What causes kidney stones? - Arash Shadman

譯者: Marssi Draw 審譯者: Regina Chu

The biggest kidney stone on record weighed more than a kilogram

史上最大的腎結石超過一公斤

and was 17 centimeters in diameter.

直徑長達 17 公分

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

病人可沒真的吞下 像椰子一樣大的石頭

Kidney stones form inside the body,

腎結石是在體內形成

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

但不幸的是排出時會讓人非常疼痛

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

腎結石是一團結晶體 可能在腎臟

ureters,

輸尿管

bladder,

膀胱

or urethra.

或尿道形成

Urine contains compounds that consist of calcium,

尿液裡包含了鈣

sodium,

鈉

potassium,

鉀

oxalate,

草酸鹽

uric acid,

尿酸

and phosphate.

磷酸鹽

If the levels of these particles get too high,

如果這些粒子的含量過高

or if urine becomes too acidic or basic,

或是尿液的酸鹼度太高

the particles can clump together and crystallize.

這些粒子可能會聚在一起並結晶化

Unless the problem is addressed,

除非把問題處理掉

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

不然結晶會日以繼月逐年

forming a detectable stone.

形成一顆讓人感覺得到的石頭

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

草酸鈣結石最常這樣形成

and accounts for about 80% of kidney stones.

八成的腎結石也是起因於草酸鈣

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

少部分腎結石 是由磷酸鈣或尿酸形成

A slightly different type of stone

這種石頭有點不同

made of the minerals magnesium ammonium phosphate, or struvite,

因為它是由礦物磷酸銨鎂 或稱水磷鎂銨石形成

can be caused by bacterial infection.

可能由細菌感染引起

And even rarer stones can result from genetic disorders

極少數的結石可能是由遺傳疾病

or certain medications.

或某種藥物引起

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

腎結石不移動的話 就可能不會被察覺

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

當結石從腎跑進輸尿管

its sharp edges scratch the walls of the urinary tract.

尖銳的邊緣就會刮磨尿道

Nerve endings embedded in this tissue transmit excruciating pain signals

嵌在這個組織的神經末梢

便透過神經系統傳達劇痛的信號

through the nervous system.

And the scratches can send blood flowing into the urine.

刮痕可能讓血流進尿液中

This can be accompanied by symptoms of nausea,

可能伴隨的症狀有噁心

vomiting,

嘔吐

and a burning sensation while urinating.

以及排尿時有灼熱感

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

如果結石大到會阻塞排尿

it can create an infection, or back flow,

就可能引發感染或尿液逆流

and damage the kidneys themselves.

而傷害腎臟

But most kidney stones don't become this serious,

但大部分的腎結石不會太嚴重

or even require invasive treatment.

也不需要侵入性治療

Masses less than five millimeters in diameter

團塊直徑小於五公厘

will usually pass out of the body on their own.

通常身體會自行排出

A doctor will often simply recommend drinking large amounts of water

醫生通常只會建議大量喝水

to help speed the process along,

加快過程

and maybe taking some pain killers.

也許服用止痛藥

If the stone is slightly larger, medications like alpha blockers

如果結石稍大 可以用甲型阻斷劑治療

can help by relaxing the muscles in the ureter

讓輸尿管的肌肉鬆弛

and making it easier for the stone to get through.

石頭就會較易排出

Another medication called potassium citrate

另一種稱為檸檬酸鉀的藥物

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

可以藉由稀釋尿液的酸度 來分解石頭

For medium-sized stones up to about ten millimeters,

大至十公厘的中型結石

one option is pulverizing them with soundwaves.

可以用超音波震碎

Extracorporeal shock wave lithotripsy uses high-intensity pulses

體外震波碎石術 運用高強度脈衝

of focused ultrasonic energy aimed directly at the stone.

將能量集中的超音波 直接聚焦在結石上

The pulses create vibrations inside the stone itself

這些脈衝在結石內製造震動

and small bubbles jostle it.

和小泡泡來推擠結石

These combined forces crush the stone into smaller pieces

這些力量共同將結石震碎

that can pass out of the body more easily.

結石就能比較容易從身體裡排出

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

但是萬一石頭太大

if it's simply too big.

用音波震碎的效果就不太好

So sometimes, more invasive treatments are necessary.

所以有時候還是必須採取侵入性治療

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

有種稱為支架的硬管子 可以放進輸尿管來擴張它

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

光纖可傳送雷射脈衝來擊碎結石

Stones can also be surgically removed through an incision

碎石可透過手術

在病人背部或腹股溝 做切口取出

in the patient's back or groin.

What about just avoiding kidney stones in the first place?

那要怎麼避免腎結石開始形成呢？

For people prone to them,

對於可能有結石的人

their doctor may recommend drinking plenty of water,

醫生可能會建議他們多喝水

which dilutes the calcium oxalate and other compounds

稀釋草酸鈣和其他化合物

that eventually build up into painful stones.

避免日後變成讓人疼痛的結石

Foods like potato chips,

飲食方面，像是洋芋片

spinach,

波菜

rhubarb,

大黃

and beets are high in oxalate,

和甜菜都富含草酸鹽

so doctors might advise limiting them.

醫生可能會建議他們限制用量

Even though calcium is often found in stones,

即使結石裡常含有鈣

calcium in foods and beverages can actually help

飲食中的鈣卻有益

by binding to oxalate in the digestive tract

因為草酸鹽和鈣會在消化道中結合

before it can be absorbed and reach the kidneys.

避免被吸收、進入腎臟

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

即使得了腎結石，你也不孤單

Data suggests that rates are rising,

數據顯示患者日漸增加

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

但是要打破世界紀錄 應該不會太快