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Fu W, Zhu B, Chen J, Jin X. Risk relationship between inflammatory bowel disease and urolithiasis: A two-sample Mendelian randomization study. PLoS One 2024; 19:e0301545. [PMID: 38593126 PMCID: PMC11003619 DOI: 10.1371/journal.pone.0301545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/17/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The causal genetic relationship between common parenteral manifestations of inflammatory bowel disease (IBD) and urolithiasis remains unclear because their timing is difficult to determine. This study investigated the causal genetic association between IBD and urolithiasis using Mendelian randomization (MR) based on data from large population-based genome-wide association studies (GWASs). METHODS A two-sample MR analysis was performed to assess the potential relationship between IBD and urolithiasis. Specific single nucleotide polymorphism data were obtained from GWASs, including IBD (n = 59957) and its main subtypes, Crohn's disease (CD) (n = 40266) and ulcerative colitis (UC) (n = 45975). Summarized data on urolithiasis (n = 218792) were obtained from different GWAS studies. A random-effects model was analyzed using inverse-variance weighting, MR-Egger, and weighted medians. RESULTS Genetic predisposition to IBD and the risk of urolithiasis were significantly associated [odds ratio (OR), 1.04 (95% confidence interval [CI], 1.00-.08), P = 0.01]. Consistently, the weighted median method yielded similar results [OR, 1.06 (95% CI, 1.00-1.12), P = 0.02]. The MR-Egger method also demonstrated comparable findings [OR, 1.02 (95% CI, 0.96-1.08), P = 0.45]. Both funnel plots and MR-Egger intercepts indicated no directional pleiotropic effects between IBD and urolithiasis. CD was strongly associated with it in its subtype analysis [OR, 1.04 (95% CI, 1.01-1.07), P = 0.01], and UC was also causally associated with urolithiasis, although the association was not significant [OR, 0.99 (95% CI, 0.95-1.03), P = 0.71]. CONCLUSION A unidirectional positive causal correlation was identified between IBD and urolithiasis, with varying degrees of association observed among the different subtypes of IBD. Recognizing the increased incidence of urolithiasis in patients with IBD is crucial in clinical practice. Early detection and surveillance of IBD, improved patient awareness, adoption of preventive strategies, and promotion of collaborative efforts among healthcare providers regarding treatment methodologies are vital for improving patient outcomes.
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Affiliation(s)
- Wenqiang Fu
- Affiliated Hospital, Anorectal, Panzhihua University, Panzhihua, Sichuan, China
| | - Bin Zhu
- Outpatient Department, Tibet Military Region General Hospital of PLA, Lhasa, China
| | - Jun Chen
- Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Xuelin Jin
- Affiliated Hospital, Anorectal, Panzhihua University, Panzhihua, Sichuan, China
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Abdulrhman A, Alsweed A, Alotaibi MR, Aldakhil AY, Alahmadi SF, Albishri SM, Alhmed NI. Urolithiasis in patients with inflammatory bowel disease: A systematic review and meta-analysis of 13,339,065 individuals. Medicine (Baltimore) 2023; 102:e33938. [PMID: 37327280 PMCID: PMC10270553 DOI: 10.1097/md.0000000000033938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/16/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND This study aimed to summarize the current literature regarding the prevalence of renal stones in patients with inflammatory bowel disease (IBD). Moreover, we aimed to evaluate the risk factors of urolithiasis in patients with IBD and the difference between patients with IBD and healthy controls in terms of urinary profile. METHODS On February 23, 2022, a computerized search was conducted on PubMed, OVID via MEDLINE, Web of Science, and Scopus using relevant keywords. Three independent reviewers performed 2-stage screening and data extraction. The National Institutes of Health tools were employed for quality assessment. Review Manager 5.4 software was used to calculate the mean difference (MD) between IBD patients and non-IBD in terms of urine profile using the Inverse-variance model and to estimate the odds ratio of reported risk factors for renal stones with the Generic Inverse-Variance model. RESULTS Thirty-two articles (n = 13,339,065 patients) were included. The overall prevalence of renal stones in patients with IBD was 6.3%, 95% Confidence interval (4.8%-8.3%). The prevalence of urolithiasis was more common in Chron's disease vs Ulcerative colitis (7.9% vs 5.6%) and in old studies (1964-2009) than in more recent studies (2010-2022) (7.3% vs 5.2%), respectively. Compared to non-IBD patients, patients with IBD were associated with significantly lower urine volume (MD = -518.84 mL/day, P < .00001), calcium 24-hour urine (MD = -28.46 mg/day, P < .0001), citrate 24-hour urine (MD = -144.35 mg/day, P < .00001), sodium 24-hour urine (MD = -23.72 mg/day, P = .04), and magnesium 24-hour urine (MD = -33.25 mg/day, P < .00001). CONCLUSION The overall prevalence of renal stones in patients with IBD was comparable to the general population. Patients with Chron's disease were associated with a higher prevalence of urolithiasis compared to Ulcerative colitis. Drugs that induce renal calculi should be stopped in high-risk patients.
