Gå direkt till huvudinnehållet

Stensjukdom i urinvägarna

Senast uppdaterad: Senast reviderad:
Sakkunnig:


Definition:
Konkrement i de övre urinvägarna. Njurstenar bildas när lösta ämnen i urinen överskrider sin maximala löslighet.
Förekomst:
I Sverige är incidensen 0,78 per 1 000 invånare per år. Medianåldern är 53 år och tillståndet är dubbelt så vanligt bland män.
Symtom:
Typiska anfall ger plötsligt insättande starka och kolikliknande flanksmärtor som strålar mot ljumsken, uttalat rörelsebehov, följt av illamående och kräkningar.
Kliniska fynd:
Dunkömhet över njurlogen och mikroskopisk hematuri.
Diagnostik:
Urinsticka kan påvisa hematuri, infektion och proteiner. Spiral-DT utan intravenös kontrastförstärkning (sten-DT, DT-njursten) är standardundersökning vid misstanke om stenar i de övre urinvägarna – negativ undersökning utesluter med hög sannolikhet sten.
Behandling:
Akutbehandling innefattar rikligt med dryck (förutom vid smärtanfall), smärtstillande (NSAID i första hand) och eventuellt extrakorporal stenkrossning med stötvåg (ESVL). Förebyggande behandling rekommenderas vid komplicerad stensjukdom och innefattar kostråd eller läkemedel.
  1. Morgan MS, Pearle MS. Medical management of renal stones. BMJ. 2016 Mar 14;352:i52. pmid: 26977089 PubMed  
  2. Hemminki K, Hemminki O, Försti AFa et al. Familial risks in urolithiasis in the population of Sweden. BJU Int. 2018 Mar;121(3):479-485. PMID: 29235239 PubMed  
  3. Ljunghall S, Danielson BG, Fellstrom B, Holmgren K, Johansson G, Wikstrom B. Family history of renal stones in recurrent stone patients. Br J Urol 1985;57:370-374. PubMed  
  4. Swartz MA, Lydon-Rochelle MT, Simon D, Wright JL, Porter MP. Admission for nephrolithiasis in pregnancy and risk of adverse birth outcomes. Obstet Gynecol 2007; 109: 1099-1104. PubMed  
  5. Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 2010; 157: 132-7. PubMed  
  6. Karlsen SJ. Kirurgisk behandling av urolithiasis i Norge. Tidsskr Nor Lægeforen 1996; 116: 2875 - 8. PubMed  
  7. Daudon M, Donsimoni R, Hennequin C et al. Sex- and age-related composition of 10.617 calculi analyzed by infrared spectroscopy. Urol Res 2005; 23: 319-26. PubMed  
  8. Rule AD, Bergstralh EJ, Melton LJ III, Li X, Weaver AL, Lieske JC. Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 2009; 4: 804-11. PubMed  
  9. Parmar MS. Kidney stones. BMJ 2004; 328: 1420-4. PubMed  
  10. Mollerup CL, Vestergaard P, Frokjaer VG, Mosekilde L, Christiansen P, Blichert-Toft M. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ 2002; 325: 807. British Medical Journal  
  11. Moe OW. Kidney stones: pathophysiology and medical management. Lancet 2006; 367: 333-44. PubMed  
  12. Burns JR, Gauthier JF, Finlayson B. Dissolution kinetics of uric acid calculi. J Urol 1984;131:708-711. PubMed  
  13. Low RK, Stoller ML. Uric acid-related nephrolithiasis. Urol Clin North Am 1997;24:135-148. PubMed  
  14. Grentz L, Massey LK. Contribution of dietary oxalate to urinary oxalate in health and disease. Topics in Clinical Nutrition 2002; 17: 60-70. PubMed  
  15. Baxmann AC, Mendonca CD, Heilberg IP. Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int 2003; 63: 1066-71. PubMed  
  16. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005; 293: 455-62. PMID: 15671430 PubMed  
  17. Kramer HJ, Choi HK, Atkinson K, Stampfer M, Curhan GC. The association between gout and nephrolithiasis in men: the health professionals' follow-up study. Kidney Int 2003; 64: 1022-6. PubMed  
  18. Eskelinen M, Ikonen J, Lipponen P. Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic. Eur Urol 1998;34: 467-73. PubMed  
  19. Sourtzis S, Thibaeau J, Damry N, Raslan A, Vandendris M, Bellemans M. Radiologic examination of renal colic: unenhanced CT compared with excretory urography. Am J Roentgenol 1999; 172: 1491-4. PubMed  
  20. Lauritsen J, Andersen JR, Nordling J, Thomsen HS. Unenhanced computed tomography in acute renal colic reduces cost outside radiology department. Acta Radiol 2008; 49: 1-5. PubMed  
  21. Antonelli J, Maalouf N. Nephrolithiasis. BMJ Best Practice, last updated Dec 22, 2016
  22. Curhan GC, Aronson D, Preminger GM. Diagnosis and acute management of suspected nephrolithiasis in adults. UpToDate, last updated Jul 02, 2019. www.uptodate.com  
  23. Shokeir AA, Mahran MR, Abdulmaaboud M. Renal colic in pregnant women: role of renal resistive index. Urology 2000;55:344-347. PubMed  
  24. Berrington de Gonzalez A and Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363: 345-51. PubMed  
  25. Smith-Bindman R, Aubin C, John Bailitz J et al. Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis. N Engl J Med 2014; 371:1100-1110 DOI: 10.1056. www.aliem.com  
