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Clinical characteristics of potential kidney donors with asymptomatic kidney stones
Elizabeth C Lorenz1, John C Lieske, Terri J Vrtiska
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Insights
Asymptomatic kidney stones present differently than symptomatic ones, often lacking common comorbidities. This suggests distinct causes for stone formation versus passage.
Area of Science:
- Nephrology
- Urology
- Radiology
Background:
- Symptomatic kidney stones are linked to older age, male gender, white race, hypertension, obesity, metabolic syndrome, and chronic kidney disease.
- Characteristics of asymptomatic kidney stones remain largely unknown.
Purpose of the Study:
- To compare the demographic and comorbidity profiles of individuals with asymptomatic kidney stones versus those without.
- To investigate differences in stone burden between individuals with and without a history of symptomatic kidney stones.
Main Methods:
- Retrospective analysis of 1957 potential kidney donors who underwent computed tomography (CT) scans.
- Radiographic assessment for renal abnormalities, including kidney stones.
- Comparison of comorbidities and stone characteristics between groups.
Main Results:
- 11% of potential donors had radiographic stones, with 10% having only asymptomatic stones.
- Asymptomatic stone formers were more likely white, had low urine volumes, and showed specific renal imaging findings (e.g., parenchymal thinning, scarring, medullary sponge kidney, polycystic kidney disease).
- Asymptomatic stone formers did not exhibit common comorbidities associated with symptomatic stones. Those with past symptomatic stones had more stones but a significantly larger maximum stone diameter.
Conclusions:
- Asymptomatic kidney stone formers possess distinct demographic and comorbidity profiles compared to symptomatic stone formers.
- The findings suggest potentially different pathophysiological mechanisms underlying asymptomatic stone formation versus symptomatic stone passage.
Background:
Patients with symptomatic kidney stones are characterized by older age, male gender, white race, hypertension, obesity, metabolic syndrome and chronic kidney disease. Whether these characteristics differ in patients with asymptomatic kidney stones is unknown.
Methods:
All potential kidney donors who underwent protocol computed tomography angiograms/urograms (2000-08) at the Mayo Clinic were identified. Renal abnormalities, including kidney stones, were assessed radiographically. Comorbidities, including past symptomatic kidney stones, were abstracted from the medical record. Characteristics of persons with and without radiographic stones were compared. Stone burden among persons with and without past symptomatic stones was compared.
Results:
Among 1957 potential kidney donors, 3% had past symptomatic stones and 11% had radiographic stones (10% had only asymptomatic radiographic stones). Asymptomatic stone formers were more likely to be of white race, have low urine volumes and have radiographic findings of renal parenchymal thinning, focal renal scarring, medullary sponge kidney and polycystic kidney disease. Asymptomatic stone formers were not characterized by older age, male gender, hypertension, obesity, metabolic syndrome, abnormal kidney function, hyperuricemia, hypercalcemia or hypophosphatemia. Among persons with radiographic stones, those with past symptomatic stones had a slightly higher number of stones (mean 2.7 versus 2.4; P = 0.04), but a much greater diameter for the largest stone (mean 4.8 versus 1.6 mm; P < 0.001).
Conclusions:
Asymptomatic kidney stone formers have different demographic characteristics and many lack the comorbidities that have been described in persons with symptomatic kidney stones. These findings suggest that different pathophysiologic mechanisms could be involved in asymptomatic stone formation versus symptomatic stone passage.
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