Urinary stones in subjects with a permanent ileostomy

Kennedy, H.J.; Fletcher, E. W. L.; Truelove, S. C.

doi:10.1002/bjs.1800691111

Cited by 20 publications

(7 citation statements)

References 22 publications

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“…It has been reported that the risk of calculus formation is higher in IBD patients after bowel resection or ileostomy 17–19 . In our study, calculi recurred or worsened after ileostomy, and treatment was difficult in many patients who had undergone surgical treatment for urolithiasis.…”

Section: Discussionmentioning

confidence: 52%

Clinical evaluation of urolithiasis in Crohn's disease

et al. 2009

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Objectives:To investigate the characteristics of urolithiasis associated with Crohn's disease in a Japanese population. Methods: We studied 98 patients with Crohn's disease: 39 with urolithiasis and 59 without urolithiasis. Patients were treated at the Social Insurance Central General Hospital, or at the Toho University Omori, Ohashi, or Sakura Medical Centers. Results: Calculi were more frequent in men (n = 30) than women (n = 9). Mean time from diagnosis of Crohn's disease to diagnosis of calculi was 8.8 years (range 0 to 22 years). Calculi were present on the right side in 19 patients and the left side in 19 patients. Stone were composed of calcium oxalate in nine patients, calcium oxalate and calcium phosphate in two patients, and ammonium urate in five patients. The rate of concurrent calculi was significantly higher in ileostomates. The probability of developing calculi was approximately eight times higher for patients with a urine pH of Յ6.0 than for those with a urine pH of Ն6.5. Conclusions: The rate of concurrent urolithiasis was higher in patients with a urine pH of Յ6.0, ileostomy, or two or more bowel resections. To prevent formation of calculi, Crohn's disease patients require regular urological examination including urinalysis, ultrasonography, and kidney ureter bladder X-ray.

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Section: Discussionmentioning

confidence: 52%

Clinical evaluation of urolithiasis in Crohn's disease

et al. 2009

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“…There was no significant change in haematocrit or platelet count and the neutrophil leucocytosis incurred was within the range expected for a marathon run (Maughan, 1983). DISCUSSION A wide range of sporting activities are undertaken by ileostomates (Kennedy et al, 1982) who are encouraged by their medical advisers to lead a full life. Running is an ideal sport for the ileostomate as it allows sustained aerobic exercise and competition without physical contact.…”

Section: Ileostomy Outputmentioning

confidence: 76%

“…Ileostomates in general tend to be a cautious, possibly introverted group (Kennedy et al, 1982) and may therefore be more likely than the average person to follow medical advice. Diet should pose few problems (Gazzard et al, 1978;Thomson et al, 1970).…”

Section: Ileostomy Outputmentioning

confidence: 99%

“…After colectomy and ileostomy for ulcerative colitis, an ileostomate is very likely to return to work and full physical activities (Daly, 1968;Mlorowitz and Kirsner, 1981;Ritchie, 1971) including a wide range of sports (Daly, 1968;Kennedy et al, 1982). However, many studies have shown that states of mild or borderline salt depletion are very common in these people despite their apparent health (Clarke et al, 1967;Hill et al, 1975;Turnberg et al, 1978;Newton et al, 1982;Haalboom et al, 1983;Kennedy et, al, 1983).…”

Section: Introductionmentioning

confidence: 99%

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Marathon without a colon: salt and water balance in endurance running ileostomates.

Isaacs¹

1984

Br J Sports Med

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Five trained ileostomates completed a marathon in a cool environment without ill effect. During the race, the ileostomy losses of sodium (1.0-2.7 mmol.h-1 ) and of water (9.2-19 mI.X1 ) were small, but urinary excretion of sodium was very low (0.2-0.75 mmol.hl ) despite drinking a combination of water and glucose-electrolyte solution. The concentration of potassium in the ileostomy discharge tended to increase, also suggesting a sodium retaining state. Healthy ileostomates after suitable training are successful marathon runners, but the prevalence of mild salt depletion in ileostomates generally suggests that it may be advisable for them to take only glucose-electrolyte solutions when competing at any ambient temperature or when preparing for a marathon which is to take place in a warm environment.

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“…About 5-25% of patients with IBD develop kidney stones, which tend to increase further after bowel resection and ileostomy diversion [87][88][89][90][91]. Other reviews in this series describe the pathogenesis of the more commonly occurring calcium oxalate and uric acid calculi in these diseases.…”

Section: Ammonium Urate Stonesmentioning

confidence: 97%

Miscellaneous Stone Types

Cutrell

Reilly

2011

Clinic Rev Bone Miner Metab

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Drug-induced calculi and other rare stone types, such as ammonium acid urate or protein matrix stones, represent only about 2% of all renal calculi. However, the chance to easily reverse stone formation risk by discontinuing the offending drug makes identification of these entities important for clinicians. Additionally, study of these rare stone types contributes to understanding the biochemistry of stone formation. Drug-induced calculi may be classified into two groups based on the mechanism of stone formation. The first group includes drugs that provoke calculi composed of principally the drug and its metabolites. These medications tend to be poorly soluble, highly excreted in urine, and required at high dosages for long durations of therapy. Historically, sulfonamides, triamterene, and the HIV protease inhibitor indinavir were leading causes of drug-induced calculi. Uses of novel agents within these drug classes or alternative therapies have reduced the incidence attributed to these drugs, although risk from newer, commonly used medications-notably ciprofloxacin, aminopenicillins, ceftriaxone, ephedrine, and guaifenesinare increasingly being recognized. Microscopic analysis for crystalluria or infrared spectroscopy of collected stones aid in recognition of calculi composed primarily of a drug and its metabolites. Understanding of drug metabolism and pharmacokinetics, particularly related to effects of urine pH on drug solubility and excretion, provides a rational basis for both prevention and treatment recommendations. When possible, clinicians should avoid or exercise great caution when prescribing these medications to patients with a prior history of stones. The second group of drug-induced calculi includes drugs that cause stones due to their metabolic effects, primarily on calcium or purine metabolism. Because these calculi are identical in physical composition to the more common nephrolithiasis types, careful medication history and high clinical suspicion are required for diagnosis of these drug-induced ''metabolic'' calculi. Most drugs in this class are readily expected based on their effects on urinary calcium excretion such as calcium/Vitamin D supplements and loop diuretics. Carbonic anhydrase inhibitors, including the antiepileptics topiramate and zonisamide, are also included in this group. Ammonium acid urate stones are endemic in developing countries due to dietary limitations and recurrent diarrheal illness, but rarely occur in developed countries. Identification of these stones should raise clinical suspicion of epidemiologic risk factors including recurrent urinary tract infections with urea-splitting organisms, inflammatory bowel disease, and laxative abuse. Interestingly, these unusual clinical scenarios can recapitulate a common biochemical pathway to stone formation. Protein matrix stones are another unusual stone type associated with specific epidemiologic factors, namely recurrent urinary infections and proteinuric end-stage renal disease. Although distinctly rare, protein matrix stones ...

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Urinary stones in subjects with a permanent ileostomy

Cited by 20 publications

References 22 publications

Clinical evaluation of urolithiasis in Crohn's disease

Clinical evaluation of urolithiasis in Crohn's disease

Marathon without a colon: salt and water balance in endurance running ileostomates.

Miscellaneous Stone Types

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