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This blog aims to make "evidence-based medicine" understandable to the lay person
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Tuesday, April 30, 2013

Can kidney stones cause kidney disease or kidney failure?

I covered the short-term symptoms and consequences of kidney stones in my previous post. Let's talk a little about the long term consequences. A question that is often asked is whether kidney stones can lead to progressive kidney disease/kidney failure. This is not an easy question to answer; in fact it should probably be rephrased to say, "can kidney stones be associated with kidney disease/failure?" This is because current medical studies that have addressed this issue have proven association, and not causation. At least, not yet!

Researchers studied this issue in patients who were diagnosed with kidney stones in Minnesota, US, between 1986 to 2003, and followed patients for an average of about 8 years to see if they developed kidney disease (CKD), or kidney failure (ESRD). Their study revealed that people with kidney stones could be at a higher risk of developing CKD, but not ESRD.  However, more recently, another study addressing this question was published in the British Medical Journal in August 2012. The results of this study showed that patients who developed even one kidney stone were significantly more likely to develop both CKD, and ESRD (over 11 years of follow up). Before you panic on reading this, let me say that the results do remind me of a quote variously attributed to Mark Twain and Benjamin Disraeli (among others): "there are three kinds of lies: lies, damned lies, and statistics"! Without taking away anything from the researchers/statisticians of this second study, the results clearly showed that even though the risk was higher, in real terms, the absolute risk still remained pretty low (2.4 per million person-days in people with stones). 

So what does this mean for you? If you have a kidney stone, you could have a very slightly higher chance of developing kidney disease/failure than the average Joe. In other words, the overwhelming majority of patients with kidney stones will not see themselves advancing to kidney failure

How kidney stones cause chronic kidney disease (if at all) is a question that still needs further research. Current hypothetical explanation include calcification of the kidneys' interstitial tissue, scarring, urinary tract obstruction, side effects of interventions like lithotripsy that are done to treat stones, etc. As I mentioned above, the relationship between kidney disease and stones might just be an association, wherein a third factor is causing both these entities to appear! 

1 comment:

  1. Dr. Michael Traver of Western Michigan Urological Associates discusses kidney stones, symptoms, evaluation and treatment.

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