Skip to main content
Erschienen in: Die Nephrologie 2/2023

07.02.2023 | Urolithiasis | CME

Pathogenese, Progression und Metaphylaxe der Nephrolithiasis

Im Fokus: Kalziumnephrolithiasis

verfasst von: Dr. med. Anja Pfau

Erschienen in: Die Nephrologie | Ausgabe 2/2023

zum CME-Kurs Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Prävalenz der Nephrolithiasis ist weltweit steigend. Eine zentrale Rolle bei der Steinbildung und -progression spielt dabei die Zusammensetzung des Urins, welche durch Ernährung, Lebensstil, genetische Prädisposition und erworbene Erkrankungen beeinflusst werden kann. Epidemiologische Studien konnten dabei einen Zusammenhang zwischen Nierensteinen und Übergewicht, metabolischem Syndrom und Insulinresistenz nachweisen. Auch inflammatorische Prozesse und Einflüsse durch das Mikrobiom werden derzeit diskutiert. Die vorliegende Arbeit fasst die wesentlichen Risikofaktoren einer Nephrolithiasis zusammen und erläutert sich daraus ableitende Therapieoptionen der rezidivierenden Nephrolithiasis, welche Allgemeinmaßnahmen und eine medikamentöse Metaphylaxe umfassen. Der vorliegende Artikel legt dabei einen besonderen Schwerpunkt auf die häufigste Steinart, die Kalziumnephrolithiasis, gibt aber auch einen Überblick über seltenere Nierensteinerkrankungen.
Literatur
1.
Zurück zum Zitat Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y (2017) Epidemiology of stone disease across the world. World J Urol 35(9):1301–1320 PubMedCrossRef Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y (2017) Epidemiology of stone disease across the world. World J Urol 35(9):1301–1320 PubMedCrossRef
2.
Zurück zum Zitat Scales CD Jr., Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America P (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165 PubMedPubMedCentralCrossRef Scales CD Jr., Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America P (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165 PubMedPubMedCentralCrossRef
4.
Zurück zum Zitat Rule AD, Bergstralh EJ, Melton LJ 3rd, Li X, Weaver AL, Lieske JC (2009) Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 4(4):804–811 PubMedPubMedCentralCrossRef Rule AD, Bergstralh EJ, Melton LJ 3rd, Li X, Weaver AL, Lieske JC (2009) Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 4(4):804–811 PubMedPubMedCentralCrossRef
5.
Zurück zum Zitat Moe OW (2006) Kidney stones: pathophysiology and medical management. Lancet 367(9507):333–344 PubMedCrossRef Moe OW (2006) Kidney stones: pathophysiology and medical management. Lancet 367(9507):333–344 PubMedCrossRef
7.
Zurück zum Zitat Khan SR, Canales BK, Dominguez-Gutierrez PR (2021) Randall’s plaque and calcium oxalate stone formation: role for immunity and inflammation. Nat Rev Nephrol 17(6):417–433 PubMedCrossRef Khan SR, Canales BK, Dominguez-Gutierrez PR (2021) Randall’s plaque and calcium oxalate stone formation: role for immunity and inflammation. Nat Rev Nephrol 17(6):417–433 PubMedCrossRef
8.
Zurück zum Zitat Ticinesi A, Milani C, Guerra A, Allegri F, Lauretani F, Nouvenne A et al (2018) Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 67(12):2097–2106 PubMedCrossRef Ticinesi A, Milani C, Guerra A, Allegri F, Lauretani F, Nouvenne A et al (2018) Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 67(12):2097–2106 PubMedCrossRef
9.
Zurück zum Zitat Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E et al (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29(6):715–734 PubMedPubMedCentralCrossRef Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E et al (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29(6):715–734 PubMedPubMedCentralCrossRef
10.
