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Renal stone formation in patients with inflammatory bowel disease
R Caudarella1, E Rizzoli, L Pironi
1Istituto di Patologia Medica II e Medicina del Lavoro D. Campanacci, Bologna Italy.
Insights
Patients with inflammatory bowel disease (IBD) have higher kidney stone risk due to lower urinary volume, citrate, and magnesium. These factors are altered differently in Crohn's disease and ulcerative colitis, especially after surgery.
Area of Science:
- Nephrology
- Gastroenterology
- Urology
Background:
- Patients with inflammatory bowel disease (IBD) exhibit a higher incidence of kidney stones compared to the general population.
- Understanding the specific lithogenetic risk factors in IBD is crucial for patient management.
Purpose of the Study:
- To evaluate the primary lithogenetic risk factors in patients with Crohn's disease and ulcerative colitis.
- To compare these factors between pre- and post-operative stages and with healthy individuals.
Main Methods:
- Analysis of urinary parameters including volume, pH, citrate, and magnesium excretion.
- Comparison of risk factors in Crohn's disease and ulcerative colitis patients before and after surgical interventions.
- Stratification of patients based on IBD type and surgical status.
Main Results:
- Patients with IBD show decreased urinary citrate, magnesium, volume, and pH, contributing to kidney stone risk.
- Crohn's disease patients exhibit reduced citrate and magnesium excretion and low urinary volume and pH, which worsen post-surgery.
- Ulcerative colitis patients show reduced citrate and acidic pH pre-surgery; proctocolectomy significantly decreases urinary volume, pH, citrate, and magnesium.
Conclusions:
- IBD patients face a heightened risk of kidney stone formation due to multiple lithogenetic factors, notably reduced urinary volume and inhibitors.
- Urinary volume reduction and decreased small molecular weight inhibitors are consistent findings across IBD patients, indicating significant lithogenic potential.
- Surgical interventions, particularly proctocolectomy, exacerbate stone formation risk in IBD patients by further altering urinary parameters.
Abstract:
Kidney stones are more common in patients with inflammatory bowel disease (IBD) than in the general population. The main lithogenetic risk factors were evaluated in patients affected by Crohn's disease and ulcerative colitis. Our results show the presence of several factors, besides hyperoxaluria, in patients with IBD although their behaviour appears different in Crohn's disease and ulcerative colitis at pre- and post-operative stages. Before surgery in patients with Crohn's disease we found a decreased citrate (p < 0.001) and magnesium (p < 0.005) excretion together with a low urinary volume (p < 0.001) and pH (p < 0.005). After surgery patients with Crohn's disease showed a further reduction of magnesium and citrate. Patients with ulcerative colitis before surgery showed a reduced citrate excretion (p < 0.05) and a more acidic pH (p < 0.05) than healthy subjects. Surgical treatment of proctocolectomy with ileal pouch-anal anastomosis seems to increase the risk of stone formation; in fact, after surgery we observed a relevant decrease of urinary volume (p < 0.001), pH (p < 0.0001) and urinary excretion of citrate (p < 0.0001) as well as magnesium (p < 0.005). Patients with IBD seem to be at greater risk of stone formation than patients with idiopathic calcium lithiasis; in fact, they show a lower excretion of citrate (p < 0.001) and magnesium (p < 0.001) together with a low urinary pH (p < 0.001) and volume (p < 0.001). Urinary volume reduction is probably one of the major risk factors together with the decrease of small molecular weight inhibitors that is a constant finding in all patients with IBD.