Maeda S et al, 2011: Chronic kidney disease in urolithiasis patients following successful extracorporeal shockwave lithotripsy
Maeda S, Naganuma T, Takemoto Y, Shoji T, Okamura M, Nakatani T.
Department of Urology, Metabolism and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
Recently, it has been reported that kidney stones are a significant and independent risk factor for chronic kidney disease (CKD) in the general population. However, the prevalence of CKD in patients following successful extracorporealshockwave lithotripsy (ESWL) has yet to be elucidated. In the present study, the prevalence of CKD and the clinical factors associated with the presence of CKD in patients following successful ESWL were investigated. A cross‑sectional study was performed in 114 patients who had undergone ESWL for upper urinary tract stones and 96 age- and gender-matched healthy control subjects. We initially determined the stage of CKD and compared the prevalence of CKD between healthy subjects and patients who underwent successful ESWL. We then investigated the clinical factors associated with the presence of CKD by logistic regression analysis. The prevalence of CKD was significantly higher in patients following successful ESWL than in the healthy subjects [40 patients (35.1%) vs. 9 healthy controls (9.4%), P<0.0001]. Logistic regression analysis showed that the significant factors associated with the presence of CKD were increased body mass index (BMI) and the presence of a ureteric stone (pre‑ESWL stone position). The findings indicated that there was a high prevalence of CKD among patients following successful ESWL, and that an increased BMI and a ureteric stone were factors associated with the presence of CKD.
Mol Med Report. 2012 Jan;5(1):3-6. doi: 10.3892/mmr.2011.586. Epub 2011 Sep 13
PMID: 21922140 [PubMed - in process]
When reading the title of this article the impression is that intention of the study was to show whether a successful ESWL treatment increased the risk of developing chronic kidney disease (CKD) nor not. Careful interpretation of the results showed, however, that the risk factors for CKD were high age, high BMI and stones located in the ureter (that is with an obvious risk of causing obstruction). In contrast neither multiple ESWL sessions nor stone size differed significantly between patients with and without CKD. Inasmuch as patients treated for stones in the kidney did not have an increased occurrence of CKD, it is likely that the development of CKD is directly related to the stone disease itself and to the possible negative effect on the renal function by a period of ureteral obstruction.
Further studies should compare not only different stone removing procedures, but also how the renal function is affected in patients with spontaneous stone passage.