¹¾Ñ¡æ ã¹¢éÒ§·ÕèÁÕ¹ÔèÇ ÍÒ¨ÁջǴÃéÒÇÁÒ·éͧ¹éÍ ˹éÒ¢Ò ¶Ø§Íѳ±Ð ËÃ×Í á¤ÁÍÇÑÂÇÐà¾ÈËÔ§ ËÃ×ͼÙé»èǺҧ¤¹ ¨ÐÁÕÍÒ¡ÒûǴ·éͧÍÂèÒ§·Ñ¹·Õ»Ç´ÍÂèÒ§ÃØ¹áç»Ç´ºÔ´àËÁ×͹¤ÅÍ´ÅÙ¡ËÃ×Í ÍÒ¨¨ÐÁÕÍÒ¡ÒäÅ×è¹äÊéÍÒà¨Õ¹ ÃèÇÁ´éÇÂä´é
- ¹ÔèÇÍØ´µÑ¹·Õè·èÍäµµè͡Ѻ¡ÃÐà¾ÒлÑÊÊÒÇÐ ureterovesicle junction ¼Ùé»èǨÐÁÕÍÒ¡ÒÃÃФÒÂà¤×ͧàÇÅÒ»ÑÊÊÒÇÐ »ÑÊÊÒÇкèÍ »ÑÊÊÒÇТØè¹à»ç¹Ë¹Í§ä´é
- ¹ÔèÇÍÂÙè㹡ÃÐà¾ÒлÑÊÊÒÇÐ ÍÒ¨¨ÐäÁèÁÕÍÒ¡Òà ËÃ×ÍÍÒ¨¨ÐÁÕÍÒ¡ÒûÑÊÊÒÇТѴä´é ÊèǹÁÒ¡¼Ùé»èǨÐÁÕÍÒ¡ÒûǴ»ÑÊÊÒÇÐ »ÑÊÊÒÇТѴ »ÑÊÊÒÇТØè¹ ËÃ×Í »ÑÊÊÒÇÐà»ç¹ÊÕá´§¨Ò§æ »ÑÊÊÒÇÐÊдش àÁ×èÍËÂØ´àºè§ ¼Ùé»èÇ¡ç¨ÐÊÒÁÒö»ÑÊÊÒÇÐÍÍ¡ÁÒä´éãËÁèáÅÐà¡Ô´ÍÒ¡ÒâÖé¹ÁÒÍÕ¡
- ¹ÔèÇã¹·èÍ»ÑÊÊÒÇÐ urethra ¨ÐËÅØ´Å§ÁÒ¨Ò¡¡ÃÐà¾ÒлÑÊÊÒÇÐà»ç¹ÊèǹãËè ¼Ùé»èǨÐÁÕÍÒ¡ÒûǴà¡Ô´¢Ö鹷ѹ·Õ ·Õè¡ÓÅѧ»ÑÊÊÒÇлǴÃéÒÇÁÒµÒÁÍÇÑÂÇÐà¾È ÅÓ»ÑÊÊÒÇШÐËÂØ´áÅÐÍÍ¡à»ç¹Ë´æ ËÃ×Í»ÑÊÊÒÇÐäÁèÍÍ¡ÁÒàÅ¡çä´é ËÒ¡¤ÅÓ´ÙµÒÁ·èÍ»ÑÊÊÒÇСç¨Ð¤ÅÓ¾º¡é͹¹ÔèÇá¢ç§æä´é
¼ÅàÊÕ¢ͧ¹ÔèÇã¹äµ àªè¹ »Ç´·éͧàÁ×è͹ÔèÇÍØ´·èÍäµ ÁÕ¡ÒõԴàª×éÍ·Ò§à´Ô¹»ÑÊÊÒÇÐàÃ×éÍÃѧ ¶éÒÁÕ¡ÒÃÍØ´µÑ¹¹Ò¹¨Ð·ÓãËéà¡Ô´¡ÒÃàÊ×èÍÁ¢Í§äµã¹ÀÒÂËÅѧä´é
ÀÒÇдѧµèÍ仹Õéà»ç¹ÀÒÇÐàÃè§´èǹ·ÕèµéͧÃÕºãËé¡ÒÃÃÑ¡ÉÒâ´Â·Ñ¹·Õ ËÃ×Í µéͧÃÕº»ÃÖ¡ÉÒÈÑÅÂá¾·Âì ·Ò§à´Ô¹»ÑÊÊÒÇÐ[38]
- Urosepsis induced by an obstructing stone
- Kidney stones larger than 7 mm (it is unusual for these stones to spontaneously pass)
- Complete ureteral obstruction on imaging
- Solitary kidney with a kidney stone (high risk of renal injury)
- Acute renal failure and hydronephrosis
- Persistent colicky pain
á¹Ç·Ò§¡ÒÃÃÑ¡ÉÒ ÁÕÊͧÇÔ¸Õ¤×Í ¡ÒÃãªéÂÒ áÅСÒüèҵѴ [19,20]
¼Ùé»èÇ·ÕèÁÕ¹ÔèÇ¢¹Ò´àÊé¹¼èÒ¹ÈÙ¹Âì¡ÅÒ§ÁÒ¡¡ÇèÒ 1 «Á. ÁÕÍÒ¡ÒûǴºèÍÂæËÃ×Í »Ç´Ãعáç ÁÕ¡ÒÃÍØ´µÑ¹¢Í§·Ò§à´Ô¹»ÑÊÊÒÇЫÖè§·ÓãËéäµÁÕ¡Ò÷ӧҹŴŧ ÁÕ¡ÒÃÍÑ¡àʺµÔ´àª×éÍÃèÇÁ´éÇ ÁÑ¡¨ÐµéͧãËé¡ÒÃÃÑ¡ÉÒ·Ò§ÈÑÅ¡ÃÃÁ ÊÓËÃѺ ¼Ùé»èÇ·Õè»ÑÊÊÒÇÐÁÕ¹ÔèÇËÅØ´ÍÍ¡ÁÒºèÍÂæ à¤Â¼èҵѴáÅéÇà¡Ô´ÁÕ¹ÔèÇ¢Öé¹ÁÒãËÁè ¹ÔèÇ¡é͹ⵢÖé¹àÃ×èÍÂæÁըӹǹÁÒ¡¢Öé¹àÃ×èÍÂæ ÃèÇÁ¡ÑºÁÕ¤ÇÒÁ¼Ô´»¡µÔ 㹡Ãкǹ¡ÒÃà»ÅÕè¹á»Å§·Ò§à¤ÁÕ (Metabolism) ÀÒÂã¹ÃèÒ§¡Ò ¨ÐãËé¡ÒÃÃÑ¡ÉÒâ´Â¡ÒÃãªéÂÒ à¾×èͤǺ¤ØÁ»éͧ¡Ñ¹¡ÒÃà¡Ô´¹ÔèÇ¢Öé¹ãËÁèáÅлéͧ¡Ñ¹¡ÒâÂÒ¢¹Ò´¢Í§¹ÔèÇ¡é͹à´ÔÁ ËÃ×Íã¹ÃÒ¢ͧ ¼Ùé»èÇ·ÕèÁÕ¹ÔèÇ¢¹Ò´àÅç¡ (ÁÕàÊé¹¼èÒ¹ÈÙ¹Âì¡ÅÒ§àÅç¡¡ÇèÒ 1 «Á.) äÁèÁÕÍÒ¡ÒûǴ äÁèÁÕ¡ÒÃÍÑ¡àʺ äÁèÁÕ¡ÒÃÍØ´µÑ¹ äÁèÁÕ¹ÔèÇãËÁèà¡Ô´¢Öé¹ áÅТ¹Ò´¢Í§¹ÔèÇäÁèÁÕ¡ÒÃà»ÅÕè¹á»Å§¡çÁÑ¡ãËé¡ÒÃÃÑ¡ÉҤǺ¤ØÁ¡ÒÃà¡Ô´¹ÔèÇãËÁèáÅСÒÃⵢͧ¡é͹¹ÔèÇâ´Â ãªéÂÒ੾ÒÐã¹¹ÔèǪ¹Ô´¹Ñ鹿 áÅеԴµÒÁ¡ÒÃà»ÅÕè¹á»Å§¢¹Ò´¢Í§¹ÔèÇà»ç¹ÃÐÂÐæ
¹ÔèÇã¹äµ
1. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒÃà½éÒµÔ´µÒÁã¡ÅéªÔ´ ¹ÔèÇ·ÕèäÁèÁÕÍÒ¡ÒÃáÅÐÁÕàÊé¹¼èÒ¹ÈÙ¹Âì¡ÅÒ§àÅç¡¡ÇèÒ 1«Á. ¨ÐµÔ´µÒÁâ´Â¡ÒõÃǨ»ÑÊÊÒÇÐÇèÒÁÕ¡ÒõԴàª×éÍËÃ×ÍäÁè µÔ´µÒÁÀÒ¾¶èÒÂÃѧÊÕ à»ç¹ÃÐÂÐà¾×èÍ´Ù¡ÒÃà»ÅÕè¹á»Å§ã¹¢¹Ò´¢Í§¹ÔèÇ µÔ´µÒÁ¡Ò÷ӧҹ¢Í§äµ áÅСÒÃà»ÅÕè¹ÃÙ»ÃèÒ§¢Í§äµ
2. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒÃãËéÂÒ ¹ÔèÇ·Õèä´é·Ó¡ÒÃÇÔà¤ÃÒÐËìÇèÒà»ç¹¹ÔèǪ¹Ô´ã´áÅéÇ¡çÍÒ¨ãËéÂÒÅÐÅÒ¹ÔèÇä´é àªè¹ ¹ÔèǡôÂÙÃÔ¤ ¨ÐãËéÂÒ·Õè·ÓãËé»ÑÊÊÒÇÐà»ç¹´èÒ§ ËÃ×Í ÃèÇÁ¡ÑºãËéÂÒÅ´ÃдѺ¡Ã´ÂÙÃÔ¤ ËÃ×Í «Õʵչã¹àÅ×Í´ ÍÒ¨ãËéÂÒÃЧѺ¤ÇÒÁà¨çº»Ç´áÅÐÂÒ»¯ÔªÕǹÐÃèÇÁ´éÇÂ
3. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒüèҵѴàÍÒ¹ÔèÇÍÍ¡ â´Â·ÑèÇ仼èҵѴ àÁ×è͹ÔèÇÁÕ¢¹Ò´ãËè äµÁÕ¡ÒÃÍÑ¡àʺ äµÁÕ¡ÒÃÍØ´¡Ñé¹ ËÃ×Íäµ·Ó§Ò¹äÁè»Ã¡µÔ
4. ¡ÒÃÃÑ¡ÉÒâ´Âãªéà¤Ã×èͧÊÅÒ¹ÔèÇ´éǾÅѧàÊÕ§ àËÁÒÐÊÓËÃѺ¹ÔèÇ·ÕèÁÕ¢¹Ò´àÅç¡ ÁÕàÊé¹¼èÒÈÙ¹Âì¡ÅÒ§äÁèà¡Ô¹ 3 «Á. áÅÐ ·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹ·ÕèµèÓ¡ÇèÒäÁèÁÕ¡ÒõպµÑ¹ à¾×èÍãËé¹ÔèÇ·ÕèÊÅÒ«Öè§ÁÕ¢¹Ò´àÅç¡Å§ ÊÒÁÒö¼èÒ¹»¹ÍÍ¡ÁҡѺ»ÑÊÊÒÇÐä´é
¹ÔèÇã¹·èÍäµ
1. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒÃà½éÒµÔ´µÒÁÍÂèÒ§ã¡ÅéªÔ´ ¹ÔèÇ·ÕèÁÕàÊé¹¼èÒ¹ÈÙ¹Âì¡ÅÒ§àÅç¡¡ÇèÒ 0.5 «Á.ÁÑ¡¨ÐËÅØ´ÍÍ¡ÁÒä´éàͧ «Öè§ÊÒÁÒö·ÃÒºä´éâ´Â¡ÒõÃǨ¨Ò¡ÀÒ¾¶èÒ·ҧÃѧÊÕà»ç¹ÃÐÂÐæ ´Ù¡ÒÃà¤Å×è͹·Õè¢Í§¡é͹¹ÔèÇÇèÒà¤Å×è͹µèÓŧ¨Ò¡à´ÔÁËÃ×ÍäÁè ÍÒ¨ãËéÂÒ¢ÂÒ·èÍäµãËé¡ÇéÒ§¢Öé¹ áÅд×èÁ¹éÓÁÒ¡æÃèÇÁ´éÇÂ
2. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒÃãªéà¤Ã×èͧÊèͧ·èÍäµà¢éÒä»·Ó¡ÒäպËÃ×ͤÅéͧ ËÃ×Íãªé¤Å×è¹àÊÕ§¤ÇÒÁ¶ÕèÊÙ§ ËÃ×Í àÅà«ÍÃì ¡ÃÐá·¡ÊÅÒ¹ÔèÇãËéÁÕ¢¹Ò´àÅç¡Å§
3. ¡ÒÃÃÑ¡ÉÒâ´Â¡ÒüèҵѴ 㹡óշÕè¹ÔèÇäÁèÁÕ¡ÒÃà¤Å×è͹·Õè äµÁÕ¡ÒÃÍÑ¡àʺ äÁèÁÕ»ÑÊÊÒÇÐäËÅÍÍ¡ àªè¹¡Ã³ÕÁÕäµ¢éÒ§à´ÕÂÇ ËÃ×Íà»ç¹¹ÔèÇã¹·èÍäµ·Ñé§ 2 ¢éÒ§ ËÃ×ÍãËé¡ÒÃÃÑ¡ÉÒâ´Âãªé à¤Ã×èͧÊèͧ·èÍäµ ËÃ×Í ÊÅÒ¹ÔèÇáÅéÇ äÁè»ÃÐʺ¼ÅÊÓàÃç¨
¹ÔèÇ㹡ÃÐà¾ÒлÑÊÊÒÇÐ
1. ãªéÇÔ¸Õ¢ºÍÍ¡ ÇÔ¸Õ¹ÕéãªéÊÓËÃѺ¼ÙéãËèà·èÒ¹Ñé¹ ¹ÔèÇÁÕ¢¹Ò´àÊé¹¼èÒ¹ÈÙ¹Âì¡ÅÒ§äÁèà¡Ô¹ 2 «Á.â´Â¡ÒÃÊÍ´à¤Ã×èͧÁ×Í¢º¹ÔèÇ ¼èÒ¹·èÍ»ÑÊÊÒÇÐà¢éÒä»
2. ãªéÇÔ¸Õ¼èҵѴ˹éÒ·éͧ ¨Ðãªé㹡óռÙé»èÇÂà»ç¹à´ç¡ ËÃ×ÍÁÕ¹ÔèÇ¢¹Ò´âµÁÒ¡ ËÃ×͹ÔèÇ·Õèá¢ç§ÁÒ¡ äÁèÊÒÁÒö¢ºä´é ËÃ×ÍÁÕ¡ÒÃÍØ´µÑ¹·Ò§à´Ô¹»ÑÊÊÒÇÐÊèǹÅèÒ§·ÓãËéäÁèÊÒÁÒöÊÍ´ à¤Ã×èͧÁ×Íà¢éÒä»à¾×èÍ·Ó¡Ò⺹ÔèÇä´é
¹ÔèÇã¹·èÍ»ÑÊÊÒÇÐ
1. ãªéÇÔ¸Õ¢º ËÅѧ¨Ò¡ÊÒÁÒö´Ñ¹¹ÔèÇ¡ÅѺà¢éÒä»ã¹¡ÃÐà¾ÒлÑÊÊÒÇÐ
2. ãªéÇÔ¸Õ¤ÕºÍÍ¡ ¶éÒ¹ÔèÇÁÒµÔ´·ÕèÃÙà»Ô´»ÅÒ·èÍ·Ò§à´Ô¹»ÑÊÊÒÇÐ
3. ãªéÇÔ¸Õ¼èҵѴÍÍ¡·Ò§Ë¹éÒ·éͧ
4. ãªéÇÔ¸Õ¼èҵѴ·Õè·èÍ»ÑÊÊÒÇÐ µÃ§µÓá˹觷Õè¹ÔèǵԴ
¡ÒÃÃÑ¡ÉÒ¹ÔèÇ´éÇÂÂÒ [19,20]
1. ÂÒ·ÕèãªéÃÑ¡ÉÒ¹ÔèÇ·Õèà¡Ô´¨Ò¡à¡Å×Íá¤Åà«ÕèÂÁ
- ÂҢѺ»ÑÊÊÒÇÐä´éá¡è hydrochlorothiazide, chlorothiazide «Öè§ÊÒÁÒöŴ¡ÒâѺá¤Åà«ÕèÂÁáµèÍÒ¨µéͧ
ãËéâ»áµÊà«ÕèÂÁàÊÃÔÁ´éÇÂ㹺ҧÃÒ à¹×èͧ¨Ò¡ÂҢѺ»ÑÊÊÒÇÐ ÍÒ¨·ÓãËéâ»áµÊà«ÕèÂÁã¹àÅ×Í´µèÓ«Öè§Êè§¼Å
ãËé«Ôà·Ãµ citrate µèÓ ·ÓãËéà¡Ô´¹ÔèÇä´é§èÒ¢Öé¹
- Cellulose phosphate ÂÒµÑǹÕé¨Ð¨Ñº¡Ñºá¤Åà«ÕèÂÁã¹ÅÓäÊé ãªé㹡óշÕè»ÑÊÊÒÇÐÁÕá¤Åà«ÕèÂÁÊÙ§áÅÐà¡Ô´
¹ÔèÇ«éÓ
- Potassium magnesium citrate ¨Ò¡ÃÒ§ҹÊÒÁÒöŴ¡ÒÃà¡Ô´¹ÔèÇä´éÃéÍÂÅÐ85 ¢éͤÇÃÃÐÇѧ¤×Í ÂÒ¨Ð
ä»·ÓãËéÃдѺâ»áµÊà«ÕèÂÁã¹àÅ×Í´ÊÙ§¢Öé¹ã¹ ¼Ùé»èÇ·ÕèÁÕ¡Ò÷ӧҹ¢Í§äµÅ´Å§
2. ÂÒ·ÕèãªéÃÑ¡ÉÒ¹ÔèÇ·Õèà¡Ô´¨Ò¡ Oxalates
- ãËéÃѺ»ÃзҹÍÒËÒ÷ÕèÁÕÇÔµÒÁÔ¹ B6 àªè¹¡ÅéÇ ¶ÑèÇ áµ§âÁ ¶ÑèÇàËÅ×ͧ ¸Ñ¾×ªËÃ×ÍÃѺ»ÃзҹÇÔµÒÁÔ¹ B6
