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[Urolithiasis associated with Crohn's disease: a case report]
K Shiraishi1, M Yamamoto, K Takai
1Department of Urology, Yamaguchi University School of Medicine.
Hinyokika Kiyo. Acta Urologica Japonica
|December 16, 1998
Summary
This case study highlights a patient with Crohn's disease who developed kidney stones (urolithiasis) after intestinal surgery. Effective management involved surgical stone removal and strict dietary changes to prevent recurrence.
Area of Science:
- Nephrology
- Gastroenterology
- Urology
Background:
- Crohn's disease, an inflammatory bowel condition, can necessitate extensive surgical interventions.
- Previous jejuno-ileal resection in a patient with Crohn's disease predisposed to complications.
Observation:
- A 28-year-old female presented with bilateral renal stones and elevated urinary oxalate levels post-intestinal surgery.
- Initial treatments including extracorporeal shock wave lithotripsy and medical management failed to prevent stone recurrence and enlargement.
Findings:
- Surgical intervention (transurethral lithotomy and percutaneous nephrolithotripsy) was required for stone removal.
- Renal biopsy revealed calcium oxalate monohydrate stones with crystal deposition in renal tubules.
- Aggressive medical and dietary management (low oxalate, low fat, alkalinization) successfully prevented stone recurrence for 10 months post-operatively.
Implications:
- This case underscores the link between extensive bowel resection in Crohn's disease and the development of secondary urolithiasis.
- Comprehensive management strategies combining surgical intervention with long-term medical and dietary adjustments are crucial for patients with complex urolithiasis.
- Understanding the pathophysiology of oxalate stone formation in post-surgical Crohn's disease patients is vital for preventing renal damage.