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Affiliation(s)
- Aldukhayel Abdulrhman
- Department of Family and Community Medicine, Qassim University, College of Medicine, Buraidah, Saudi Arabia
| | - Adil Alsweed
- PHC Physician, Ministry of Health, Qassim, Saudi Arabia
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Kumar S, Pollok R, Goldsmith D. Renal and Urological Disorders Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022:6658535. [PMID: 35942657 PMCID: PMC10393213 DOI: 10.1093/ibd/izac140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 12/15/2022]
Abstract
Renal and urinary tract complications related to inflammatory bowel disease (IBD) have been relatively understudied in the literature compared with other extraintestinal manifestations. Presentation of these renal manifestations can be subtle, and their detection is complicated by a lack of clarity regarding the optimal screening and routine monitoring of renal function in IBD patients. Urolithiasis is the most common manifestation. Penetrating Crohn's disease involving the genitourinary system as an extraintestinal complication is rare but associated with considerable morbidity. Some biologic agents used to treat IBD have been implicated in progressive renal impairment, although differentiating between drug-related side effects and deteriorating kidney function due to extraintestinal manifestations can be challenging. The most common findings on renal biopsy of IBD patients with renal injury are tubulointerstitial nephritis and IgA nephropathy, the former also being associated with drug-induced nephrotoxicity related to IBD medication. Amyloidosis, albeit rare, must be diagnosed early to reduce the chance of progression to renal failure. In this review, we evaluate the key literature relating to renal and urological involvement in IBD and emphasize the high index of suspicion required for the prompt diagnosis and treatment of these manifestations and complications, considering the potential severity and implications of acute or chronic loss of renal function. We also provide suggestions for future research priorities.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - David Goldsmith
- Renal and Transplantation Department, Guys and St Thomas' Hospitals NHS Foundation Trust, Great Maze Pond, London, UK
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Ukashi O, Barash Y, Klang E, Zilberman T, Ungar B, Kopylov U, Ben-Horin S, Veisman I. Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection. J Clin Med 2022; 11:jcm11051359. [PMID: 35268450 PMCID: PMC8911438 DOI: 10.3390/jcm11051359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Correspondence: ; Tel.: +972-35-305-000; Fax: +972-35-304-408
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Tal Zilberman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
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Herbert J, Teeter E, Burstiner LS, Doka R, Royer A, Owings AH, Liu J, Glover SC, Hosseini-Carroll P. Urinary manifestations in African American and Caucasian inflammatory bowel disease patients: a retrospective cohort study. BMC Urol 2022; 22:1. [PMID: 34983468 PMCID: PMC8728902 DOI: 10.1186/s12894-021-00951-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Inflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn’s disease (CD), are associated with urinary extra-intestinal manifestations, like urolithiasis and uncomplicated urinary tract infections (UTIs). The literature reviewed for this study identifies an increased association of CD and urolithiasis against the general population as well as UC. Furthermore, the rates in which urinary comorbidities manifest have not been well characterized in cross-race analyses. The purpose of this study is to establish the prevalence of common urinary extra-intestinal manifestations in CD and UC and to further determine at what rate these affect the African American and Caucasian populations. Methodology This is a retrospective cohort study using de-identified data collected from a research data base that included 6 integrated facilities associated with one tertiary healthcare center from 2012 to 2019. The electronic chart records for 3104 Caucasian and African American IBD patients were reviewed for frequency of urolithiasis and uncomplicated UTI via diagnosed ICD-10 codes. Comparison between data groups was made using multivariate regressions, t-tests, and chi square tests. Results Our study included 3104 patients of which 59% were female, 38% were African American, and 43% were diagnosed with UC. Similar proportions of UC and CD diagnosed patients developed urolithiasis (6.0% vs 6.7%, p = 0.46), as well as uncomplicated UTIs (15.6% vs. 14.9%, p = 0.56). Similar proportions of African American and Caucasian patients developed urolithiasis (5.4% vs 7.0%, p = 0.09), but a higher proportion of African Americans developed uncomplicated UTIs (19.4% vs 12.6%, p ≤ 0.001). Conclusion We found similar rates of urolithiasis formation in both UC and CD in this study. Furthermore, these rates were not significantly different between African American and Caucasian IBD populations. This suggests that UC patients have an elevated risk of urolithiasis formation as those patients with CD. Additionally, African Americans with IBD have a higher frequency of uncomplicated UTI as compared to their Caucasian counterparts.
