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The prevalence of nephrolithiasis in patients with primary gout: a cross-sectional study using helical computed
1Department of Rheumatology and Department of Radiology, Midorigaoka Hospital, Osaka, Japan.
Insights
Computed tomography (CT) revealed a 26.9% prevalence of kidney stones in gout patients, significantly higher than historical reports. Patient history alone is insufficient for accurate urolithiasis prevalence assessment in gout.
Area of Science:
- Nephrology
- Radiology
- Urology
Background:
- Gout is a metabolic disorder associated with an increased risk of kidney stones (nephrolithiasis).
- Accurate prevalence data for nephrolithiasis in gout patients is crucial for effective management.
- Relying solely on patient history may underestimate the true prevalence of urolithiasis.
Purpose of the Study:
- To determine the prevalence of nephrolithiasis in male patients with primary gout using computed tomography (CT).
- To compare CT-identified nephrolithiasis prevalence with urolithiasis prevalence derived from patient medical histories.
- To highlight the discrepancy between imaging-confirmed and history-reported urolithiasis in gout patients.
Main Methods:
- A cohort of 383 male patients with primary gout underwent unenhanced 2-row helical CT scans of the kidneys.
- Urolithiasis history was collected through patient inquiry.
- Demographic data, body mass index, and laboratory results were recorded.
Main Results:
- CT scans detected nephrolithiasis in 26.9% (103/383) of gout patients.
- Only 17.0% (65/383) of patients reported a history of urinary tract calculus.
- A significant proportion (62%) of patients with CT-confirmed stones had no prior history of urolithiasis.
Conclusions:
- The actual prevalence of nephrolithiasis in primary gout patients is 26.9%, as confirmed by CT imaging.
- Patient history is an unreliable method for assessing urolithiasis prevalence in gout.
- Distinguishing between imaging-confirmed prevalence and history-based cumulative incidence is essential for accurate epidemiological understanding.
Objective:
To investigate the prevalence of nephrolithiasis in gouty patients by computed tomography (CT) imaging and to compare it with the "prevalence" of urolithiasis calculated from histories of urinary tract calculus.
Methods:
The kidneys of 383 male patients with primary gout were examined using an unenhanced 2-row helical CT detector, imaging at 2 mm collimation and a helical pitch of 3. The urolithiasis history of the 383 patients was investigated by inquiry. Patients' ages, body mass index, and laboratory data from a 1-hour clearance test were determined.
Results:
CT scans confirmed nephrolithiasis in 103 (26.9%, 95% confidence interval 22.5%-31.6%) of the 383 gouty patients, and history of urinary calculus was positive in 65 (17.0%, 95% confidence interval 13.4%-21.1%) of the 383. However, 64 (62%) of the 103 stone-formers identified by CT had no history of urolithiasis. There was a significant difference between the ages of the 103 stone-formers identified by CT and the 65 stone-formers identified from the history.
Conclusion:
The prevalence of nephrolithiasis obtained using CT was 26.9% in the 383 patients with primary gout. Our results imply that we cannot determine an accurate prevalence of urolithiasis from a patient's history. Most of the "prevalence" reported in the past may not correspond to a statistically justifiable one, but instead to the "cumulative incidence" during the contraction period of gout. Thus, the prevalence of nephrolithiasis confirmed by a cross-sectional method and the "prevalence" of urolithiasis calculated from patients' calculus histories should be clearly distinguished.
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