- Cholestyramine à»ç¹ÂÒ·ÕèãªéÃÑ¡ÉÒä¢Áѹã¹àÅ×Í´ÊÙ§áµèÊÒÁÒö¹ÓÁÒãªéÃÑ¡ÉÒ¹ÔèÇä´é
3. ÂÒ·ÕèãªéÃÑ¡ÉÒ¹ÔèÇ·Õèà¡Ô´¨Ò¡¡Ã´ÂÙÃÔ¤
- à¹×èͧ¨Ò¡¡Ã´ÂÙÃÔ¤¨ÐµÐ¡Í¹à»ç¹¹ÔèÇã¹ÀÒÇзÕèÁÕ»ÑÊÊÒÇÐà»ç¹¡Ã´´Ñ§¹Ñé¹µéͧãËé¼Ùé»èÇÂä´éÃѺ´èÒ§ áµè¤ÇÃÃÐÇѧ㹼Ùé»èÇ ·ÕèÁÕ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ âäËÑÇ㨠ÂÒ·ÕèÅ´¡Ã´ÂÙÃÔ¤ã¹àÅ×Í´ä´éá¡è allopurinol áÅÐÂÒ·ÕèÅ´¡Ã´ÂÙÃԤ㹻ÑÊÊÒÇÐä´éá¡è potassium citrate ÊÒÁÒö¹ÓÁÒãªéªèÇÂ㹡ÒÃÃÑ¡ÉÒä´é
4. ÂÒ·ÕèãªéÃÑ¡ÉÒ¹ÔèÇ Struvite stones
- ÂÒ»¯ÔªÕǹÐà¾×èͦèÒàª×éÍẤ·ÕàÃÕµéͧãËé¹Ò¹ 10-14 Çѹ
- Acetohydroxamic Acid ÂÒ¹Õé¨ÐÅ´¡ÒÃà¡Ô´¹ÔèÇáÁéÇèÒã¹»ÑÊÊÒÇÐÂѧÁÕàª×éÍẤ·ÕàÃÕÂ
- Aluminum Hydroxide Gel à¾×èͨѺ¡Ñº phosphate ã¹ÅÓäÊé
5. ÂÒ·ÕèãªéÃÑ¡ÉÒ Cystine stones
- sodium bicarbonate à¾×èÍà¾ÔèÁ¤ÇÒÁà»ç¹´èÒ§ãËéá¡è»ÑÊÊÒÇÐ
¡ÒÃÃÑ¡ÉÒ¹ÔèÇ´éÇ¡ÒüèҵѴ
¢éͺ觪Õé㹡ÒüèҵѴ[19]
¡é͹¹ÔèÇÁÕ¢¹Ò´ãËèà¡Ô¹¡ÇèÒ·Õè¨ÐËÅØ´ÍÍ¡àͧä´é
¡é͹¹ÔèÇÁÕ¡ÒâÂÒ¢¹Ò´âµ¢Öé¹
¡é͹¹ÔèÇÍØ´¡Ñé¹·Ò§à´Ô¹»ÑÊÊÒÇÐ
¡é͹¹ÔèÇ·Õè¡èÍãËéà¡Ô´¡ÒõԴàª×éÍ
ÇÔ¸Õ¡ÒüèҵѴ [19]
Extracorporeal shock wave lithotripsy (ESWL) ãªé¤Å×è¹àÊÕ§¤ÇÒÁ¶ÕèÊÙ§Êè§¾Åѧ¼èÒ¹¼ÔÇ˹ѧä»ÊÙè¡é͹¹ÔèÇ·ÓãËé¡é͹¹ÔèÇᵡÍÍ¡à»ç¹¡é͹àÅç¡æ ÊÅÒ¹ÔèÇâ´Â¢¹Ò´¢Í§¹ÔèǵéͧäÁèà¡Ô¹ 2.5 «Á.¡é͹¹ÔèÇÍÂÙèà˹×Í·éͧ¹éÍ ãªéä´é´Õ¡Ñº¹ÔèǪ¹Ô´ struvite ãªéäÁèä´é¼Å¡Ñº¹ÔèǪ¹Ô´ cystine ÍѵÃÒ¤ÇÒÁÊÓàÃç¨ÃéÍÂÅÐ70-90 ËÅѧ·Ó¼Ùé»èÇÂÊÒÁÒö¡ÅѺ价ӧҹä´éµÒÁ»Ã¡µÔ âäá·Ã¡«é͹·ÕèÊӤѤ×ÍàÅ×Í´Í͡㹷ҧà´Ô¹»ÑÊÊÒÇмÙé»èǨ֧¤ÇÃËÅÕ¡àÅÕè§ÂÒ aspirin ¡è͹·Ó 1-2 ÊÑ»´ÒËì ¢éÍËéÒÁ·Ó¤×Í ËÔ§µÑ駤ÃÃÀì ¼Ùé»èÇ·ÕèÁÕÀÒÇÐàÅ×Í´ÍÍ¡¼Ô´»¡µÔ ¼Ùé»èÇ·ÕèÍéǹÁÒ¡ ËÃ×ÍÁÕ¡ÒÃÍØ´µÑ¹·Ò§à´Ô¹»ÑÊÊÒÇÐã¹Êèǹ·ÕèµèÓ¡ÇèÒµÓá˹觷Õèà¡Ô´¹ÔèÇ
Ureteroscopy â´Â¡ÒÃÊǹÊèͧ¡ÅéͧáÅéÇãªéµÐ¡ÃéÒ¤ÅéͧàÍÒ¹ÔèÇã¹·èÍäµÍÍ¡ ãªé੾ÒйÔèÇ ·ÕèÁÕ¢¹Ò´¹éÍ¡ÇèÒ 5 ÁÔÅÅÔàÁµÃ áÅÐÍÂÙèã¹µÓá˹觷ÕèµèÓ¡ÇèÒ¡Ãд١ÊÐ⾡
Open nephrostomy äÁè¤è͹ÔÂÁ·Ó¡Ñ¹áÅéÇ㹻Ѩ¨ØºÑ¹
Percutaneous nephrolithotomy ¤×Í¡ÒÃà¨ÒÐà¢éÒä»Âѧ¡ÃÇÂäµáÅйӹÔèÇÍÍ¡ÁÒ ã¹¡Ã³Õ·Õèãªé ESWL áÅéÇäÁèä´é¼ÅËÃ×Íà»ç¹¹ÔèǪ¹Ô´ cystine ËÃ×͹ÔèÇ¢¹Ò´ãËèÁÒ¡