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Affiliation(s)
- Jake Herbert
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA.
| | - Emily Teeter
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Landen Shane Burstiner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Ralfi Doka
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Amor Royer
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anna H Owings
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia Liu
- Division of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Sarah C Glover
- Department of Digestive Disease, University of Mississippi Medical Center, Jackson, MS, USA
| | - Pegah Hosseini-Carroll
- Department of Digestive Disease, University of Mississippi Medical Center, Jackson, MS, USA
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6
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Dimke H, Winther-Jensen M, Allin KH, Lund L, Jess T. Risk of Urolithiasis in Patients With Inflammatory Bowel Disease: A Nationwide Danish Cohort Study 1977-2018. Clin Gastroenterol Hepatol 2021; 19:2532-2540.e2. [PMID: 33007511 DOI: 10.1016/j.cgh.2020.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) are suggested to be at increased risk of urolithiasis, but the magnitude of risk and the impact of medical and surgical treatment on this risk remain unknown. We therefore aimed to determine overall and treatment-related risk of urolithiasis in patients with IBD in a nationwide population-based cohort study. METHODS Using national registers, we identified all patients with IBD and all cases of urolithiasis in Denmark during 1977-2018. We obtained information on all IBD medications and surgical procedures during 1995-2018. IBD cases were matched 1:10 on age and sex to non-IBD individuals. RESULTS In total, 2,549 (3%) of 75,236 IBD patients and 11,258 (2%) of 767,403 non-IBD individuals developed urolithiasis, resulting in a 2-fold increased risk of urolithiasis (HR, 2.27; 95% CI, 2.17-2.38) in patients with IBD. The patients were also at increased risk of repetitive urolithiasis events (RR, 1.09; 95% CI: 1.04-1.15) and had increased risk of urolithiasis prior to IBD diagnosis (OR, 1.42; 95% CI: 1.34-1.50). After IBD diagnosis, risk of urolithiasis was associated with anti-TNF therapy and surgery. CONCLUSION Patients with IBD had a 2-fold increased risk of urolithiasis after IBD diagnosis and a 42% increased risk prior to IBD diagnosis. Risk was increased in anti-TNF exposed patients, and after surgery, suggesting that IBD severity per se and surgery, with altered intestinal absorption, increase risk of urolithiasis. Since stone formation is associated with adverse outcomes including sepsis, subpopulations of IBD patients, especially those undergoing strong immunosuppression might benefit from additional urolithiasis screening.
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Affiliation(s)
- Henrik Dimke
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark.
