Stone Prevalence in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> It is uncertain how often patients with autosomal dominant polycystic kidney disease (ADPKD) develop kidney stones. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> To review English-language studies reporting the incidence and prevalence of stones and stone interventions in adults with ADPKD. </jats:p></jats:sec><jats:sec><jats:title>Design:</jats:title><jats:p> Systematic review and meta-analysis. </jats:p></jats:sec><jats:sec><jats:title>Setting:</jats:title><jats:p> Any country of origin. </jats:p></jats:sec><jats:sec><jats:title>Patients:</jats:title><jats:p> Adult patients with ADPKD. </jats:p></jats:sec><jats:sec><jats:title>Measurements:</jats:title><jats:p> Incidence or prevalence of kidney stones and stone interventions. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We reviewed 1812 citations from bibliographic databases, abstracted data from 49 eligible studies, and assessed methodological quality in duplicate. In some studies, the proportion of adults with ADPKD with the outcome were compared to adults without ADPKD; for these studies, prevalence risk ratios were calculated and pooled using a random effects model. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> We identified 49 articles that met our review criteria. The methodological quality of many studies was limited (scores ranging from 2 to 14 out of 22, with a higher score indicating higher quality). No study clearly reported stone incidence, and in the cross-sectional studies, the definition of stones was often unclear. The prevalence of stones ranged from 3% to 59%, and a prevalence of stone interventions ranged from 1% to 8%; the average patient age at the time of assessment ranged from 26 to 61 years across the studies. Two studies reported a nonstatistically significant higher stone prevalence in patients with ADPKD compared to unaffected family members. Compared to unaffected family members, patients with ADPKD had a higher prevalence of kidney stones (6 cross-sectional studies; unadjusted prevalence ratio: 1.8; 95% confidence interval: 1.3 to 2.6; P = .0007; test for heterogeneity: I<jats:sup>2</jats:sup> = 0%, P = .8). </jats:p></jats:sec><jats:sec><jats:title>Limitations:</jats:title><jats:p> Studies were limited to articles published in English. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The prevalence of kidney stones and stone interventions in adults with ADPKD remains uncertain. Future studies of higher methodological quality are needed to better characterize the incidence and prevalence of kidney stones in patients with ADPKD. </jats:p></jats:sec><jats:sec><jats:title>Trial registration:</jats:title><jats:p> We did not register the protocol for this systematic review. </jats:p></jats:sec>

Polycystic Renal Disease Presented by Anuria and Nephrolithiasis Associated Progressive Kidney Damage: A Case Report

“…1 Kidney stones develop in 20-30% of patients with ADPKD and urinary stones are usually treated with conservative methods (urinary alkalinization, spontaneous stone passage, extracorporeal shock wave etc.). 2,3 Uric acid stones and calcium oxalate stones are the most frequently detected stones and seen in similar proportions. 4 Hydronephrosis, which is the most valuable radiological finding in the diagnosis of stone-related postrenal insufficiency, may be difficult to differentiate from common cysts in ADPKD patients.…”

“…In cases with urolithiasis, the rate of patients who undergo interventional treatment is between 1-8%, but there is no meaningful data on the rate of stonerelated interventions in adults with ADPKD. 2,7 Stone-related pain in ADPKD can be confused with pain due to cyst rupture. However, it should be considered in patients with acute GFR losses under chronic follow-up, as in our case, and advanced imaging with low-dose non-contrast CT should definitely be performed in these patients if the diagnosis cannot be made by US.…”

“…1 Kidney stones develop in 20-30% of patients with ADPKD and urinary stones are usually treated with conservative methods (urinary alkalinization, spontaneous stone passage, extracorporeal shock wave etc.). 2,3 Uric acid stones and calcium oxalate stones are the most frequently detected stones and seen in similar proportions.4 Hydronephrosis, which is the most valuable radiological finding in the diagnosis of stone-related postrenal insufficiency, may be difficult to differentiate from common cysts in ADPKD patients. 3 When kidney dysfunction develops in ADPKD patients, glomerular filtration rate (GFR) loss reaches an average of 4.4 to 5.9 mL/min per year.1 Faster deterioration in these patients requires investigation for prerenal factors such as dehydration that triggers acute kidney damage or stone-related postrenal factors.…”

“…3 When kidney dysfunction develops in ADPKD patients, glomerular filtration rate (GFR) loss reaches an average of 4.4 to 5.9 mL/min per year.1 Faster deterioration in these patients requires investigation for prerenal factors such as dehydration that triggers acute kidney damage or stone-related postrenal factors. 2 In ADPKD, stone-related postrenal obstruction should be considered in rapid GFR losses despite negative ultrasound report for hydronephrosis as there is frequent occurrence of kidney stones and the difficulty in detecting hydronephrosis with ultrasonography (US) in these patients. 5 Here, we presented a case of ADPKD who developed stone-related renal dysfunction during chronic follow-up, and renal function improved after the intervention.…”

“…After development of the renal failure in ADPKD, progression is usually rapid and varies according to genetic and clinical risk factors.6 It should be kept in mind that stones are observed with high frequency in these patients and unexplained accelerated progression in deterioration may be caused by obstruction in the urinary system. 2,7 Cysts in both kidneys that disrupt the normal anatomy can easily be confused with pelvic enlargement due to obstruction. Therefore, in patients with a diagnosis of ADPKD who are investigated for postrenal kidney failure, pelvic enlargement may not be differentiated by US because of the abundant cysts.…”