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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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Mazziotti S, Ascenti G, Scribano E, Gaeta M, Pandolfo A, Bombaci F, Donato R, Fries W, Blandino A. Guide to magnetic resonance in Crohn's disease: from common findings to the more rare complicances. Inflamm Bowel Dis 2011; 17:1209-22. [PMID: 21484963 DOI: 10.1002/ibd.21548] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/27/2010] [Indexed: 12/13/2022]
Abstract
Considering that multiple imaging examinations are often necessary for monitoring Crohn's disease (CD) activity and severity in order to guide and monitor appropriate treatment, the ideal imaging test would be reproducible, well tolerated by patients, and free of ionizing radiation. For these reasons recent studies have highlighted the role of a magnetic resonance imaging (MRI) technique optimized for small bowel imaging in the evaluation of small bowel disorders. In this regard there are two main methodological approaches represented by MR enterography, following administration of an oral contrast medium, and MR enteroclysis, following administration of contrast medium through a nasojejuneal tube. MRI may be used to demonstrate the pathologic findings and complications of CD. In particular, MR has excellent sensitivity and specificity, ranging from 88%-98% and 78%-100%, respectively, for the detection of active inflammation, wall thickening, ulcerations, increased wall enhancement, increased vascularity, perienteric inflammation, and reactive adenopathy. MR also allows more accurate identification of associated complications including penetrating and fibrostenotic disease as well as the more rare extraintestinal manifestations that are usually associated with severe and longstanding intestinal inflammation, the latter often guiding the therapeutic approach. In the progression of CD some rare complications can occur that, to our knowledge, were only briefly or never mentioned in the radiological literature regarding MR enterography or enteroclysis and in which the application of these techniques play a key role.
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Affiliation(s)
- Silvio Mazziotti
- Department of Radiological Sciences, University of Messina, Policlinico "G. Martino," Messina, Italy.
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Abstract
Noncalculous ureteral obstructions in Crohn's disease are often asymptomatic and unidentified. Occurring in about 3% of patients, they occur on the right side in more than 70% of cases, because of frequently associated ileocecal disease. If they are associated with inflammation or fibrosis of retroperitoneal periureteral fat nephrectomy may become necessary. Conservative treatment should be considered first, with urine drainage (ureteral stent, or percutaneous nephrostomy), diet, and corticotherapy. However bowel resection is often necessary during follow up. If this fails to cure the ureteral obstruction, ureterolysis should be performed. We report the case of a 32 year old woman with noncalculous ureteral obstruction revealing Crohn's disease.
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Affiliation(s)
- Sébastien Gaujoux
- Service de chirurgie viscérale et digestive, Centre Hospitalier de Longjumeau, 159 rue du président François Mitterrand, 91164 Longjumeau Cedex
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Ueno Y, Tanaka S, Kanao H, Yoshioka K, Hatakeyama T, Shimamoto M, Miyanaka Y, Hiyama T, Ito M, Kitadai Y, Yoshihara M, Chayama K. A case of Crohn's disease with hydronephrosis caused by ureteropelvic junction obstruction. Eur J Gastroenterol Hepatol 2006; 18:1015-8. [PMID: 16894317 DOI: 10.1097/01.meg.0000224472.59051.7e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ureteral obstruction is a rare extraintestinal manifestation of Crohn's disease (CD). We report the case of a 20-year-old man who presented with fever, diarrhoea, and lower abdominal pain. Diagnostic studies confirmed CD and revealed an abdominal mass obstructing the right ureter and hydronephrosis. Ureteropelvic junction (UPJ) obstruction was diagnosed. Despite an elemental diet and mesalazine therapy, the hydronephrosis persisted, and the patient eventually required surgery. Successful laparoscopic pyeloplasty was performed. This is the first report of CD associated with UPJ obstruction. Ureteral obstruction as a complication of CD is discussed.
