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Extra risk of renal disease after kidney stones

End-stage renal disease more likely after kidney stones while young

Louise Prime

Friday, 31 August 2012

End-stage renal disease (ESRD) is more likely in people who have previously had kidney stones, especially for women who had them while young, research shows. The study, published today on bmj.com, found that renal problems were significantly more likely among people with a history of at least one episode of kidney stones than among those who had never had stones, for all age and sex groups.

Researchers followed more than 3 million patients in Canada for a median of 11 years, during which time 23,706 of them had at least one kidney stone. Of these, 0.2% subsequently developed ESRD, 0.3% developed sustained doubling of creatinine levels from baseline and 4% developed stage 3b-5 chronic kidney disease (CKD).

Compared with people who had no kidney stones, those who had at least one stone during follow-up were about twice as likely to later suffer sustained doubling of creatinine levels or ESRD (adjusted hazard ratios 1.94 and 2.16 respectively), and more likely to develop stage 3b-5 CKD (hazard ratio 1.74).

The unadjusted rate of adverse renal outcomes in people who had had at least one kidney stone was 2.48 per million person-days, compared with 0.52 per million person-days in those who had never suffered a kidney stone.

Although the increase in risk of renal problems associated with having had kidney stones was small, it was statistically significant even after adjusting for several possible confounding factors. The under-50s and women had a greater excess risk than older patients and men.

The authors suggest that the increase in risk might result from the calcification process involved in stone formation causing later kidney damage, as well progressive scarring from obstruction.

They concluded: “We found a graded association between episodes of kidney stones and the risk of adverse renal outcomes, including ESRD. Further research should be aimed at determining the mechanisms explaining this association and assessing the optimal way to prevent kidney stones in the general population, especially young women.”

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