Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis

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Abstract

AIM

To evaluate the incidence and characteristics of kidney stones in kidney transplant recipients.

METHODS

A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the inception of the databases through March 2016. Studies assessing the incidence of kidney stones in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of kidney stones.

RESULTS

Twenty one studies with 64416 kidney transplant patients were included in the analyses to assess the incidence of kidney stones after kidney transplantation. The estimated incidence of kidney stones was 1.0% (95%CI: 0.6%-1.4%). The mean duration to diagnosis of kidney stones after kidney transplantation was 28 ± 22 mo. The mean age of patients with kidney stones was 42 ± 7 years. Within reported studies, approximately 50% of kidney transplant recipients with kidney stones were males. 67% of kidney stones were calcium-based stones (30% mixed CaOx/CaP, 27%CaOx and 10%CaP), followed by struvite stones (20%) and uric acid stones (13%).

CONCLUSION

The estimated incidence of kidney stones in patients after kidney transplantation is 1.0%. Although calcium based stones are the most common kidney stones after transplantation, struvite stones (also known as “infection stones”) are not uncommon in kidney transplant recipients. These findings may impact the prevention and clinical management of kidney stones after kidney transplantation.

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Most cited references 39

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The ROKS nomogram for predicting a second symptomatic stone episode.

Andrew D Rule, John Lieske, Xujian Li … (2014)

Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials.

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Renal stone epidemiology in Rochester, Minnesota: an update.

Matthew Gettman, John Lieske, Cynthia Leibson … (2006)

Studies in Western countries have suggested an increasing incidence of nephrolithiasis (NL) in the latter part of the 20th century. Therefore, we updated NL epidemiology data for the Rochester population over the years 1970-2000. All Rochester residents with any diagnostic code that could be linked to NL in the years of 1970, 1980, 1990, and 2000 were identified, and the records reviewed to determine if they met the criteria for a symptomatic kidney stone as defined in a previous Rochester, MN study. Age-adjusted incidence (+/-s.e.) of new onset symptomatic stone disease for men was 155.1 (+/-28.5) and 105.0 (+/-16.8) per 100,000 per year in 1970 and 2000, respectively. For women, the corresponding rates were 43.2 (+/-14.0) and 68.4 (+/-12.3) per 100,000 per year, respectively. On average, rates for women increased by about 1.9% per year (P=0.064), whereas rates for men declined by 1.7% per year (P=0.019). The overall man to woman ratio decreased from 3.1 to 1.3 during the 30 years (P=0.006). Incident stone rates were highest for men aged 60-69 years, whereas for women, they plateaued after age 30. Therefore, since 1970 overall NL incidence rates in Rochester have remained relatively flat. However, NL rates for men have declined, whereas rates for women appear to be increasing. The reasons remain to be determined.

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Urological complications in 1,000 consecutive renal transplant recipients.

D Shoskes, D Hanbury, R Cranston … (1994)

The urological complications in the first consecutive 1,000 renal transplants at our transplant center are reported with a minimum followup of 12 months. The kidney was implanted in the iliac fossa in all cases and in all but 3 the ureter was inserted into the bladder with a Politano-Leadbetter technique. Overall, there were 71 primary complications in 68 patients (7.1%), which included 36 ureteral obstructions, 25 ureteral or bladder leaks (including ureteral necrosis), 7 bladder outflow obstructions, 2 ureteral stones and 1 case of symptomatic vesicoureteral reflux. The use of high dose steroids in the early years was associated with a 10% urological complication rate, which decreased to 4% in patients receiving low dose steroids thereafter combined with azathioprine or cyclosporine. The urological complication was corrected after 1 procedure in 65 cases and after 2 procedures in 4. No grafts were lost due to urological complications. Two patients died, 1 of sepsis following transurethral resection of the prostate and subsequent ureteral necrosis, and 1 of hemorrhage following nephrostomy tube insertion. Most ureteral complications were treated by an open operation, although in recent years endoscopic techniques have become more common. Meticulous retrieval technique, low dose steroid protocols and rapid diagnosis are the crucial factors associated with a minimal incidence of urological complications after renal transplantation.

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Author and article information

Journal

Journal ID (nlm-ta): World J Transplant

Journal ID (publisher-id): WJT

Title: World Journal of Transplantation

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 2220-3230

Publication date (Print): 24 December 2016

Publication date (Electronic): 24 December 2016

Volume: 6

Issue: 4

Pages: 790-797

Affiliations

Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Wonngarm Kittanamongkolchai, Insara J Jaffer Sathick, Tsering Dhondup, Stephen B Erickson, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States

Author notes

Author contributions: Cheungpasitporn W and Thongprayoon C contributed equally to this work; Cheungpasitporn W and Thongprayoon C: Performed the search, analysis and interpretation of data, analysis of data and final approval of the version to be published; Mao MA, Kittanamongkolchai W, Jaffer Sathick IJ and Dhondup T: Critical revising of the intellectual content and final approval of the version to be published; Erickson SB: Concept and design, critical revising of the intellectual content and final approval of the version to be published.

Correspondence to: Wisit Cheungpasitporn, MD, Assistant Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. wcheungpasitporn@ 123456gmail.com

Telephone: +1-507-2667093 Fax: +1-507-2667891

Article

Other ID: jWJT.v6.i4.pg790

DOI: 10.5500/wjt.v6.i4.790

PMC ID: 5175239

PubMed ID: 28058231

SO-VID: 6527a8ab-14ba-45f8-8481-bb21aa4588f5

License:

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

History

Date received : 18 May 2016

Date revision received : 8 September 2016

Date accepted : 22 October 2016

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Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis

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Abstract

AIM

METHODS

RESULTS

CONCLUSION

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Regulatory T cell (Treg) therapy

Most cited references 39

The ROKS nomogram for predicting a second symptomatic stone episode.

Renal stone epidemiology in Rochester, Minnesota: an update.

Urological complications in 1,000 consecutive renal transplant recipients.

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Cited by 12

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