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The impact of cystinuria on renal function
Dean G Assimos1, Stephen W Leslie, Christopher Ng
1Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Patients with cystinuria experience worse kidney function and higher risks of renal loss compared to calcium oxalate stone formers. Minimally invasive procedures are recommended for stone removal in cystinuric individuals.
Area of Science:
- Nephrology
- Urology
- Biochemistry
Background:
- Cystinuria patients frequently develop recurrent kidney stones, necessitating multiple procedures that may impair renal function.
- Assessing the long-term impact of cystine stones on kidney function is crucial for patient management.
Purpose of the Study:
- To compare the renal function levels of patients with cystinuria and cystine stone formation against those with calcium oxalate stones.
- To identify factors associated with impaired renal function in cystinuric patients.
Main Methods:
- Analysis of clinical data from 40 cystinuric patients and comparison with 3,964 calcium oxalate stone formers.
- Serum creatinine levels and rates of nephrectomy were compared between the two groups.
Main Results:
- Cystinuric patients exhibited significantly higher mean serum creatinine levels (1.13 vs. 1.01 mg/dL) and a greater percentage with elevated creatinine (5.8% vs. 2.2%) compared to calcium oxalate stone formers.
- Male gender, increased open surgical procedures, and nephrectomy were linked to higher serum creatinine in cystinuric patients.
- A significantly higher proportion of cystinuric patients (14.1%) underwent nephrectomy compared to calcium oxalate stone formers (2.9%).
Conclusions:
- Cystinuric patients face a higher risk of renal function decline and potential kidney loss compared to calcium oxalate stone formers.
- Minimally invasive surgical approaches are advised for stone removal in cystinuria to preserve renal function.
Purpose:
Patients with cystinuria frequently have recurrent renal calculi and may subsequently require multiple stone removing procedures during their lifetime which could have an impact on overall renal function. We determined the potential impact of cystinuria and cystine stone formation on the level of renal function compared to calcium oxalate stone formers.
Materials And Methods:
Clinical data on 40 cystinuric patients followed at 2 medical centers and 45 such individuals in a large stone population data base were analyzed. These results were compared to data on 3,964 calcium oxalate stone formers enrolled in this data base.
Results:
Mean serum creatinine plus or minus standard deviation for stone forming cystinuric patients was significantly higher than that of the calcium oxalate cohort (1.13 +/- 0.28 versus 1.01 +/- 0.28 mg./100 ml., p = 0.0001). A significantly greater percentage of cystinuric patients (5.8%) had an abnormally increased serum creatinine compared to the calcium oxalate stone formers (2.2%, p = 0.046). Male gender, increasing number of open surgical stone removing procedures and nephrectomy were significant variables associated with an increased serum creatinine (p = 0.0010, p = 0.0038, p = 0.0133, respectively). An increasing number of open surgical stone removing procedures had a significant positive correlation with performance of nephrectomy in the cystinuric population (p = 0.0166). A significantly greater percentage of cystinuric patients compared to the calcium oxalate cohort were subjected to nephrectomy (14.1% versus 2.9%, p = 0.007).
Conclusions:
Cystinuric patients have higher serum creatinine levels than calcium oxalate stone formers and they are at more risk for renal loss. When stone removal is required, a minimally invasive approach is preferred.