| | - Matilde Winther-Jensen
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Lund
- Research Unit for Urology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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7
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Ludvigsson JF, Holmgren J, Grip O, Halfvarson J, Askling J, Sachs MC, Olén O. Adult-onset inflammatory bowel disease and rate of serious infections compared to the general population: a nationwide register-based cohort study 2002-2017. Scand J Gastroenterol 2021; 56:1152-1162. [PMID: 34369254 DOI: 10.1080/00365521.2021.1924259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate absolute and relative risk of serious infections in adult/elderly inflammatory bowel disease (IBD) diagnosed 2002-2017. METHODS Nationwide, register-based cohort study of Swedish patients with IBD compared with general population matched reference individuals with regard to time to first serious infection, equal to hospital admission. Multivariable Cox regression estimated hazard ratios (HRs) for any serious infection. Secondary outcomes included site-specific infections, opportunistic infections and sepsis. RESULTS We identified 47 798 individuals with IBD. During a follow-up of 329 000 person-years, they had 8752 first serious infections (26.6 per 1000 person-years). This compared with an incidence rate of 10.7 per 1000 person-years in matched reference individuals, corresponding to a 2.53-fold increased hazard of serious infections (95%CI = 2.47-2.59). The HR for serious infection in elderly-onset IBD was 2.01 (95%CI = 1.95-2.08). The relative hazard of serious infection was somewhat higher in Crohn's disease (2.94; 95%CI = 2.81-3.06) than in ulcerative colitis (2.24; 95%CI = 2.17-2.31). The HR for serious infections was high in the first year of follow-up (5.17; 95%CI = 4.93-5.42). Individuals with IBD were at a particularly high relative hazard of gastrointestinal and opportunistic infections. The HR for sepsis was 2.47 (95%CI = 2.32-2.63). The relative rates for serious infections in IBD increased in recent years. CONCLUSIONS Patients with adult-onset IBD are at increased risk of serious infections, particularly gastrointestinal and opportunistic infections. Relative rates were highest just after IBD diagnosis, and seem to have increased in recent years.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Johanna Holmgren
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Askling
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael C Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ola Olén
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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8
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Azimirad M, Tajbakhsh M, Yadegar A, Zali MR. Recurrent urinary tract infection with antibiotic-resistant Klebsiella pneumoniae in a patient with Crohn's disease: A case report. Clin Case Rep 2021; 9:e04531. [PMID: 34401151 PMCID: PMC8355749 DOI: 10.1002/ccr3.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 11/06/2022] Open
Abstract
Recurrent urinary tract infections with resistant strains of Klebsiella pneumoniae are a potential complication of the long-term use of immunosuppressive therapy in patients with Crohn's disease.
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Affiliation(s)
- Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Mercedeh Tajbakhsh
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
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9
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Agarwal DK, Krambeck AE, Sharma V, Maldonado FJ, Westerman ME, Knoedler JJ, Rivera ME. Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections. World J Urol 2019; 38:2029-2033. [PMID: 31646382 DOI: 10.1007/s00345-019-02977-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/04/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To determine if treatment of non-obstructing urolithiasis is effective in management of recurrent UTI. MATERIALS AND METHODS A retrospective review was performed of patients undergoing elective management of non-struvite upper tract urinary calculi with recurrent UTI from 2009 to 2016. Recurrent UTI was defined at ≥ 3 UTI in 12 months, with symptoms and documented urine culture. Preoperative CT was performed in all patients to determine stone burden. All patients had postoperative imaging and ≥ 12 months of follow-up. Pre- and postoperative variables were between patients who had recurrent UTI after treatment versus those who did not. RESULTS 46 patients met inclusion criteria. 42 (91.3%) were female. Median age was 63.7 years (IQR 49.1, 73.4) and median total stone burden was 20 mm (IQR 14-35). Within the cohort, 20 (43.5%) underwent ureteroscopy only, 26 (56.5%) underwent PCNL ± URS, and none underwent ESWL. Median postoperative follow-up was 2.9 years (IQR 2.0, 4.3). Only five patients (10.9%) had recurrent UTI after treatment. 80% were with the preoperative pathogen. The presence of residual stone was an independent risk factor for recurrent UTI after treatment (p < 0.046). Diabetes, hypertension, immunosuppression and chronic kidney disease were not. CONCLUSIONS Stone removal for patients with recurrent UTIs was associated with a high rate of success (89.1%) in elimination of further recurrent UTIs. Residual fragments are independently associated with persistent recurrent UTIs and thus, complete stone removal is of paramount importance in treatment of this patient population.
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Affiliation(s)
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Marcelino E Rivera
- Department of Urology, Mayo Clinic, Rochester, MN, USA. .,, 1801 N Senate Blvd, Ste 220, Indianapolis, IN, 46202, USA.