Zurück zum Zitat Pfau A, Knauf F (2016) Update on nephrolithiasis: core curriculum 2016. Am J Kidney Dis 68(6):973–985 PubMedCrossRef Pfau A, Knauf F (2016) Update on nephrolithiasis: core curriculum 2016. Am J Kidney Dis 68(6):973–985 PubMedCrossRef
11.
Zurück zum Zitat Taylor EN, Stampfer MJ, Curhan GC (2004) Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol 15(12):3225–3232 PubMedCrossRef Taylor EN, Stampfer MJ, Curhan GC (2004) Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol 15(12):3225–3232 PubMedCrossRef
12.
Zurück zum Zitat Curhan GC, Willett WC, Knight EL, Stampfer MJ (2004) Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med 164(8):885–891 PubMedCrossRef Curhan GC, Willett WC, Knight EL, Stampfer MJ (2004) Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med 164(8):885–891 PubMedCrossRef
13.
Zurück zum Zitat Littlejohns TJ, Neal NL, Bradbury KE, Heers H, Allen NE, Turney BW (2020) Fluid intake and dietary factors and the risk of incident kidney stones in UK Biobank: a population-based prospective cohort study. Eur Urol Focus 6(4):752–761 PubMedCrossRef Littlejohns TJ, Neal NL, Bradbury KE, Heers H, Allen NE, Turney BW (2020) Fluid intake and dietary factors and the risk of incident kidney stones in UK Biobank: a population-based prospective cohort study. Eur Urol Focus 6(4):752–761 PubMedCrossRef
14.
Zurück zum Zitat Ferraro PM, Taylor EN, Gambaro G, Curhan GC (2017) Dietary and lifestyle risk factors associated with incident kidney stones in men and women. J Urol 198(4):858–863 PubMedPubMedCentralCrossRef Ferraro PM, Taylor EN, Gambaro G, Curhan GC (2017) Dietary and lifestyle risk factors associated with incident kidney stones in men and women. J Urol 198(4):858–863 PubMedPubMedCentralCrossRef
15.
Zurück zum Zitat Ferraro PM, Bargagli M, Trinchieri A, Gambaro G (2020) Risk of kidney stones: influence of dietary factors, dietary patterns, and vegetarian-vegan diets. Nutrients 12(3):779 PubMedPubMedCentralCrossRef Ferraro PM, Bargagli M, Trinchieri A, Gambaro G (2020) Risk of kidney stones: influence of dietary factors, dietary patterns, and vegetarian-vegan diets. Nutrients 12(3):779 PubMedPubMedCentralCrossRef
16.
Zurück zum Zitat Ferraro PM, Taylor EN, Gambaro G, Curhan GC (2013) Soda and other beverages and the risk of kidney stones. Clin J Am Soc Nephrol 8(8):1389–1395 PubMedPubMedCentralCrossRef Ferraro PM, Taylor EN, Gambaro G, Curhan GC (2013) Soda and other beverages and the risk of kidney stones. Clin J Am Soc Nephrol 8(8):1389–1395 PubMedPubMedCentralCrossRef
17.
Zurück zum Zitat Taylor EN, Curhan GC (2013) Dietary calcium from dairy and nondairy sources, and risk of symptomatic kidney stones. J Urol 190(4):1255–1259 PubMedPubMedCentralCrossRef Taylor EN, Curhan GC (2013) Dietary calcium from dairy and nondairy sources, and risk of symptomatic kidney stones. J Urol 190(4):1255–1259 PubMedPubMedCentralCrossRef
18.
Zurück zum Zitat Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328(12):833–838 PubMedCrossRef Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328(12):833–838 PubMedCrossRef
19.
Zurück zum Zitat Hess B, Jost C, Zipperle L, Takkinen R, Jaeger P (1998) High-calcium intake abolishes hyperoxaluria and reduces urinary crystallization during a 20-fold normal oxalate load in humans. Nephrol Dial Transplant 13(9):2241–2247 PubMedCrossRef Hess B, Jost C, Zipperle L, Takkinen R, Jaeger P (1998) High-calcium intake abolishes hyperoxaluria and reduces urinary crystallization during a 20-fold normal oxalate load in humans. Nephrol Dial Transplant 13(9):2241–2247 PubMedCrossRef
20.
