A Rise in Kidney Stones Is Seen in U.S. Children 美国少年结石率上升

楼主:QuenQuen 时间:2008-10-29 22:45:00 点击:380 回复:4
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  A Rise in Kidney Stones Is Seen in U.S. Children 美国少年结石率上升
  
  YOUNG VICTIM Tessa Cesario, 11, developed a kidney stone in February. She has since cut back on salt and is drinking more water.
  少年患者Tessa Cesario,今年11岁,二月份患上了肾结石。从那以后她开始减少盐的摄取量并多饮水。
  
  By LAURIE TARKAN
  Published: October 27, 2008
  To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.
  While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.
  “The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”
  令家长们十分震惊的是,曾经只是被视为中年人生活紊乱而导致的肾结石,现在已经开始出现在5、6岁的儿童身上。
  尽管目前还没有确凿的数据显示患者的具体数量,但美国的儿科泌尿科医生和肾科医生普遍表示他们所接待的少年患者在急剧地上升。有一些医院甚至开设了儿科肾结石专科门诊。
  “老年医生可能会说,在70、80年代,他们每隔几个月就会有一例肾结石患者。”Caleb P. Nelson博士,曾经在哈佛医学院担任泌尿学讲师,现任波士顿儿童医院新成立的肾结石中心的副主任,这样表示,“现在我们每隔一周就有儿童患者。”
  Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville , said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”
  In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.
  The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.
  Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.
  John C. Pope IV博士,纳什维尔市范德比尔特地区门罗-Carell少年儿童医院的泌尿科外科及小儿科的副教授,这样说道:“当我们告诉家长病情时,他们大部分表示从未听说过儿童患上肾结石并认为他们的小孩出了什么严重的问题。”
  近期在中国,众多儿童患上了肾结石。因为他们饮用了为增加蛋白质检验值而添加三聚氰胺这种非法的、毒性的化学物而稀释的牛奶。
  尽管大部分关于肾结石的研究来自于成年患者的调查,但专家表示它同样适用于儿童。这些调查显示大部分肾结石的主要病因来自于饮食问题所导致的尿液里几种物质的结晶化。当这些物质结晶得过于浓缩时,肾结石就形成了。
  Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
  Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.
  40%-65%的肾结石的形成是草酸盐(某些食物的副产品)与尿液里的钙质结合在一起。(其它比较普遍的肾结石种类有钙磷酸盐结石和尿酸结石)。造成这种结合的两个最大因素是:喝水不够及吃盐太多,两者都会增加尿液中的钙质和草酸盐。
  过多的盐分必须通过肾排泄,但当盐和钙在排泄过程中结合在一起时,它们会在尿液和肾内形成一种更浓的钙质。
  “What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.
  “我们知道的事实就是儿童饮食中盐的摄取量增多了”,就职于威斯康星州大学的附属儿科肾结石诊所小儿泌尿科副主任Bruce L.Slaughenhoupt说。他和其他医学专家表示,带盐薯片和炸薯条,还有三明治肉、罐装汤、打包快餐,甚至还有象Gatorade此类的运动饮料,这些食物因为太受学生欢迎而改成了用专门吸引儿童的果汁盒包装出售。
  Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.
  “Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.
  The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.
  儿童也不习惯多喝水。“他们不想在学校上洗手间,他们没有时间,所以他们喝水较少。”巴尔的摩市Johns Hopkins儿童中心儿童肾科和少儿结石专家门诊的医学主任Alicia Neu说。相反,他们只是在觉得口渴的时候才会喝上一次水,但那却来得太少、太迟,尤其是对于那些喜欢运动或非常活跃的孩子们而言。
  “多喝水是肾结石中最重要的步骤之一。”Neu博士说。
  成年人肾结石的病例也有所上升,尤其是女性。专家说,他们发现更多的成年人20多、30多就开始肾结石了。在过去,人们通常40多、50多才患肾结石。
  “It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”
  The median age of children with stones is about 10.
  Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”
  “肾结石不再是中年病”,Nelson博士说,“我们大部分人怀疑儿童中出现这种病例是因为整个人口的增长”。
  儿童平均患结石的年龄是10岁。
  很多专家说肥胖症的增加是成人患结石的原因,儿童亦然。但结石诊所看到的不都是肥胖儿童,体重正常也不排除肾结石。“我们所观察的学生和青少年,大部分是相当匀称、活跃的孩子,”Nelson博士说,“我们没有发现爱玩Nintendo的肥胖人群。”
  Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”
  Dr. Pope, in Nashville , agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.
