Urolithiasis in complicated inflammatory bowel disease: a comprehensive analysis of urine profile and stone composition
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UROLOGY - ORIGINAL PAPER
Urolithiasis in complicated inflammatory bowel disease: a comprehensive analysis of urine profile and stone composition Fabio C. Torricelli1 · Chad Reichard2 · Manoj Monga3 Received: 5 August 2020 / Accepted: 8 September 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate the impact of extensive surgery on urine profile, serum exams and stone composition of complicated IBD patients. Methods Patients with IBD and a history of total proctocolectomy (TPC) with fecal diversion (end ileostomy or ileal pouch anal anastomosis—IPAA) were selected. Only patients with at least one complete 24-h urine profile were included. A case– control study was performed selecting patients with kidney stone disease in a random way who had also at least on complete 24-h urine profile. Case and controls were matched for age, gender, and body mass index (BMI). Groups were compared to urine profile, serum exams and stone composition. Results Sixty-eight patients were enrolled in this study, 34 patients with IBD who underwent TPC and had diagnosis of kidney stones and 34 matched patients with only kidney stones. IBD patients had a significantly lower urine volume, urine citrate and urine sodium. Regarding serum exams, only serum bicarbonate was statistically significant lower. In both groups, calcium oxalate stone was the most common. Conclusion Patients with IBD with TPC and kidney stones have a low urine volume and low urine citrate as main risk factors for kidney stone formation. As seen in the general population, calcium oxalate is the most common stone composition. Keywords Inflammatory bowel disease · Kidney · Lithotripsy · Urinary calculi
Introduction Inflammatory bowel disease (IBD), which primarily includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory condition that affects more than 1.4 million people in the United States [1]. Urolithiasis has an established association with IBD; historical studies show the rates of symptomatic stone formation is about two to threefold higher in IBD patients than general population [2, 3]. A small study by Cury et al. suggested that the rates of asymptomatic urolithiasis may be as high as 38% in IBD patients [4]. * Manoj Monga [email protected] 1
Department of Urology, University of Sao Paulo Medical School, São Paulo, SP, Brazil
2
Department of Urology, University of Indiana, Indianapolis, IN, USA
3
Department of Urology, University of California, 200 W. Arbor Drive, MC8897, San Diego, CA 92103‑8897, USA
For IBD cases that are refractory to medical therapy (with anti-inflammatory agents, immunomodulators, antibiotics and biologics), surgery remains the only option for management of IBD with approximately 30% of the patient population eventually requiring colectomy [5–7]. Data also reinforce the fact that elevated risk of urolithiasis continues even after surgery for IBD. In fact, an Australian study suggests that post-surgical patients with UC may have double the risk for stone formation [8]. Following tota
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