ការបង្ការ និងការគ្រប់គ្រងគ្រួសក្នុងតម្រងនោម៖ មគ្គុទ្ទេសក៍ទំនើបមួយដើម្បីរក្សាសុខភាពឲ្យគ្មានគ្រួស

បានធ្វើបច្ចុប្បន្នភាពចុងក្រោយ៖ ខែ​សីហា 16, 2026

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Kidney stones are one of the most common urological conditions I see — and one of the most preventable. Here is a patient-friendly overview of how stones form, how diet genuinely changes the odds, and where treatment such as ESWL fits in.

This article draws on a presentation I gave at the Royal Phnom Penh Urology Seminar in June 2019. Several years on, the principles of stone prevention have not changed much, which is itself a useful signal about which advice is worth following.

First: When a Stone Is an Emergency

Prevention is slow work. This part is not. Go to an emergency department rather than waiting for an appointment if you have:

• Fever or shaking chills together with flank pain — a blocked kidney that is also infected can progress to sepsis within hours and needs drainage, not antibiotics alone. This is the one that kills people.
• Pain that ordinary painkillers are not touching, or persistent vomiting.
• Passing little or no urine, especially with a single kidney or stones on both sides.
• Flank pain during pregnancy, or with known kidney impairment or a transplanted kidney.

តុល្យភាពអំបិល

Kidney stones are fundamentally about a disruption in the balance of salts within the urinary tract. Picture a salt farm: sea water is let in, the water evaporates, and salt is left behind. Stones form when urine becomes supersaturated with poorly soluble compounds that can no longer stay dissolved, and crystals precipitate.

តើអ្នកណាខ្លះដែលមានហានិភ័យ?

• Sex and age: more common in men, and typically first appearing in young to middle adulthood.
• Lifetime prevalence: roughly one in eight men and one in fourteen women will have a stone at some point.
• Other conditions: obesity, high blood pressure and diabetes all raise the risk.
• Family history: a close relative with stones meaningfully increases your own risk.
• Climate and occupation: heat and sweating matter a great deal in Thailand, and outdoor work is its own risk factor.

ហេតុអ្វីបានជាថ្មបង្កើតជា?

Supersaturation arises mainly from dehydration and inherited tendencies to excrete more of certain ions. The building blocks include calcium, oxalate, phosphate, magnesium and uric acid. The four common types are calcium oxalate (by far the most frequent), struvite (associated with infection), uric acid (linked to persistently acidic urine) and calcium phosphate.

Which one you make changes the advice completely — uric acid stones can often be dissolved with medication, as described in this case study, while calcium stones cannot. That is why any stone you pass should be kept and sent for analysis. A fragment in a clean container is worth more than a description of it.

សសរស្តម្ភនៃការបង្ការ៖ ការគ្រប់គ្រងរបបអាហារ

The magic words are balance, balance and balance. The figures below are general targets used for stone formers; the precise plan for any individual comes after stone analysis and, where indicated, a metabolic evaluation. They are a starting point for a conversation, not a prescription to self-apply.

ការទទួលទានជាតិទឹក — កត្តាសំខាន់បំផុត

Dehydration is the most important and easiest factor to correct. The usual recommendation is more than 2.5 litres of fluid daily, adjusted upward in heat or with heavy sweating. The practical marker is pale urine throughout the day. One exception worth stating: if you have heart failure, significant kidney impairment or have been told to restrict fluids, agree your target with your doctor rather than following a general number.

កាល់ស្យូម — ការយល់ច្រឡំទូទៅ

Many patients believe they should cut out calcium to prevent calcium stones. This is backwards. Low dietary calcium leaves more oxalate free to be absorbed and excreted, and it raises stone risk rather than lowering it.

• The target: 800 to 1,200 mg a day, from food where possible.
• Why: in a randomised trial in men with recurrent calcium oxalate stones, a normal-calcium diet with reduced animal protein and salt roughly halved recurrence compared with a low-calcium diet.
• Practical point: if you take calcium supplements, take them with meals, so the calcium binds oxalate in the gut instead of being absorbed. Supplements taken between meals do not have the same protective effect.

ការគ្រប់គ្រងអុកស៊ីឡាត

Because calcium oxalate is the most common stone type, oxalate matters — but the aim is moderation rather than elimination. Very restrictive oxalate diets are hard to sustain and cut out genuinely healthy foods. The higher-oxalate items worth moderating include spinach, rhubarb, beetroot, nuts, seeds, dark chocolate and cocoa, black tea and some soy products.

The most useful single habit is not avoidance but pairing: eat oxalate-containing foods together with a calcium-containing food in the same meal, so the two bind in the gut rather than in your kidney.