Zurück zum Zitat Bargagli M, Ferraro PM, Vittori M, Lombardi G, Gambaro G, Somani B (2021) Calcium and vitamin D supplementation and their association with kidney stone disease: a narrative review. Nutrients 13(12):4363 PubMedPubMedCentralCrossRef Bargagli M, Ferraro PM, Vittori M, Lombardi G, Gambaro G, Somani B (2021) Calcium and vitamin D supplementation and their association with kidney stone disease: a narrative review. Nutrients 13(12):4363 PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 126(7):497–504 PubMedCrossRef Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 126(7):497–504 PubMedCrossRef
22.
Zurück zum Zitat Shoag J, Tasian GE, Goldfarb DS, Eisner BH (2015) The new epidemiology of nephrolithiasis. Adv Chronic Kidney Dis 22(4):273–278 PubMedCrossRef Shoag J, Tasian GE, Goldfarb DS, Eisner BH (2015) The new epidemiology of nephrolithiasis. Adv Chronic Kidney Dis 22(4):273–278 PubMedCrossRef
23.
Zurück zum Zitat Ferraro PM, Curhan GC, Gambaro G, Taylor EN (2016) Total, dietary, and supplemental vitamin C intake and risk of incident kidney stones. Am J Kidney Dis 67(3):400–407 PubMedCrossRef Ferraro PM, Curhan GC, Gambaro G, Taylor EN (2016) Total, dietary, and supplemental vitamin C intake and risk of incident kidney stones. Am J Kidney Dis 67(3):400–407 PubMedCrossRef
24.
Zurück zum Zitat Massey LK, Whiting SJ (1995) Dietary salt, urinary calcium, and kidney stone risk. Nutr Rev 53(5):131–139 PubMedCrossRef Massey LK, Whiting SJ (1995) Dietary salt, urinary calcium, and kidney stone risk. Nutr Rev 53(5):131–139 PubMedCrossRef
26.
Zurück zum Zitat Sorensen MD, Hsi RS, Chi T, Shara N, Wactawski-Wende J, Kahn AJ et al (2014) Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women’s Health Initiative report. J Urol 192(6):1694–1699 PubMedPubMedCentralCrossRef Sorensen MD, Hsi RS, Chi T, Shara N, Wactawski-Wende J, Kahn AJ et al (2014) Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women’s Health Initiative report. J Urol 192(6):1694–1699 PubMedPubMedCentralCrossRef
27.
Zurück zum Zitat Taylor EN, Stampfer MJ, Curhan GC (2005) Obesity, weight gain, and the risk of kidney stones. JAMA 293(4):455–462 PubMedCrossRef Taylor EN, Stampfer MJ, Curhan GC (2005) Obesity, weight gain, and the risk of kidney stones. JAMA 293(4):455–462 PubMedCrossRef
28.
Zurück zum Zitat Taylor EN, Stampfer MJ, Curhan GC (2005) Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 68(3):1230–1235 PubMedCrossRef Taylor EN, Stampfer MJ, Curhan GC (2005) Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 68(3):1230–1235 PubMedCrossRef
29.
Zurück zum Zitat Weinberg AE, Patel CJ, Chertow GM, Leppert JT (2014) Diabetic severity and risk of kidney stone disease. Eur Urol 65(1):242–247 PubMedCrossRef Weinberg AE, Patel CJ, Chertow GM, Leppert JT (2014) Diabetic severity and risk of kidney stone disease. Eur Urol 65(1):242–247 PubMedCrossRef
30.
Zurück zum Zitat Eisner BH, Porten SP, Bechis SK, Stoller ML (2010) Diabetic kidney stone formers excrete more oxalate and have lower urine pH than nondiabetic stone formers. J Urol 183(6):2244–2248 PubMedCrossRef Eisner BH, Porten SP, Bechis SK, Stoller ML (2010) Diabetic kidney stone formers excrete more oxalate and have lower urine pH than nondiabetic stone formers. J Urol 183(6):2244–2248 PubMedCrossRef
31.
Zurück zum Zitat Balasubramanian P, Wanner C, Ferreira JP, Ofstad AP, Elsaesser A, Zinman B et al (2022) Empagliflozin and decreased risk of nephrolithiasis: a potential new role for SGLT2 inhibition? J Clin Endocrinol Metab 107(7):e3003–e3007 PubMedPubMedCentralCrossRef Balasubramanian P, Wanner C, Ferreira JP, Ofstad AP, Elsaesser A, Zinman B et al (2022) Empagliflozin and decreased risk of nephrolithiasis: a potential new role for SGLT2 inhibition? J Clin Endocrinol Metab 107(7):e3003–e3007 PubMedPubMedCentralCrossRef
