Recurrent nephrolithiasis and loss of kidney function: a cohort study

Abstract

Purpose: To evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function.

Methods: Adults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period.

Results: 240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% (n = 42) had worsening GFR, with the average change in GFR of - 8.64 ml/min/1.73 m² per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% (n = 35) had calcium oxalate stones. Univariate analysis showed older patients (p < 0.001), more symptomatic stone episodes (p < 0.001) and non-calcium-containing stones (p < 0.001) were strongly associated with deteriorating kidney function. Age (p = 0.002) and number of acute stone episodes (p = 0.011) were significant predictive factors when unadjusted to co-morbidities. Age (p = 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was - 2.83/min/1.73 m² per year.

Conclusions: Recurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.

Keywords: Chronic kidney disease; GFR slope; Nephrolithiasis; Renal calculi.

Fig. 1

Sampling of the cohort presented to emergency department with at least two confirmed symptomatic episodes of nephrolithiasis from ICD-10 Coding

Fig. 2

Scatterplot demonstrating the average eGFR slope for 240 patients calculated from serum creatinine at baseline to the end of data collection (December 2019). Each point (blue) represents an eGFR value. The solid (red) line is the average eGFR slope which is − 2.83 ml/min/1.73 m² per year. The mean eGFR slope in healthy subjects is − 1.07 ± 0.42 ml/min/1.73 m² per year [10]