  26. Türk C, Knoll T, Petrik A, et al. Guidelines on urolithiasis. European Association of Urology 2015. uroweb.org  
  27. Preminger GM, Tiselius HG, Assimos DG, et al.; EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol 2007; 178: 2418-34. PubMed  
  28. Türk C, Petřík A, Sarica K et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016 Mar;69(3):475-82. PMID: 26344917 PubMed  
  29. Kober A, Dobrovits M, Djavan B, et al. Local active warming: an effective treatment for pain, anxiety and nausea caused by renal colic. J Urol 2003; 170: 741-4. PubMed  
  30. Zerwekh JE, Reed-Gitomer BY and Pak CY. Pathogenesis of hypercalciuric nephrolithiasis. Endocrinol Metab Clin North Am 2003; 31: 869-84. PubMed  
  31. Harrington M and Cashman KD. High salt intake appears to increase bone resorption in postmenopausal women but high potassium intake ameliorates this adverse effect. Nutr Rev 2003; 61: 179-83. PubMed  
  32. 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. PubMed  
  33. Curhan GC, Willett WC, Knight EL and Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Arch Intern Med 2004; 164: 885-91. PubMed  
  34. Taylor EN, Stampfer MJ and Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol 2004; 15: 3225-32. PubMed  
  35. Pathan SA, Mitra B, Straney LD, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: A double-blind, multigroup, randomised controlled trial. Lancet 2016. PMID: 26993881 PubMed  
  36. Pathan SA, Mitra B, Cameron PA. A Systematic Review and Meta-analysis Comparing the Efficacy of Nonsteroidal Anti-inflammatory Drugs, Opioids, and Paracetamol in the Treatment of Acute Renal Colic. Eur Urol. 2017 Nov 21. pii: S0302-2838(17)30977-6. doi: 10.1016/j.eururo.2017.11.001. (Review) PMID: 29174580 PubMed  
  37. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ 2004; 328: 1401-4. PubMed  
  38. Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD006027. DOI: 10.1002/14651858.CD006027.pub2. DOI  
  39. Läkemedelsverket www.lakemedelsverket.se  
  40. Pathan SA, Mitra B, Straney LD, et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: A double-blind, multigroup, randomised controlled trial. Lancet 2016. doi:10.1016/S0140-6736(16)00652-8 DOI  
  41. Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MTWT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008509. DOI: 10.1002/14651858.CD008509.pub2. The Cochrane Library  
  42. Raison N, Ahmed K, Brunckhorst O, et al. Alpha blockers in the management of ureteric lithiasis: A meta-analysis. Int J Clin Pract. 2017 Jan;71(1). PMID: 28097758 PubMed  
  43. Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: a systematic review and meta-analysis. BMJ 2016; 355: i6112. pmid:27908918 PubMed  
  44. Meltzer AC, Burrows PK, Wolfson AB, et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Intern Med. 2018. PMID: 29913020 PubMed  
  45. Liu LR, Li QJ, Wei Q, et al. Percussion, diuresis, and inversion therapy for the passage of lower pole kidney stones following shock wave lithotripsy. Cochrane Database Syst Rev 2013. doi:10.1002/14651858.CD008569 DOI  
  46. Nabi G, Cook J, N'Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007; 334: 572. British Medical Journal  
  47. Mora B, Giorni E, Dobrovits M, et al. Transcutaneous electrical nerve stimulation: An effective treatment for pain caused by renal colic in emergency care. J Urology 2006; 175:1737-41. PubMed  
  48. Fink HA, Wilt TJ, Eidman KE, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an american college of physicians clinical guideline. Ann Intern Med 2013 Apr 2;158(7):535-43. PMID: 23546565 PubMed  
  49. Bao Y, Tu X, Wei Q, et al. Water for preventing urinary stones. Cochrane Database Syst Rev 2020. pmid:32045491 PubMed  
  50. Ekeruo WO, Tan YH, Young MD, et al. Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients. J Urol 2004; 172: 159-63. PubMed  
  51. Guide från Scandinavian NephroUrolithiasis Group 2017 www.urolithiasisguide.com  
  52. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 1999;162:688-691. PubMed  
  53. Ueno A, Kawamura T, Ogawa A, Takayasu H. Relation of spontaneous passage of ureteral calculi to size. Urology 1977;10:544-546. PubMed  
  54. Dropkin BM, Moses RA, Sharma D, Pais VM Jrl. The natural history of nonobstructing asymptomatic renal stones managed with active surveillance. J Urol 2015; 193:1265. DOI: 10.1016/j.juro.2014.11.056 DOI  
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Steinar J. Karlsen, tidligere klinikksjef og professor dr. med., Oslo Urologiske Universitetsklinikk, Aker universitetssykehus helseforetak og Universitetet i Oslo