What causes kidney stones? - Arash Shadman

Translator: 潘 可儿 Reviewer: Alan Watson

根據記載

The biggest kidney stone on record weighed more than a kilogram

最大嘅腎結石重量超過一公斤

and was 17 centimeters in diameter.

直徑長達 17 厘米

The patient didn't actually swallow a stone the size of a coconut.

但事實係病人冇曾經 吞咗一粒椰子咁大嘅石頭落肚

Kidney stones form inside the body,

腎結石係喺身體裏面形成嘅

but unfortunately, they're extremely painful to get out.

但要攞佢哋出嚟嘅話，就好痛苦喇

A kidney stone is a hard mass of crystals that can form in the kidneys,

腎結石指喺腎臟、輸尿管 膀胱、尿道

ureters,

bladder,

or urethra.

形成嘅一塊好硬嘅晶體

Urine contains compounds that consist of calcium,

尿液中嘅化合物包含 鈣、鈉、鉀、草酸、尿酸同埋磷酸鹽

sodium,

potassium,

oxalate,

uric acid,

and phosphate.

If the levels of these particles get too high,

如果呢啲成份嘅含量水平過高 或者尿液過酸、過鹼

or if urine becomes too acidic or basic,

the particles can clump together and crystallize.

呢啲成份就會聚集結晶

Unless the problem is addressed,

結晶得唔得到解決，就會越嚟越大

the crystals will gradually grow over a few weeks, months, or even years,

以致經過幾星期、幾個月 甚至幾年嘅時間

forming a detectable stone.

變成一粒可以檢測得到嘅腎石

Calcium oxalate is the most common type of crystal to form this way,

腎石當中，草酸鈣形成嘅腎石 係最常見嘅

and accounts for about 80% of kidney stones.

大概佔八成腎結石

Less common kidney stones are made of calcium phosphate, or uric acid.

磷酸鈣或者尿酸形成嘅腎石就冇咁常見

A slightly different type of stone

病毒感染有可能令腎石嘅成分 變為礦物質鎂、磷酸銨、鳥糞石

made of the minerals magnesium ammonium phosphate, or struvite,

can be caused by bacterial infection.

And even rarer stones can result from genetic disorders

遺傳疾病或者某啲藥物 都會形成更加罕見嘅腎石

or certain medications.

A kidney stone can go undetected until it starts to move.

一粒腎石要被檢測得到

就要喺身體裏面移動

When a stone travels through the kidney and into the ureter,

當一粒腎石經過腎臟嚟到輸尿管

its sharp edges scratch the walls of the urinary tract.

佢鋒利嘅邊緣會刮損泌尿道嘅內壁

Nerve endings embedded in this tissue transmit excruciating pain signals

內壁組織含有嘅神經末梢

神經末梢會通過神經系統 傳遞極度痛苦嘅信號

through the nervous system.

And the scratches can send blood flowing into the urine.

而且刮損會導致內壁出血

This can be accompanied by symptoms of nausea,

出血同時伴隨著噁心、嘔吐嘅癥狀

vomiting,

and a burning sensation while urinating.

排尿時仲會有一種灼燒感

If a stone gets big enough to actually block the flow of urine,

如果一粒腎石大到可以阻塞尿液流動

it can create an infection, or back flow,

佢就會引起感染，或者尿液倒流

and damage the kidneys themselves.

甚至破壞腎臟本身

But most kidney stones don't become this serious,

但係大部份腎結石 都冇嚴重到要做手術嘅地步

or even require invasive treatment.

Masses less than five millimeters in diameter

直徑小於五厘米嘅結石 通常由可以由身體自身排出

will usually pass out of the body on their own.

A doctor will often simply recommend drinking large amounts of water

醫生一般會建議通過大量飲水 嚟加速結石排出

to help speed the process along,

and maybe taking some pain killers.

有需要仲可以食止痛藥

If the stone is slightly larger, medications like alpha blockers

如果結石比較大

服用好似 α-受體阻滯劑嘅藥物 可以幫助放鬆輸尿管嘅肌肉

can help by relaxing the muscles in the ureter

and making it easier for the stone to get through.

令到結石更容易排出

Another medication called potassium citrate

另一種叫檸檬酸鉀嘅藥物

can help dissolve the stones by creating a less acidic urine.

可以通過製造冇咁酸嘅尿酸嚟溶解結石

For medium-sized stones up to about ten millimeters,

至於直徑去到十厘米嘅中等結石

one option is pulverizing them with soundwaves.

其中一種治療就係聲波粉碎

Extracorporeal shock wave lithotripsy uses high-intensity pulses

體外衝擊波碎石術 利用高強度超聲波脈衝嘅能量打擊結石

of focused ultrasonic energy aimed directly at the stone.

The pulses create vibrations inside the stone itself

脈衝令到結石內部震動

and small bubbles jostle it.

內部嘅細泡泡嘗試膨漲

These combined forces crush the stone into smaller pieces

呢兩種力將結石打散

that can pass out of the body more easily.

令佢更加容易排出身體

But zapping a stone with sound doesn't work as well

如果結石太大嘅話，聲波碎石都冇用喇

if it's simply too big.

So sometimes, more invasive treatments are necessary.

所以有時候，就需要入侵性嘅療程

A rigid tube called a stent can be placed in the ureter to expand it.

支架連管可以放入撐大輸尿管

Optical fibers can deliver laser pulses to break up the stone.

光纖可以傳導激光脈衝，擊碎結石

Stones can also be surgically removed through an incision

同樣，結石可以通過 喺病人背脊或者腹股溝開刀攞出

in the patient's back or groin.

What about just avoiding kidney stones in the first place?

如果一開始就避免腎結石會點？

For people prone to them,

對於腎結石高危嘅人

their doctor may recommend drinking plenty of water,

醫生會勸佢哋多飲啲水

which dilutes the calcium oxalate and other compounds

因為水可以稀釋 最終形成結石嘅草酸鈣同其他物質

that eventually build up into painful stones.

Foods like potato chips,

薯片、菠菜、大黃同甜菜 都有好高嘅草酸

spinach,

rhubarb,

and beets are high in oxalate,

so doctors might advise limiting them.

所以醫生建議食少啲佢哋

Even though calcium is often found in stones,

雖然結石當中含有鈣

calcium in foods and beverages can actually help

但係食物同飲料中嘅鈣

能夠喺草酸到達腎臟之前 就喺消化道同草酸結合

by binding to oxalate in the digestive tract

before it can be absorbed and reach the kidneys.

If you do end up with a kidney stone, you're not alone.

如果你有腎結石，你並唔孤單

Data suggests that rates are rising,

數據顯示腎結石嘅患病率正上升緊

but that world record probably won't be broken any time soon.

但係世界最大嘅腎結石紀錄 係冇咁快就被打破嘅