Declining renal function may predict an increased likelihood of urinary stone development, according to new data presented at the American Urological Association 2020 Virtual Experience.
In a retrospective study of 3450 stone-forming and 112,072 non-stone forming patients, each 1 mL/min/1.73 m2 decline in estimated glomerular filtration rate (eGFR) was associated with a 3.7% increased risk of stone development in the following 2 years in a fully adjusted model, Sudarshan Srirangapatanam, BA, a medical student, and David Bayne, MD, MPH, of the University of California San Francisco, and colleagues reported in a poster presentation.
“This suggests that upstream changes in the renal papilla which affect GFR also may be contributing to mineralization,” the investigators noted. “Kidney function decline could be used as a possible predictive tool for risk of stone formation.”
Stone formers who underwent surgical intervention, such as percutaneous nephrolithotomy, ureteroscopy, and shock wave lithotripsy, had stable eGFR postoperatively at 1 year, whereas those who did not have a surgical intervention experienced an eGFR decline of 0.82 mL/min/1.73 m2 at 1 year.
The investigators estimated GFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Stone formers had an overall eGFR decline of 2.8 mL/min/1.73 m2 per year, whereas non-stone formers had a decline of 0.04 mL/min/1.73 m2 per year.
“Clinically, unexplained GFR decline should increase suspicion for nephrolithiasis and appropriate evaluation and treatment should be considered,” the investigators concluded. “Intervention after the acute event ultimately needs to address upstream changes in the renal papilla to help reduce the high recurrence rates seen by patients.”
Srirangapatanam S, Bayne D, Ahn J, et al. Association of urinary stone disease with kidney function decline. Presented at the American Urological Association 2020 Virtual Experience held in May. Abstract MP03-06