Urological Procedures in Urolithiasis and Their Association with Chronic Kidney Disease

Abstract

Background and Objectives: Epidemiological evidence suggests that patients with urolithiasis are at increased risk for end-stage renal disease (ESRD). It is unclear if urological intervention impacts the progression of chronic kidney disease (CKD). Methods:We conducted a retrospective observational cohort study of patients in the Marshfield Epidemiologic Study Area database between January 1991 and May 2007, where 1,340 patients diagnosed with urolithiasis were extracted. Of the 1,340 subjects, 446 had urological procedures for management of urolithiasis. Those that underwent these procedures were compared to those that did not. Cox proportional hazards models adjusted for age, gender, and comorbidities were performed to evaluate the risk for CKD, elevated serum creatinine, and any-cause mortality. Results:Baseline comorbidities in patients with and without procedures were not significantly different except for obesity (P<0.0001). Subjects that underwent procedures were at increased risk for elevated serum creatinine (Hazard Ratio (HR) [95% CI] =1.49 [1.19-1.85]) when compared to those that did not undergo a urologic procedure during the study period. The results did not reveal a significant difference in incidence of CKD or any-cause mortality. Conclusions:Patients who undergo urologic procedures are at increased risk for elevated creatinine. Urological procedures do not appear to impact incidence of CKD or mortality and, in fact, may prevent long-term renal dysfunction. Keywords: Chronic kidney disease; Urolithiasis; Nephrolithiasis; Urological procedures T he burden of urolithiasis has been increasing, with lifetime incidences of 10% for men and 5% for women in recent studies. [1][2][3][4][5] Early clinical observations suggest that certain nephrolithiasis conditions (eg, staghorn calculi) and genetic diseases (eg, primary hyperoxaluria; dental disease; 2,8-hydroxyadenine crystalluria; cystinuria) are leading to progressive loss of epidermal growth factor receptor (eGFR) and end-stage renal disease (ESRD) at a younger age. 6 An increasing number of studies have been done over the past few years concerning the relationship between kidney stones (nephrolithiasis/urolithiasis) and the development of chronic kidney disease (CKD). Clinical Medicine & Research1-7 Kidney stones were found to be a risk factor for CKD in a recent study by a group at the Mayo Clinic in Rochester, MN.3 Alexander et al 7 found that even a single kidney stone episode was associated with a significant increase in the risk of adverse renal outcomes including ESRD, with median follow up of 11 years. A large prospective cohort study of people in the United Kingdom found that kidney stones posed a significant risk for ESRD in women, but not in men. They explained this difference by noting anatomical protection from obstructive complications due to differences in anatomy. 5 Several studies have shown an association between nephrolithiasis and certain comorbidities. More recently, the association between nephrolithiasis and an increased risk of ...

Regression of Renal Failure after Unilateral Simple Nephrectomy

“…However, kidney stones are infrequently implicated as the primary cause of ESRD (0.2-3.2% of all ESRD cases) [3][4][5]. It is unclear if urological intervention impacts the progression of CKD with regards to urolithiasis [2]. Herein, we report a case of CKD and concomitant unilateral kidney stone with ipsilateral nonfunctioning kidney which surprisingly regressed after unilateral simple nephrectomy.…”

“…Chronic kidney disease (CKD) is widely recognized as a significant public health concern [1]. Epidemiological evidence suggests that patients with urolithiasis are at increased risk for end-stage renal disease (ESRD) [2]. However, kidney stones are infrequently implicated as the primary cause of ESRD (0.2-3.2% of all ESRD cases) [3][4][5].…”

Oxalate Content of Enteral Nutrition Formulas

“…Urolithiasis is a debilitating condition (4), frequently recurring, and contributes to reduced health‐related quality of life (5). In some instances, it can result in chronic kidney disease (6), nephrectomy, and even death (7). The management, of urolithiasis whether surgical or medical, costs upwards of $10 billion annually (8).…”