¡Òûéͧ¡Ñ¹áÅÐÅ´¤ÇÒÁàÊÕè§¡ÒÃà¡Ô´à»ç¹¹ÔèÇ ËÃ×Í¡ÒÃà¡Ô´à»ç¹¹ÔèÇ«éÓ [19-20,45,52-54]
- ãËé´×èÁ¹éÓÇѹÅÐ 6-8 á¡éÇ ( 2.5 ÅԵà ËÃ×ÍÁÒ¡¡ÇèÒ 4 ÅÔµÃã¹ÃÒ·Õèà»ç¹¹ÔèǪ¹Ô´ Cystine )
- ¤ÇÃàÅÕè§¡Òô×èÁ¡Òá¿·Õèà¢éÁ¢é¹ÁÒ¡ÍÂèÒ§µèÍà¹×èͧ à¹×èͧ¨Ò¡ ¨Ð·ÓãËéÃдѺà¡Å×Íá¤Åà«ÕÂÁã¹»ÑÊÊÒÇÐ
ÊÙ§¢Öé¹ä´é
- ¡Òô×èÁ¹éÓÁйÒÇÇѹÅÐá¡éÇÍÒ¨ÁÕ¼ÅãËéÃдѺ citrate ã¹»ÑÊÊÒÇÐà¾ÔèÁÊÙ§¢Öé¹ «Ö觪èÇ»éͧ¡Ñ¹¹ÔèÇ·Õèà¡Ô´¨Ò¡
à¡Å×Íá¤Åà«ÕèÂÁä´é
- ¤ÇÃËÅÕ¡àÅÕè§à¤Ã×èͧ´×èÁâ¤ÅèÒ à¹×èͧ¨Ò¡ÍҨ价ÓãËé citrate ã¹»ÑÊÊÒÇÐŴŧ
- ¡ÒáԹÊÁعä¾Ãä·Âàªè¹ãºÍè͹ËéÒ˹ǴáÁÇ (java tea) ÊÒÁÒöŴ ¡ÒÃà¡Ô´¹ÔèǪ¹Ô´à¡Å×Íá¤Åà«ÕèÂÁ
áÅЪ¹Ô´¡Ã´ÂÙÃÔ¤ä´é
- ¼Ùé»èÇ·ÕèÁÕ¹ÔèÇà¡Å×Íá¤Åà«ÕèÂÁ¤ÇÃÅ´ÍÒËÒÃà¤çÁ·ÕèÁÕà¡Å×Íâ«à´ÕÂÁà¹×èͧ¨Ò¡â«à´ÕÂÁ ÁÕ¼Åà¾ÔèÁ¡ÒâѺá¤Åà«ÕèÂÁ
ã¹»ÑÊÊÒÇÐ
- äÁè´×èÁàËÅéÒ àºÕÂÃì äǹì ËÃ×Íà¤Ã×èͧ´×èÁáÍÅ¡ÍÎÍÅìÁÒ¡à¡Ô¹ à¹×èͧ¨Ò¡áÍÅ¡ÍÎÍÅìÁÕÄ·¸Ôì¢Ñº»ÑÊÊÒÇÐã¹
ªèǧáá áÅеÒÁ´éÇÂÀÒÇТҴ¹éÓ (dehydration) ã¹ÃÐÂеèÍÁÒ
- Å´ÍÒËÒ÷ÕèãËéÊÒþÔÇÃÕ¹ purine ÊÙ§àªè¹à¤Ã×èͧ㹠ÊѵÇì»Õ¡ àºÕÂÃì ¶ÑèÇ à¾×èÍ»éͧ¡Ñ¹¡ÒÃà¡Ô´¹ÔèÇẺ¡Ã´ÂÙÃÔ¤
- ¡Ô¹á¤Åà«ÕèÂÁ¾ÃéÍÁÍÒËÒÃãËéÁÒ¡¾Í·Ø¡Çѹ ¢¹Ò´ÊÓËÃѺªÒǵÐÇѹµ¡¤×Í 1,000-2,000 ÁÔÅÅÔ¡ÃÑÁµèÍÇѹ
¢¹Ò´ÊÓËÃѺ¤¹ä·Â¤§µéͧŴµÒÁÊèǹ â´Âá¤Åà«ÕèÂÁã¹·Ò§à´Ô¹ÍÒËÒèЪèǨѺÊÒÃÍÍ¡«Òàŵã¹
¾×ª¼Ñ¡áÅТѺÍ͡仾ÃéÍÁÍØ¨¨ÒÃÐ ·ÓãËé¡Òôٴ«ÖÁÍÍ¡«Òàŵ¹éÍÂŧ
- ¼Ùé·ÕèÁÕ¹ÔèǤÇÃÃѺ»ÃзҹÍÒËÒ÷ÕèÁÕãÂÁÒ¡ à¾×èͪèÇÂÅ´¡Òáè͵ÑǢͧá¤Åà«ÕèÂÁáÅÐÍÍ¡«Òàŵã¹Ãкº
·Ò§à´Ô¹»ÑÊÊÒÇÐ
- ¤ÇÃÅ´ÍÒËÒÃâ»ÃµÕ¹à¹×èͧ¨Ò¡ÍÒËÒÃâ»ÃµÕ¹¨Ðà¾ÔèÁ¡ÒâѺà¡Å×Íá¤Åà«ÕèÂÁ ¡Ã´ÂÙÃÔ¤ áÅÐÍÍ¡«Òàŵ ã¹
»ÑÊÊÒÇзÓãËéà¡Ô´¹ÔèÇä´é§èÒÂ
- ãËéÅ´ÍÒËÒ÷ÕèÁÕÍÍ¡«Òàŵ ÊÙ§àªè¹ ¶ÑèÇ ªçÍ¡â¡áŵ ʵÍàºÍÃÕè ¾ÃØ¹ áͺà»ÔéÅ ¾ÃÔ¡ä·Â´Ó à¹Â
â¡â¡é ¡Òá¿ à»ç¹µé¹ ¶éÒÂѧÁÕÍÍ¡«Òàŵ ã¹»ÑÊÊÒÇÐÊÙ§¡çãËéÇÔµÒÁÔ¹ B6 ÃèÇÁ´éÇÂ
ºÃóҹءÃÁ
1. º·¤ÇÒÁ ¹ÔèÇã¹äµ àÃÕºàÃÕ§¨Ò¡º·¤ÇÒÁ¢Í§ È.»ÔÂÐÃѵ¹ì âµÊØ¢ÐǧÈì ·ÕèÁÒ http://www.bloggang.com/viewdiary.php?id
