Increased risk of chronic kidney disease in uric acid stone formers with high neutrophil-to-lymphocyte ratio

Abstract

Urolithiasis is associated with an increased risk of chronic kidney disease (CKD), irrespective of stone compositions. Chronic inflammation is an important factor for CKD progression. Neutrophil-to-lymphocyte ratio (NLR) has been recognized as a reliable biomarker of inflammation, yet its use in predicting renal deterioration in patients with urolithiasis remains limited. We aimed to explore whether the combination of stone composition and NLR could be useful as a predictor for CKD risk. A total of 336 stone formers with at least one stone submission for analysis were enrolled in the retrospective study. Stones were classified into uric acid and calcium groups. Renal functions were assessed at least one month after stone treatment. Uric acid stone formers had significantly lower estimated glomerular filtration rate (eGFR) compared with calcium stone formers (p < 0.001). NLR was significantly higher in uric acid stone formers (p = 0.005), and a significantly negative correlation (p < 0.001) between NLR and eGFR had been observed only in uric acid stone group. Univariate and multivariate logistic regression analyses showed that higher proportion of uric acid stone composition and higher NLR were both significantly associated with CKD risks. A nomogram integrating independent predictors was generated for CKD prediction, yielding an AUC of 0.811 (0.764–0.858). In conclusion, our study demonstrated that stone formers with higher proportion of uric acid composition and higher NLR levels were associated with higher CKD risk.

Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group

“…The risk of ESKD seems to be increased in recurrent symptomatic and asymptomatic, compared with incident, stone formers [ 22 ]. Compared with other stone formers, uric acid stones seem to be more often associated with higher neutrophil to lymphocyte ratio and CKD risk [ 23 ]. The fact that the risk of developing CKD persists even after adjustment for age, sex and metabolic confounders (hypertension, diabetes, hyperlipidaemia and cardiovascular disease) suggests that there might be a direct causal relationship between nephrolithiasis and CKD [ 24 ].…”