By creator to www.renalandurologynews.com
Kidney stones develop in roughly 2% of first-time kidney transplant recipients inside Three years following transplantation, a price that’s “not uncommon,” based on investigators.
“Kidney stone occasions in sufferers who obtain a kidney transplant are consequential,” Calyani Ganesan, MD, MS, of Stanford College in Palo Alto, California, and colleagues wrote within the Medical Journal of the American Society of Nephrology. “Sufferers might not expertise renal colic resulting from a denervated kidney allograft, which may result in the event of bigger stones or undetected urinary tract obstruction.”
Utilizing the US Renal Information System (USRDS), Dr Ganesan’s staff studied 83,535 recipients of their first kidney transplant throughout 2007-2018. Of those, 1436 (1.7%) have been recognized with kidney stones inside Three years of transplantation. A historical past of kidney stones within the recipient was the strongest threat issue for post-transplantation stone incidence. Kidney stone threat considerably elevated 4.7-fold amongst these with vs with out a historical past.
Longer dialysis classic was one other predisposing issue. In contrast with sufferers on dialysis for lower than 2.5 years, these on dialysis for a minimum of 2.5 years however lower than 5 years had a big 1.2-fold elevated threat for kidney stones. These on dialysis for five to 9 years and greater than 9 years had vital 1.3-, and 1.5-fold elevated dangers for kidney stones, respectively. Peritoneal dialysis was considerably related to a 1.2-fold larger threat of stones in contrast with hemodialysis. The investigators recommended that post-transplantation hyperparathyroidism and hypercalcemia might underlie this affiliation.
Gout and hypertension considerably elevated the danger for stones by 1.5- and 1.3-fold, respectively. Older age and feminine intercourse have been different contributing components. The investigators discovered no affiliation between prescription of cinacalcet, thiazide and thiazide-type diuretics, or allopurinol and the danger of a kidney stone occasion.
The proportion of deceased-donor and living-donor transplant recipients recognized with a kidney stone was 1.8% and 1.5%, respectively.
Total, a kidney stone occasion occurred in 7.Eight per 1000 person-years. An earlier USRDS research documented a price of 0.69 per 1000 person-years from 1994-1998. The investigators recommended that larger charges of imaging or monitoring would possibly account for the rise, or the discovering might correlate with the rise in kidney stone incidence within the common US inhabitants.
The investigators defined that kidney transplant recipients are immunosuppressed and due to this fact extra vulnerable to stone-related urinary tract infections, difficult pyelonephritis, and urosepsis. Such infections might drive clinicians to lower immunosuppression, which raises the danger for allograft rejection, they famous.
Dr Ganesan’s staff advisable that new kidney transplant recipients be evaluated for kidney stone threat components, significantly within the first yr. This might embrace metabolic testing with 24-hour urine assortment, dietary counseling, prescription of stone-related drugs, periodic imaging, and medical or surgical therapy for post-transplant hyperparathyroidism.
Disclosure: Some research authors declared affiliations with biotech, pharmaceutical, and/or gadget corporations. Please see the unique reference for a full record of authors’ disclosures.
Ganesan C, Holmes M, Liu S, et al. Kidney stone events after kidney transplant in the United States. Clin J Am Soc Nephrol. Printed on-line April 18, 2023. doi:10.2215/CJN.0000000000000176