=nok-mdcu62&month=10- 2007&date=03&group=14&gblog=9
2. The 5th eULIS Symposium 2007 (12th European Symposium on Urolithiasis) by Piyaratana
Tosukhowong , Chanchai Boonla ¨Ò¡ http://www.bmbmd.research.chula.ac.th/lisbon.htm
3. º·¤ÇÒÁ ¹ÔèÇ·Ò§à´Ô¹»ÑÊÊÒÇÐ â´Â ÃÈ.´ØÊÔµ ¨ÔáØÅÊÁ⪤ ¼È.à·Í´ä·Â ·Í§ÍØè¹ ¼È.ÈÔÃÔÃѵ¹ì àÃ×ͧ¨Øé ÁËÒÇÔ·ÂÒÅÑ¢͹á¡è¹ ·ÕèÁÒ
http://www.md.kku.ac.th/old/modules.php?name=News&file=article&sid=155
4. º·¤ÇÒÁàÃ×èͧ ¡ÒÃÇÔ¨ÑÂâääµáÅСÒÃäËŵÒ â´Â È.¾.. ÊØÁÒÅÕ ¹ÔÁÁÒ¹¹ÔµÂì áÅФ³Ð Êӹѡ§Ò¹¡ÒÃÇÔ¨ÑÂáË觪ҵÔ
http://www.kmnrct.nrct.go.th/healthstategic/pdf/2547/organ/05o.pdf
5. Sriboonlue P, Prasongwatana V, Chata K, Tungsanga K.Br J Urol. 1992 Mar;69(3):240-4. Prevalence
of upper urinary tract stone disease in a rural community of north-eastern Thailand.
6. Nimmannit S, Malasit P, Susaengrat W, Ong-Aj-Yooth S, Vasuvattakul S, Pidetcha P. Shayakul; C,
Nilwarangkur S. Prevalence of endemic distal renal tubular andosis and renal stone in the northeast
of Thailand Nephron 1996;72: 604-610.
7. ¡ÒÃÊÑÁÁ¹ÒáËè§ªÒµÔ àÃ×èͧ ¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇÐáÅÐ Renal tubular acidosis ¤ÃÑé§·Õè 1 14-15 ¸Ñ¹ÇÒ¤Á 2530 ¨Ñ§ËÇÑ´¢Í¹á¡è¹
8. Lonsdale K.Science. Human stones. 1968 Mar 15;159(820):1199-207.
9. Sriboonlue P., Tungsanga K, Tosukhowong P, Sitprija V. Seasonal changes in serum and electrolyte
potassium among renal stone formers form notheastern Thailand. Southeast Asian J Trop Med Public
Health 1993;24:287-92.
10. Tosukhowong P, Chotikasatit C, Tungsanga K, Sriboonlue P, Prasongwattana V, Pansin P, Sitprija V.
Abnormal erythrocyte Na, K-ATP are activity in a northeastern Thai pupulation. Southeast Asian J Trop
Med Public Health 1992;23:526-30.
