Patients who present to emergency departments with upper urinary tract stones are at higher risk of urinary tract infection (UTI) and other complications if they have concomitant inflammatory bowel disease (IBD), according to a recent study.
Using the Nationwide Emergency Department Sample (2006–2009), Briony K. Varda, MD, and colleagues at Brigham and Women’s Hospital in Boston, studied 3,587,879 seeking care for upper tract stones. Of these, 14,352 had concomitant IBD and 3,573,527 did not.
IBD patients were significantly more likely than non-IBD patients to present with infections (10.4% vs. 9.1%), sepsis (0.6% vs. 0.2%), and end-organ failure (6.3% vs. 1.6% [5.3% vs. 1.2% for kidney failure]), Dr. Varda’s group reported online ahead of print in Urology. In adjusted analyses, IBD patients had 29% and 79% increased odds of pyelonephritis/cystitis and sepsis and a 3.3-fold increased odds of hospital admission compared with non-IBD patients.
“To our knowledge, our study is the first to identify this particular relationship, and does so on a population level,” Dr. Varda’s group wrote. “It clearly demonstrates the need for better stone prevention efforts as well as pre-emptive procedures for stone eradication in the IBD population to avoid emergent and complicated presentations of acute upper urinary tract stone disease.”
Urolithiasis is a known manifestation of IBD, present in 25%–30% of sufferers, the authors pointed out. Factors associated with IBD that predispose patients to urinary stone formation include metabolic derangements, chronic dehydration, and primary malabsorption.