សូដ្យូម និងប្រូតេអ៊ីន

• សូដ្យូម៖ a high salt intake pushes more calcium into the urine. Aiming for 2,000 to 3,000 mg of sodium a day helps, and in Thai cooking most of it comes from sauces and seasoning rather than the salt shaker.
• ប្រូតេអ៊ីន៖ very high intakes acidify the urine and raise urinary calcium. A moderate intake of roughly 0.8 to 1.4 g per kg per day is the usual target. Evidence does not show a clear difference in stone risk between animal and plant protein at moderate intakes.

វីតាមីនសេ

Vitamin C in food is not a problem. High-dose supplements are, because excess ascorbate is metabolised to oxalate: intakes above 1,000 mg a day have been associated with a meaningfully higher risk of stones. If you form calcium oxalate stones, high-dose vitamin C is one supplement worth stopping.

Citrate: The Stone Inhibitor

Citrate binds calcium in the urine and raises urine pH, making crystals less likely to form. It is one of the few things that actively works against stones rather than merely not causing them.

• Natural sources: lemon and lime. Roughly half a cup of pure lemon juice diluted through the day provides a useful citrate load. Use unsweetened preparations — commercial lemonade carries a sugar load that works against you if weight or metabolic syndrome is part of the picture.
• Medical citrate: potassium citrate is the mainstay for uric acid stones and for patients with low urinary citrate. It is prescribed and monitored rather than self-started — over-alkalinisation causes its own problems.

When Prevention Is Not Enough: ESWL

Extracorporeal shock wave lithotripsy (ESWL) uses focused shock waves to break stones into fragments small enough to pass in the urine. For how the technology developed, see ការវិវត្តន៍នៃ ESWL, and the wider kidney stone service.

At Bangkok Hospital Headquarters, ESWL is performed with a 3rd-generation lithotripter as a same-day daycare procedure, using short-acting analgesia rather than general anaesthesia. Lithotripter generations differ mainly in how the stone is located and how comfortable treatment is:

លក្ខណៈពិសេស	3rd generation	4th generation
Targeting	X-ray fluoroscopy, exposure kept as low as reasonably achievable	Ultrasound localisation, no X-ray needed
Comfort	Short-acting intravenous analgesia or light sedation commonly given	Often tolerated with little or no analgesia
ភាពត្រឹមត្រូវ	The stone moves with breathing; aim is checked and corrected by the operator	Automatic ultrasound respiratory tracking
ការងើបឡើងវិញ	Daycare; admission only if complications or other conditions require it	Daycare, same-day discharge

How Well It Works — and What Changes the Answer

Published series of respiratory-tracking systems report better targeting accuracy than untracked treatment, and stone-free rates in the region of four in five patients at three-month follow-up. Those figures come from manufacturer-associated and single-centre studies rather than independent randomised comparisons, so treat them as indicative rather than as a promise.

What actually drives your own chance of success matters more than the generation of machine: stone size, stone composition, where it sits in the kidney, the distance from skin to stone, and whether anything downstream is obstructing. Very hard stones and lower-pole stones do less well, and some stones need more than one session or a different approach altogether. That assessment is what a consultation is for.

Risks and Who Should Not Have It

ESWL is non-invasive, not risk-free, and any honest account includes this list.

• Blood in the urine and bruising over the flank are common in the first day or two and settle.
• Pain as fragments pass — expected, and manageable with the medication you are sent home with.
• Steinstrasse — a column of fragments blocking the ureter. This is the complication to know about: increasing pain, or pain with fever, after treatment means being seen rather than waiting it out.
• Bleeding around the kidney is uncommon but real, and more likely with uncontrolled blood pressure or on blood-thinning medication.
• ការបង្កររោគដែលនាំអោយមានការរលាក, which is why urine is checked and cleared beforehand.
• Retreatment is sometimes needed; one session does not always finish the job.

ESWL is generally not suitable in pregnancy, with an untreated urinary infection, with a bleeding disorder or uncorrected anticoagulation, or where there is an obstruction below the stone that fragments could not pass. Tell your urologist about every medicine you take, particularly anything that thins the blood — and do not stop it yourself.

សារ​ដែល​យក​ទៅ​ផ្ទះ

• Stones are common and largely manageable — but they recur, and prevention is a long-term habit rather than a course of treatment.
• Do not cut out calcium. Cut back on salt, moderate the high-oxalate foods, and pair them with calcium in the same meal.
• Fluid is the highest-yield change, aiming for urine that stays pale.
• Keep any stone you pass. Composition changes the entire prevention plan.
• ESWL is recommended by European guidelines for most stones under 2 cm, with the best single-session results in stones under 1 cm — but suitability depends on the individual stone.
• Fever with flank pain is the emergency that all of the above is trying to prevent.