  “There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.
  Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”
  Slaughenhoupt博士在诊所接待过较多的肥胖儿童。“我们还没有比较对数据进行比较分析,”他说:“但给我的感觉是患结石病的孩子确实要胖些,有一些胖得太厉害。”
  来自纳什维尔的Pope博士持相同看法。他的医院座落在被称为结石地带的、美国南部的一个结石率较高的狭长区域。那里的医生每周要接待2-3个新的儿童结石患者。
  “在我脑海中毫无疑问的结论是,这很大程度上取决于饮食,同时又与童年风行的肥胖症直接联系。”他说。
  50%-60%患有结石的儿童所在的家庭有这种病史。“如果你有家庭病史,那么首先你要意识到你的孩子们生活中的某些方面存在风险。”Nelson博士说,“那就意味着你要长期教导孩子养成良好的饮水习惯、保持饮食平衡并尽量避免食用处理过的高盐、高脂食品。”
  There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.
  A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.
  Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.
  有数据表示,苏打水里的蔗糖会增加减肥餐中的高蛋白从而提升结石的机会,尤其在十几岁的青少年中比较普遍。
  一个普遍的误解是结石病患者应该避免钙质。事实上,奶制品有减低结石的风险,因为饮食钙与草酸盐结合后就被身体吸收了,避免了进入肾里面。
  患有肾结石的儿童在尿液从肾通过狭窄的尿管流向膀胱的过程中会在肚子的一边或胃部感觉到剧烈的疼痛。年纪较小的儿童可能更多的感觉到隐隐作痛或肚子痛,使病情更难诊断。儿童可能感到肚子不舒服,通常尿液中还有血。
  One Saturday last February, 11-year-old Tessa Cesario of Frederick , Md. , began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.
  The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.
  “I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.
  “I thought older men get kidney stones, not kids,” Ms. Cesario said.
  去年二月的一个星期六,11岁的Tessa Cesario Frederick,开始感到背痛。作为一个芭蕾舞训练员她每周5个晚上踮着脚尖训练芭蕾舞,渐渐地习惯了偶尔的疼痛和疲劳。但这次疼得太厉害,她的父母不得不带她去看医生。
  儿科医生给她照了X光,但当他打电话告诉家长结果时,她的父母震惊了。
  “我原以为他会告诉我她拉伤了某个部位而不能跳舞了,”她的妈妈Theresa Cesario女士说道。可医生却说她患了肾结石。
  “在我的想法里,只有老人才患肾结石,而不是小孩。”Cesario女士说道。
  The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.
  Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.
  Tessa Cesario is taking a wait-and-see approach. Her stone is not budging, so her parents are putting off surgery until they can work it into her dance schedule. In the meantime, she has vastly reduced her salt intake by cutting back on sandwich meats, processed soups and chips.
  And, her mother said, “she drinks a ton more water.”
  成人和儿童在肾结石的治疗上十分相似。医生努力让病人排出石头。如果石头太大或阻挡了排尿或有感染的迹象,就需要通过进行一种“二选一”的最低限度侵入身体的手术。
  短波碎石技术是一种无需进入身体的技术,它通过使用高能量的声波将石头打成碎片以便于它们更易排出。输尿管镜技术通过输尿管插入一个内诊镜来找出或消除石头。
  Tessa Cesario正处于“等等看”的状态。她的石头没有移动,所以她的父母延迟了手术来服从舞蹈课的排程。同时,她已经通过放弃食用三明治肉、包装汤和薯片来大幅度地减少盐的摄取量。
  另外,她妈妈告诉我们:“她现在大量地多喝水。”
  

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作者:crzhao 时间:2008-10-30 11:36:59
  a disorder of middle age (中年人生活紊乱而导致的肾结石)
  
  disorder here means "disease" (usually happens to middle aged person).
  
  HTH.
作者:crzhao 时间:2008-10-30 11:43:32
  Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston.(Caleb P. Nelson博士,曾经在哈佛医学院担任泌尿学讲师,现任波士顿儿童医院新成立的肾结石中心的副主任)
  
  with couple strokes on your keyboard, you just fired Dr. Caleb P. Nelson from Harvard Medical School!
作者:crzhao 时间:2008-10-30 11:49:45
  added to watered-down milk to inflate the protein count (为增加蛋白质检验值而添加三聚氰胺这种非法的、毒性的化学物而稀释的牛奶)
  
  water-down first, that is why melamine is added to boost the protein count. got it.
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