Nephrolithiasis and loss of kidney function

Abstract

Purpose of review: The prevalence of nephrolithiasis has been on the rise over recent decades. There have also been extensive efforts to identify risk factors for chronic kidney disease (CKD). The purpose of this review is to highlight recent evidence on the association of nephrolithiasis with the development of CKD and end-stage renal disease (ESRD).

Recent findings: Several epidemiologic studies over the past decade assessed the relationship between history of nephrolithiasis and CKD. Across several studies, patients with nephrolithiasis had about a two-fold higher risk for decreased renal function or need for renal replacement therapy. This risk appears to be independent of risk factors for CKD that are common in stone formers such as hypertension and diabetes mellitus. Specific risk factors for CKD in stone formers include recurrent urinary tract infections, struvite and possibly uric acid stone composition, symptomatic stones, solitary kidney, ileal conduit, neurogenic bladder, and hydronephrosis.

Summary: Recent evidence has shown a consistent relationship between nephrolithiasis history and an increased risk of CKD and ESRD. Understanding the characteristics that predispose to CKD may better inform how to optimally manage patients with nephrolithiasis and prevent this complication.

FIGURE 1

Forest plot of multivariable adjusted hazard ratios for ESRD risk with nephrolithiasis in various subgroups. Adapted with permission [23^▪▪]. ESRD, end-stage renal disease.

FIGURE 2

The cumulative ESRD incidence in symptomatic stone formers compared to controls. Adapted with permission [14^▪▪]. ESRD, end-stage renal disease.