11. Tungsanga K, Sriboonlue P, Borwornpadungkiti S, Tosuknowong P, Sitprija V. Urinary acidification in
renal stone patients from northeastern Thailand. J Urol 1992; 147:325-8.
12. Sriboonlue P, Prasongwattana V, Tungsanga K, Sitprija V. Measurements of urinary state of saturation
with respect to calcium oxalate and burshite in renal stone formers. J Med Assoc Thai 1990;73:684-9.
13. Niwarangkur S, Malasit P, Nimmanitc, Susaengrat W, Ong Aj-Yooth S, Vasuvattakul S, Pidetcha P.
Urinary constitents in an endemic area of stores and renal tubular acidosis in northeastern Thailand
Southeast Asian J Trop Med Public Health 1990;21:437-41.
14. Sriboonlue P, Sirivongs D; Bhadiswasdi V, Tungsanga K. Effect of a charge in the place of urinary
collection on urine composition. J Med Assoc Thai 1989;72:487-91.
15. Domrongkitchaiporn S, Radinahamed P. Hypocitraturia in Thai renal stone formers.
16. Nephrology 1997;3(suppl 1) : 588 (Abst)
17. Stitchantrakul W, Domrongkitchaiporn S. Urlinary risk factors for renal stone in Thai recurrent stone
formers. Nephrology 1997; 3(suppl 1) : 588 (Abst).
18. º·¤ÇÒÁ§Ò¹ÇÔ¨ÑÂàÃ×èͧ ¼Ùé»èÇÂâõ¹ÔèÇã¹·Ò§à´Ô¹»ÑÊÊÒÇзÕèÃѺ¡ÒõÃǨÃÑ¡ÉÒà»ç¹¼Ùé»èǹ͡ ·Õèâç¾ÂÒºÒÅ ¨Ñ§ËÇÑ´ÅÓ¾Ù¹ â´Â ¹¾. äªÂÃÑ¡Éì
à´ª¾Ø·¸ÇѨ¹ì áÅФ³Ð ·ÕèÁÒ http://www.lph.go.th/main/SBU/Research/FrmUpload/Upload/URO.pdf
19. º·¤ÇÒÁ¹ÔèÇã¹äµ ÃǺÃÇÁ¨Ò¡ www.siamhealth.net
·ÕèÁÒ http://www.siamhealth.net/public_html/Disease/renal/renal_calculi.htm
20. ˹ѧÊ×Íâä¹ÔèÇáÅзҧà´Ô¹»ÑÊÊÒÇÐÊÓËÃѺ»ÃЪҪ¹ â´Â È.¹¾.ÇÃÇѲ¹ì ªØÁÊÒ ³ ÍÂØ¸ÂÒ ·ÕèÁÒ www.thaiclinic.com
21. R Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones
in idiopathic hypercalciuria. N Engl J Med. 2002;346:77–84.
22. Coe FL, Evan A,Worcester E. Kidney stone disease. J Clin Invest. 2005;115(10):2598–2608.
23. Frick KK, Bushinsky DA. Molecular mechanisms of primary hypercalciuria. J Am Soc Nephrol.
2003;14(4):1082–95.
24. Johnson RJ, Feehally J. Comprehensive Clinical Nephrology. New York, NY: Mosby; 2003.
25. Leumann E, Hoppe B. The primary hyperoxalurias. J Am Soc Nephrol. 2001;12:1986–1993.
26. Taylor EN, Curhan GC. Diet and fluid prescription in stone disease. Kidney Int. 2006;70(5):835–839.
27. º·¤ÇÒÁ Nephrology : Last Minute Internal Medicine, MGrawHell 2008:141-143
28. Marc C.,O'Meara R.D.,Stonewall, Kidney stone formation. Aetna Intelihealth March 5, 2008.
·ÕèÁÒ http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31199.html
29. ºÅçÍ¡ "ºéÒ¹ÊØ¢ÀÒ¾" ¹¾.ÇÑÅÅÀ ¾ÃàÃ×ͧǧÈì ÈÙ¹Âìá¾·ÂìªØÁª¹áÁèÊѹ-àÁ×ͧÂÒÇ (CMU) âç¾ÂÒºÒÅËéÒ§©ÑµÃÅÓ»Ò§ ¢éͤÇÒÁ
Çѹ·Õè 23 ¡Ñ¹ÂÒ¹ 2551.
30. Hodgkinson A. Composition of urinary tract calculi from some developing countries.
Urol Int. 1979;34(1):26-35.
31. Lonsdale DK, Sutor DJ, Wooley SE. Composition of urinary calculi by x-ray diffraction. Collected data
from various localities. II. Czechoslovakia. Br J Urol. 1968 Aug;40(4):402-11.
32. º·¤ÇÒÁ Renal metabolism and urinary composition. â´Â È.»ÔÂÐÃѵ¹ì âµÊØ¢ÐǧÈì ·ÕèÁÒ www.blogGang.com
33. Domrongkitchaiporn S, Stitchantrakul W, Kochakarn W. Causes of hypocitraturia in recurrent calcium
stone formers: focusing on urinary potassium excretion. Am J Kidney Dis. 2006 Oct;48(4):546-54.
34. Tangnararatchakit K, Ariyaprakai W, Tapaneya-Olarn W, Shotelersuk V, Petchthong T. Cystinuria:
cause of recurrent renal stones in a 4-year-old girl. J Med Assoc Thai. 2002 Nov;85 Suppl 4:S1281-6.
35. Domrongkitchaiporn S, Ongphiphadhanakul B, Stitchantrakul W, Chansirikarn S,
Puavilai G, Rajatanavin R. Risk of calcium oxalate nephrolithiasis in postmenopausal women
supplemented with calcium or combined calcium and estrogen. Maturitas. 2002 Feb 26;41(2):149-56.