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10
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Kim YN, Jung Y. [Renal and Urinary Manifestations of Inflammatory Bowel Disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:260-268. [PMID: 31132832 DOI: 10.4166/kjg.2019.73.5.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/03/2022]
Abstract
The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4-23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.
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Affiliation(s)
- Ye Na Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeonsoon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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11
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Sfanos KS, Joshu CE. IBD as a risk factor for prostate cancer: what is the link? Nat Rev Urol 2019; 16:271-272. [DOI: 10.1038/s41585-019-0157-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Abstract
Renal and urinary involvement has been reported to occur in 4% to 23% of inflammatory bowel disease (IBD) patients. Parenchymal renal disease is rare and most commonly affects glomerular and tubulointerstitial compartments. The most common findings on renal biopsy of IBD patients are IgA nephropathy and tubulointerstitial nephritis. Overall morbidity of IBD-related renal manifestations is significant, and there is often only a short window of injury reversibility. This, along with subtle clinical presentation, requires a high index of suspicion and routine monitoring of renal function. There are no established guidelines for the optimal screening and monitoring of renal function in IBD patients.
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The systematic classification of urinary stones combine-using FTIR and SEM-EDAX. Int J Surg 2017; 41:150-161. [PMID: 28373152 DOI: 10.1016/j.ijsu.2017.03.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND To explore underlying mechanism of urinary stones formation, the composition and microstructure of urinary stones were analyzed systematically with a large sample study from China. MATERIALS AND METHODS A total of 2437 urinary stones were obtained from the urology department at our Hospital. The composition of the stones was analyzed by Fourier transform infrared spectroscopy (FTIR). Meanwhile, the microstructure and element distribution were observed with scanning electron microscopy combined with element distribution analysis (SEM-EDAX). RESULTS Urinary stones were classified into eight types, that were consisted of calcium oxalate stones (1301/2437, 53.39%), calcium phosphate stones (131/2437, 5.38%), anhydrous uric acid stones (434/2437, 17.81%), magnesium ammonium phosphate stones (12/2437, 0.49%), sodium urate stones (5/2437, 0.21%), brushite stones (4/2437, 0.16%), cystine stones (3/2437, 0.12%) and mixed stones (547/2437, 22.45%, ten subtypes were included). Under SEM, they displayed distinct microstructures: plank-like, brick-like, polyhedron or paliform crystals for calcium oxalate stones, similar sized echin-sphere or rough bulbiform or tree bark-like crystals for calcium phosphate stones, rotten-wood-like or petrous crystals for anhydrous uric acid stones, globular or gallet-like crystals for magnesium ammonium phosphate stones, sawdust-like crystals for sodium urate stones, broken-wood-like crystals for brushite stones, stacking hexagonal cystine crystals for cystine stones, and two or more of the above crystals for mixed stones. Meanwhile, they also presented distinct elemental composition and distribution by EDAX. CONCLUSIONS Urinary stones can be classified into eight types, and exhibit a diversity of microstructure and elemental compositions in China. The formation process of different types of urinary stones may be diverse.
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Gkentzis A, Kimuli M, Cartledge J, Traxer O, Biyani CS. Urolithiasis in inflammatory bowel disease and bariatric surgery. World J Nephrol 2016; 5:538-546. [PMID: 27872836 PMCID: PMC5099600 DOI: 10.5527/wjn.v5.i6.538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/31/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse current literature focusing on pathogenesis and therapeutic aspects of urolithiasis with inflammatory bowel disease (IBD) and following bariatric surgery.
METHODS A systematic literature search was performed using PubMed, supplemented with additional references. Studies assessing the association of IBD or bariatric surgery with renal stones in both paediatric and adulthood were included.
RESULTS Certain types of stones are seen more frequently with IBD. Hyperoxaluria and hypocitraturia are the main metabolic changes responsible for urolithiasis. The incidence of renal stones in malabsorptive types of bariatric surgery such as gastric bypass is high; this is not as common in modern restrictive surgical methods. Preventative methods and urine alkalinisation have been shown to be beneficial.
CONCLUSION Both conditions are associated with renal stones. Patients’ counselling and prevention strategies are the mainstay of urolithiasis management in these patients.
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