សារធាតុចិញ្ចឹម	General target for stone formers
សារធាតុរាវ	More than 2.5 litres a day, more in heat; individualised if fluids are restricted for other reasons
Calcium	800-1,200 mg a day, preferably from food and taken with meals
អុកស៊ីឡាត	Moderate the high-oxalate foods rather than eliminate them; pair with calcium
Sodium	2,000-3,000 mg a day
ប្រូតេអ៊ីន	0.8-1.4 g per kg per day
វីតាមីនសេ	Food is fine; avoid supplements above 1,000 mg a day

If you are dealing with kidney stones or want a prevention plan based on your own stone composition and metabolic profile, Dr. Soarawee Weerasopone consults at ទីស្នាក់ការកណ្តាលមន្ទីរពេទ្យបាងកក and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445. For questions about the cost of ESWL or any other procedure, please email the Urology department at bhquro@bdms.co.th, who handle all pricing enquiries.

សេវាថែទាំសុខភាពពីចម្ងាយរបស់មន្ទីរពេទ្យបាងកកអាចរកបានសម្រាប់អ្នកជំងឺដែលមិនអាចចូលរួមដោយផ្ទាល់បាន រួមទាំងអ្នកជំងឺអន្តរជាតិផងដែរ — សូមរៀបចំវាជាមុនតាមរយៈអ៊ីមែលទៅកាន់ផ្នែកជំងឺប្រព័ន្ធទឹកនោមតាមរយៈ bhquro@bdms.co.th. It suits reviewing imaging, stone analysis results and a prevention plan; acute flank pain with fever needs an emergency department rather than a teleconsultation. Samitivej Sriracha is in-person only.

សំណួរដែលសួរជាញឹកញាប់អំពីការបង្ការគ្រួសក្នុងតម្រងនោម

តើខ្ញុំគួរផឹកទឹកប៉ុន្មានដើម្បីការពារគ្រួសក្នុងតម្រងនោម?

More than 2.5 litres a day is the usual recommendation, and more in hot weather or with heavy sweating. The practical marker is urine that stays pale through the day. If you have heart failure or significant kidney impairment, or have been advised to restrict fluids, agree your target with your doctor rather than following a general figure.

តើខ្ញុំគួរជៀសវាងជាតិកាល់ស្យូមទេ ប្រសិនបើខ្ញុំមានគ្រួសក្នុងតម្រងនោម?

No — this is the most common misconception in stone prevention, and it is backwards. Low dietary calcium leaves more oxalate free to be absorbed and raises stone risk. Aim for 800 to 1,200 mg a day, preferably from food, and take any supplement with meals so the calcium binds oxalate in the gut.

តើទឹកក្រូចឆ្មាពិតជាជួយការពារគ្រួសក្នុងតម្រងនោមមែនទេ?

It helps. Lemon and lime are rich in citrate, which binds calcium in the urine and raises urine pH so crystals are less likely to form. Use unsweetened preparations — commercial lemonade carries a sugar load that works against you. For patients who need more citrate than diet provides, prescribed potassium citrate is the medical option.

តើគ្រួសក្នុងតម្រងនោមទំហំប៉ុនណាដែលត្រូវបានព្យាបាលដោយ ESWL ល្អបំផុត?

European Association of Urology guidance supports ESWL for most stones under 2 cm, with the best single-session results in stones under 1 cm. Size is not the only factor: composition, position in the kidney, the distance from skin to stone and any obstruction below it all affect whether ESWL is the right choice.

What are the risks of ESWL?

Blood in the urine and flank bruising are common and settle. Pain as fragments pass is expected. The complication to know about is steinstrasse, a column of fragments blocking the ureter — increasing pain, or pain with fever, after treatment means being seen rather than waiting. Bleeding around the kidney is uncommon but more likely with uncontrolled blood pressure or blood-thinning medication, and retreatment is sometimes needed. ESWL is generally avoided in pregnancy, with an untreated infection, with a bleeding disorder, or where an obstruction lies below the stone.

When is a kidney stone an emergency?

Fever or shaking chills with flank pain is the critical one: a blocked kidney that is also infected can progress to sepsis within hours and needs drainage rather than antibiotics alone. Also go in for pain that painkillers do not touch, persistent vomiting, passing little or no urine, or flank pain in pregnancy, in a single kidney, or with known kidney impairment.

ការបដិសេធ៖ This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Dietary targets given here are general figures for stone formers and should be individualised after stone analysis. No advice, diagnosis or prescription is given through personal messaging channels or social media. Fever with flank pain may indicate an infected obstructed kidney — seek emergency care rather than waiting for an appointment. Always consult a qualified healthcare professional before starting or changing any medical treatment.