36. Prasongwatana V, Woottisin S, Sriboonlue P, Kukongviriyapan V. Uricosuric effect of Roselle (Hibiscus
sabdariffa) in normal and renal-stone former subjects. J Ethnopharmacol. 2008 May 22;117(3):491-5.
Epub 2008 Mar 14.
37. Jaipakdee S, Prasongwatana V, Premgamone A, Reungjui S, Tosukhowong P, Tungsanga K, Suwantrai S,
Noppawinyoowong C, Maskasame S, Sriboonlue P. The effects of potassium and magnesium Supple-
mentations on urinary risk factors of renal stone patients. J Med Assoc Thai 2004 Mar;87(3):255-63.
38. Rizvan A. , Qazi , Bahar Bastani. Nephrology and Hypertension,Internal Medicine : just the
Fact.McGrawhill Book 2008:Page 721-726
39. Yudkoff BL, Linsenmeyer TA,Oakley A, Kirshblum S Urolithiasis associated with indinavir in a patient
with spinal cord injury.J Spinal Cord Med. 2004;27(3):263-5.
40. Salahuddin S, Kok DJ, Buchholz NN. Influence of body temperature on indinavir crystallization under
loop of Henle conditions. J Antimicrob Chemother. 2007 Jan;59(1):114-7. Epub 2006 Nov 9.
41. Hess B. Drug-induced urolithiasis. Curr Opin Urol. 1998 Jul;8(4):331-4.
42. Avihingsanon A, Avihingsanon Y, Darnpornprasert P, Kerr S, Ungsedhapand C, Duncombe C, Ubolyam
S, Ruxrungtham K, Phanuphak P. High prevalence of indinavir-associated renal complications in Thai
HIV-infected patients. J Med Assoc Thai. 2006 Aug;89 Suppl 2:S21-7.
43. Matlaga BR, Shah OD, Assimos DG.Drug-induced urinary calculi. Rev Urol. 2003 Fall;5(4):227-31.
44. Saltel E, Angel JB, Futter NG,Walsh WG, O'Rourke K, Mahoney JE. Increased prevalence and analysis
of risk factors for indinavir nephrolithiasis. J Urol. 2000 Dec;164(6):1895-7.
45. Tosukhowong P, Yachantha C, Sasivongsbhakdi T, Ratchanon S, Chaisawasdi S, Boonla C, Tungsanga
K. Citraturic, alkalinizing and antioxidative effects of limeade-based regimen in nephrolithiasis patients.
Urol Res. 2008 Aug;36(3-4):149-55. Epub 2008 Jun 17.
46. Sriboonlue P, Prasongwatana V, Tosukhowong P,Tungsanga K, Bovornpadoongkitti S. Increased risk of
urinary stone disease by physical exercise. Southeast Asian J Trop Med Public Health. 1996 Mar;27(1):
172-7.
47. Bovornpadungkitti S, Sriboonlue P, Tavichakorntrakool R, Prasongwatana V, Suwantrai S, Predanon C,
Tosukhowong P, Suntarapa S. Potassium, sodium and magnesium contents in skeletal muscle of renal
stone-formers: a study in an area of low potassium intake.J Med Assoc Thai. 2000 Jul;83(7):756-63
48. Aegukkatajit S. Reduction of urinary stone in children from north-eastern Thailand. J Med Assoc Thai.
1999 Dec;82(12):1230-3.
49. Sriboonlue P, Prasongwatana V, Suwantrai S, Bovornpadungkitti S, Tungsanga K, Tosukhowong
P.Nutritional potassium status of healthy adult males residing in the rural northeast Thailand. J Med
Assoc Thai. 1998 Mar;81(3):223-32.
50. Sriboonlue P, Prasongwatana V, Borvornpadoongkitti S, Suwantrai S. Some aspects of citrate
metabolism in renal-stone patients from northeastern Thailand. J Med Assoc Thai. 1996 Nov;
79(11):737-43.
51. ¡Òû¹à»×é͹ÊÒà Melamine ã¹¹Á¼§ âä¹ÔèÇã¹äµ áÅÐÁҵðҹ¡ÒäǺ¤ØÁ¤Ø³ÀÒ¾ â´Â È.¹¾.à¡ÃÕ§ µÑé§Ê§èÒ áÅÐ È.»ÔÂÐÃѵ¹ì âµÊØâ¢
ǧÈì ÊÒ¢ÒÇÔªÒâÃ¤äµ ÀÒ¤ÇÔªÒÍÒÂØÃÈÒʵÃì áÅЪÕÇà¤ÁÕ ÈÙ¹ÂìÇÔ¨ÑÂâä¹ÔèÇáÅÐâäÃкº·Ò§à´Ô¹»ÑÊÊÒÇÐ ¤³Ðá¾·ÂÈÒʵÃì áÅÐ âç¾ÂÒºÒÅ
¨ØÌÒŧ¡Ã³ì http://web.md.chula.ac.th/thaiv1/index.php?option=com_content&task=view&id=81&Itemid=1
52. A.L.Sutton. Risk of Caffeine in renal stone. Massey, Roger. (Abstract)The Journal of Urology, August
2004.
53. “ËéÒ˹ǴáÁÇ” ªèÇÂÅ´¹ÔèÇä´é Êӹѡ§Ò¹¡Í§·Ø¹Ê¹ÑºÊ¹Ø¹¡ÒÃÊÃéÒ§àÊÃÔÁÊØ¢ÀÒ¾ (ÊÊÊ.) ·ÕèÁÒ
http://www.thaihealth.or.th/node/5038
54. Englert J, Harnischfeger G., Attendoli R. Java Tea research. Plama Med 1992,58(3):137-8,Presse Med.,
1935, 43:1355-6
|
|
| |
| ҤԹҠ
Call
ҷ |
| |
|
|
|
|
|