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Affiliation(s)
- Yoshitaka Ueno
- Department of Endoscopy, Hiroshima University Hospital, Japan
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Ruffolo C, Angriman I, Scarpa M, Polese L, Barollo M, Bertin M, Pagano D, D'Amico DF. Minimally invasive management of Crohn's disease complicated by ureteral stenosis. Surg Laparosc Endosc Percutan Tech 2005; 14:292-4. [PMID: 15492662 DOI: 10.1097/00129689-200410000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ureteral involvement due to Crohn's disease occurs in 3% to 6% of cases. Herein, we present a case of a 22-year-old woman with ileocolic Crohn's disease with right hydronephrosis due to compression of the ureter that was resolved with a 3-stage, minimally invasive procedure (preoperative percutaneous nephrostomy, ureteral stent placement, and sequential laparoscopically assisted ileocolectomy). Percutaneous right nephrostomy drainage permitted us to prevent renal damage before surgery, and successive ureteral double-J catheter placement minimized the risk of ureteral damage during the laparoscopic procedure. The safety and feasibility of sequential minimally invasive management of ileocolonic Crohn's disease involving the right ureter was assessed, and a good cosmetic result was achieved.
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Affiliation(s)
- Cesare Ruffolo
- Department of Surgical and Gastroenterological Sciences, Clinica Chirurgica I, University of Padova, Padova, Italy.
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Leong WS, Sells H, Moretti KL. Anuric, obstructive uropathy in the absence of obvious radiological evidence of obstruction. ANZ J Surg 2004; 74:611-3. [PMID: 15230807 DOI: 10.1111/j.1445-2197.2004.03001.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wing-Seng Leong
- Urology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Palma Carazo F, Marchal Escalona C, De Sola Earle C, González Chamorro A, Bercedo Martínez J, Gándara Adán N. [Bilateral hydronephrosis secondary to ileocolic Crohn's disease]. Actas Urol Esp 2002; 26:425-8. [PMID: 12189739 DOI: 10.1016/s0210-4806(02)72806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Unilateral hydronephrosis can complicate a far from negligible number of patients with Crohn's disease. Bilateral hydronephrosis associated with Crohn's disease is a much more unusual entity. In the other hand, the treatment for this condition is still controversial. We present the case of a 44 year old female with several bowel obstruction episodes caused by ileocolic Crohn's disease. During the last episode she was also diagnosed of bilateral hydroureter and hydronephrosis. After the resolution of the bowel obstruction and the placement of a double J catheter in both ureters, the patient was operated. Ileocolic resection and bilateral ureterolysis with omental wrapping were performed. Although urinary and wound infection complicated the postoperative course, and a enterocutaneous fistula had to be medically treated one year later, the patient is now free of symptoms and her renal function is normal.
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Affiliation(s)
- F Palma Carazo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Costal de Sol. Marbella, Málaga
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Ben-Ami H, Behar DM, Edoute Y, Lavy A, Ginesin Y, Fischer D. Left Hydronephrosis Caused by Crohn Disease Successfully Treated Conservatively. Am J Med Sci 2000. [DOI: 10.1016/s0002-9629(15)40841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Renal and urologic complications are not uncommon in patients with inflammatory bowel disease, and can be directly or indirectly related to the underlying disease process or its treatment. Many of these patients have asymptomatic disease, or the urinary symptoms are nonspecific or overshadowed by bowel symptoms. By the time a urinary complication is considered, significant disease progression or renal damage may have occurred. These risks necessitate a high degree of diligence and periodic urologic evaluation as part of the long-term management of patients with inflammatory bowel disease.