32.
Zurück zum Zitat Bletsa E, Filippas-Dekouan S, Kostara C, Dafopoulos P, Dimou A, Pappa E et al (2021) Effect of Dapagliflozin on urine metabolome in patients with type 2 diabetes. J Clin Endocrinol Metab 106(5):1269–1283 PubMedPubMedCentralCrossRef Bletsa E, Filippas-Dekouan S, Kostara C, Dafopoulos P, Dimou A, Pappa E et al (2021) Effect of Dapagliflozin on urine metabolome in patients with type 2 diabetes. J Clin Endocrinol Metab 106(5):1269–1283 PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T (2016) Salt and nephrolithiasis. Nephrol Dial Transplant 31(1):39–45 PubMedCrossRef Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T (2016) Salt and nephrolithiasis. Nephrol Dial Transplant 31(1):39–45 PubMedCrossRef
35.
Zurück zum Zitat Goldfarb DS, Fischer ME, Keich Y, Goldberg J (2005) A twin study of genetic and dietary influences on nephrolithiasis: a report from the Vietnam Era Twin (VET) Registry. Kidney Int 67(3):1053–1061 PubMedCrossRef Goldfarb DS, Fischer ME, Keich Y, Goldberg J (2005) A twin study of genetic and dietary influences on nephrolithiasis: a report from the Vietnam Era Twin (VET) Registry. Kidney Int 67(3):1053–1061 PubMedCrossRef
36.
Zurück zum Zitat Mohebbi N, Ferraro PM, Gambaro G, Unwin R (2017) Tubular and genetic disorders associated with kidney stones. Urolithiasis 45(1):127–137 PubMedCrossRef Mohebbi N, Ferraro PM, Gambaro G, Unwin R (2017) Tubular and genetic disorders associated with kidney stones. Urolithiasis 45(1):127–137 PubMedCrossRef
37.
Zurück zum Zitat Halbritter J, Baum M, Hynes AM, Rice SJ, Thwaites DT, Gucev ZS et al (2015) Fourteen monogenic genes account for 15 % of nephrolithiasis/nephrocalcinosis. J Am Soc Nephrol 26(3):543–551 PubMedCrossRef Halbritter J, Baum M, Hynes AM, Rice SJ, Thwaites DT, Gucev ZS et al (2015) Fourteen monogenic genes account for 15 % of nephrolithiasis/nephrocalcinosis. J Am Soc Nephrol 26(3):543–551 PubMedCrossRef
38.
Zurück zum Zitat Gambaro G, Vezzoli G, Casari G, Rampoldi L, D’Angelo A, Borghi L (2004) Genetics of hypercalciuria and calcium nephrolithiasis: from the rare monogenic to the common polygenic forms. Am J Kidney Dis 44(6):963–986 PubMedCrossRef Gambaro G, Vezzoli G, Casari G, Rampoldi L, D’Angelo A, Borghi L (2004) Genetics of hypercalciuria and calcium nephrolithiasis: from the rare monogenic to the common polygenic forms. Am J Kidney Dis 44(6):963–986 PubMedCrossRef
39.
Zurück zum Zitat Taguchi K, Hamamoto S, Okada A, Unno R, Kamisawa H, Naiki T et al (2017) Genome-wide gene expression profiling of Randall’s plaques in Calcium Oxalate stone formers. J Am Soc Nephrol 28(1):333–347 PubMedCrossRef Taguchi K, Hamamoto S, Okada A, Unno R, Kamisawa H, Naiki T et al (2017) Genome-wide gene expression profiling of Randall’s plaques in Calcium Oxalate stone formers. J Am Soc Nephrol 28(1):333–347 PubMedCrossRef
40.
Zurück zum Zitat Kusmartsev S, Dominguez-Gutierrez PR, Canales BK, Bird VG, Vieweg J, Khan SR (2016) Calcium Oxalate stone fragment and crystal phagocytosis by human macrophages. J Urol 195(4 Pt 1):1143–1151 PubMedCrossRef Kusmartsev S, Dominguez-Gutierrez PR, Canales BK, Bird VG, Vieweg J, Khan SR (2016) Calcium Oxalate stone fragment and crystal phagocytosis by human macrophages. J Urol 195(4 Pt 1):1143–1151 PubMedCrossRef
41.
Zurück zum Zitat Ferraro PM, Curhan GC, Gambaro G, Taylor EN (2019) Antibiotic use and risk of incident kidney stones in female nurses. Am J Kidney Dis 74(6):736–741 PubMedPubMedCentralCrossRef Ferraro PM, Curhan GC, Gambaro G, Taylor EN (2019) Antibiotic use and risk of incident kidney stones in female nurses. Am J Kidney Dis 74(6):736–741 PubMedPubMedCentralCrossRef