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Affiliation(s)
- D S Pardi
- Inflammatory Bowel Disease Clinic, Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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Kent GG, McGowan GE, Hyams JS, Leichtner AM. Hypertension associated with unilateral hydronephrosis as a complication of Crohn's disease. J Pediatr Surg 1987; 22:1049-50. [PMID: 3430314 DOI: 10.1016/s0022-3468(87)80518-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. The treatment for this condition is still controversial. This is the case study of a 14-year-old girl with documented right-sided obstructive uropathy secondary to Crohn's disease associated with renin-mediated hypertension secondary to her obstructive uropathy. The patient had complete resolution of her hypertension following surgery, which involved only resection of the involved bowel without ureterolysis.
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Abstract
Genitourinary manifestations and complications of sigmoid diverticulitis are well recognized. These consist mainly of bladder symptoms or fistula formation. Ureteral obstruction secondary to acute sigmoid diverticulitis is rare with only 3 cases documented and reported up to the present. All 3 cases were of left ureteral obstruction. Two patients are presented with acute sigmoid diverticulitis complicated by ureteral obstruction -- one of which was obstructed bilaterally. Both patients were admitted with left lower abdominal pain and tenderness and showed elevated temperatures with leukocytosis. Neither had a significant past history of gastrointestinal or urologic disorders. Ureteral obstruction in both patients was documented preoperatively by intravenous pyelography, and postoperative resolution was documented following definitive treatment of the diverticulitis. The proximity of the sigmoid colon to the left ureter should cause more instances of this complication than is reported.
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Abstract
We report two cases of pan-proctocolectomy for ulcerative colitis who some time postoperatively developed an obstructive uropathy with the clinical and radiological features of retroperitoneal fibrosis. The incidence of this complication appears to be around 10% and the possibility of such a diagnosis should be borne in mind in any patient who has non-specific symptoms after surgery for ulcerative colitis.
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Abstract
A 22-year review of 328 patients with Crohn's disease revealed 70 patients with urinary tract symptoms. Cystitis was the most common problem, occurring in 44 patients. The urinary tract infections were recurrent in most patients, usually with 3 or 4 attacks per year. Despite the persistence of urinary infection, only 3 patients developed chronic pyelonephritis. Forty-nine patients had intravenous urography, and many were found to have slight dilatation of the upper urinary tract on one side. Seven patients had hydronephrosis, 3 with pyonephrosis. Five of 6 patients who developed calculi had a bowel resection. All of the recovered calculi were oxalate stones, but 3 were passed spontaneously and not analyzed. Eight patients, 7 of them males, had an ileovesical fistula. In 1, the colon was also affected. It was unusual for these patients to have severe urinary symptoms. One patient had a fistula from the rectum to the urethra. Although 32 of the 70 patients were female, most of the severe complications occurred in men. Aggressive investigation is not indicated, nor is radical surgery required.
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Abstract
A review of 2,368 patients with Crohn's disease identified 45 patients with hydroureteronephrosis treated with various medical and surgical regimens. Twenty-six of 30 patients undergoing both pre- and post-treatment intravenous pyelography showed resolution of the obstructed ureter, even though ureterolysis was rarely used.
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Knudsen L, Marcussen H, Fleckenstein P, Pedersen EB, Jarnum S. Urolithiasis in chronic inflammatory bowel disease. Scand J Gastroenterol 1978; 13:433-6. [PMID: 675152 DOI: 10.3109/00365527809181917] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a selected material of 228 patients with chronic inflammatory bowel disease (CIBD) the incidence of urolithiasis was 15% (95% confidence limit 11-21). The tendency to urolithiasis is significantly correlated to small-bowel resection and its extent and to obstruction in the urinary tract. On the other hand, there is no definite correlation to the duration or extent of the bowel disease. The significant correlation between urolithiasis and ileal resection is in agreement with the hyperabsorption of oxalate as an important cause of stone formation demonstrated by others. That local factors too play an essential role in the formation of urinary calculi is apparent from the increased incidence of urolithiasis in obstruction of the urinary tract. The incidence of urolithiasis was particularly high (22-25%) among patients with ileostomies. The few and negligible symptoms of and sequelae to, urolithiasis in CIBD encourage a conservative attitude.
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