42.
Zurück zum Zitat Tasian GE, Jemielita T, Goldfarb DS, Copelovitch L, Gerber JS, Wu Q et al (2018) Oral antibiotic exposure and kidney stone disease. J Am Soc Nephrol 29(6):1731–1740 PubMedPubMedCentralCrossRef Tasian GE, Jemielita T, Goldfarb DS, Copelovitch L, Gerber JS, Wu Q et al (2018) Oral antibiotic exposure and kidney stone disease. J Am Soc Nephrol 29(6):1731–1740 PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Pedro RN, Aslam AU, Bello JO, Bhatti KH, Philipraj J, Sissoko I et al (2020) Nutrients, vitamins, probiotics and herbal products: an update of their role in urolithogenesis. Urolithiasis 48(4):285–301 PubMedCrossRef Pedro RN, Aslam AU, Bello JO, Bhatti KH, Philipraj J, Sissoko I et al (2020) Nutrients, vitamins, probiotics and herbal products: an update of their role in urolithogenesis. Urolithiasis 48(4):285–301 PubMedCrossRef
45.
Zurück zum Zitat Mohebbi N, Wagner CA (2018) Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis. J Nephrol 31(4):511–522 PubMedCrossRef Mohebbi N, Wagner CA (2018) Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis. J Nephrol 31(4):511–522 PubMedCrossRef
46.
Zurück zum Zitat Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR et al (2013) Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med 158(7):535–543 PubMedCrossRef Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR et al (2013) Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med 158(7):535–543 PubMedCrossRef
47.
Zurück zum Zitat Pedersen SA, Gaist D, Schmidt SAJ, Holmich LR, Friis S, Pottegard A (2018) Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol 78(4):673–681.e9 PubMedCrossRef Pedersen SA, Gaist D, Schmidt SAJ, Holmich LR, Friis S, Pottegard A (2018) Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol 78(4):673–681.e9 PubMedCrossRef
48.
Zurück zum Zitat Dhayat NA, Faller N, Bonny O, Mohebbi N, Ritter A, Pellegrini L et al (2018) Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial. BMC Nephrol 19(1):349 PubMedPubMedCentralCrossRef Dhayat NA, Faller N, Bonny O, Mohebbi N, Ritter A, Pellegrini L et al (2018) Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial. BMC Nephrol 19(1):349 PubMedPubMedCentralCrossRef
49.
Zurück zum Zitat Demoulin N, Aydin S, Gillion V, Morelle J, Jadoul M (2022) Pathophysiology and management of Hyperoxaluria and Oxalate nephropathy: a review. Am J Kidney Dis 79(5):717–727 PubMedCrossRef Demoulin N, Aydin S, Gillion V, Morelle J, Jadoul M (2022) Pathophysiology and management of Hyperoxaluria and Oxalate nephropathy: a review. Am J Kidney Dis 79(5):717–727 PubMedCrossRef
51.
52.
Zurück zum Zitat Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A et al (2021) Cystinuria: clinical practice recommendation. Kidney Int 99(1):48–58 PubMedCrossRef Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A et al (2021) Cystinuria: clinical practice recommendation. Kidney Int 99(1):48–58 PubMedCrossRef
53.
Zurück zum Zitat Marien T, Miller NL (2015) Treatment of the infected stone. Urol Clin North Am 42(4):459–472 PubMedCrossRef Marien T, Miller NL (2015) Treatment of the infected stone. Urol Clin North Am 42(4):459–472 PubMedCrossRef
Metadaten
Titel
Pathogenese, Progression und Metaphylaxe der Nephrolithiasis
Im Fokus: Kalziumnephrolithiasis
verfasst von
Dr. med. Anja Pfau
Publikationsdatum
07.02.2023
Verlag
Springer Medizin
Schlagwörter
Urolithiasis
Ernährung
Erschienen in
Die Nephrologie / Ausgabe 2/2023
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI
https://doi.org/10.1007/s11560-023-00637-7

Weitere Artikel der Ausgabe 2/2023

Die Nephrologie 2/2023 Zur Ausgabe

Einführung zum Thema

Ethik in der Nephrologie