Chronic Kidney Disease: Insurance And Nephrolithiasis

Nephrolithiasis, or kidney stones, is a common disease that affects over 5% of adults in the US and is associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). While nephrolithiasis is not a common cause of adult AKI, it may be a more important factor in young children. The primary mechanism of nephrolithiasis-associated AKI is obstructive nephropathy, and factors at presentation with obstructive uropathy predict the likelihood of long-term renal recovery.

Nephrolithiasis is an independent risk factor for CKD, although the effect size is modest. Urologic comorbidities, urinary infection, and shared underlying risk factors (e.g. diabetes, hypertension) all impact nephrolithiasis-associated CKD risk. The risk of CKD with nephrolithiasis is independent of other well-established CKD risk factors, such as diabetes and hypertension, that are common among stone formers.

Nephrolithiasis is a preventable cause of morbidity, accounting for over $5 billion in economic costs in the US each year, both for hospitalisation and procedures to remove symptomatic stones, as well as time lost from work.

Nephrolithiasis and the risk of chronic kidney disease

Nephrolithiasis, or kidney stones, is a common systemic disease that can cause acute kidney injury and chronic kidney disease (CKD). The prevalence of nephrolithiasis has been increasing over recent decades, and it is now estimated that one in ten people will have a kidney stone at some point in their lives. This rise is partially attributed to its association with features of metabolic syndrome, such as obesity, hypertension, and diabetes, which have also been on the rise.

Several epidemiological studies have found a consistent relationship between nephrolithiasis and an increased risk of CKD and end-stage renal disease (ESRD). Patients with nephrolithiasis have about a two-fold higher risk of decreased renal function or need for renal replacement therapy. This risk appears to be independent of other CKD risk factors such as hypertension and diabetes mellitus, which are common among stone formers.

The primary mechanism of nephrolithiasis-associated acute kidney injury is obstructive nephropathy, which can lead to irreversible kidney damage if not treated promptly. Crystalline nephropathy is another potential pathway, often associated with a worse outcome. Recent studies have also implicated the activation of innate immunity and intracellular inflammasome pathways in calcium oxalate crystal-induced acute kidney injury.

Nephrolithiasis is a small but independent risk factor for CKD and ESRD. The exact mechanisms are unclear, but certain patient-specific factors likely increase the risk. These include urological diagnoses such as hydronephrosis, recurrent urinary tract infections, a solitary kidney, neurogenic bladder, and ileal conduit. Stone type may also impact the risk of kidney failure, with non-calcium-containing stones being more common in patients with reduced renal function.

While nephrolithiasis is not a common cause of adult acute kidney injury, it may be a relatively major cause in young children, accounting for up to 30% of cases. The risk of recovery from acute kidney injury depends on the extent and duration of the obstruction.

In summary, nephrolithiasis is associated with a two-fold higher risk of CKD and ESRD, independent of other well-established risk factors. Nephrolithiasis-related comorbidities, such as urinary tract infections, may specifically cause renal parenchymal damage. Further studies are needed to better understand the characteristics and mechanisms of nephrolithiasis-associated CKD.

Nephrolithiasis and the risk of end-stage renal disease

Nephrolithiasis is a common systemic disease associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). The prevalence of nephrolithiasis has been on the rise in recent decades, and it is often linked to features of metabolic syndrome such as obesity, hypertension, and diabetes. While nephrolithiasis is not a prevalent cause of adult AKI, it may be more significant in young children, accounting for up to 30% of cases. The primary mechanism of nephrolithiasis-associated AKI is obstructive nephropathy, and factors such as the extent and duration of obstruction influence the likelihood of long-term renal recovery.

Crystalline nephropathy is another pathway that can lead to nephrolithiasis-associated AKI, particularly in certain circumstances like hyperoxaluric states, and it is often associated with a worse outcome. Recent studies have also identified additional mechanisms by which calcium oxalate crystals can cause acute injury, including innate immunity and intracellular inflammasome pathways.

Several large cohort studies have established an independent association between nephrolithiasis and the development of CKD and end-stage renal disease (ESRD). The risk of CKD and ESRD is about two times higher among patients with nephrolithiasis, even when accounting for other known risk factors such as diabetes and hypertension. This increased risk may be influenced by urologic comorbidities, urinary infection, and shared underlying risk factors.

Specific risk factors that increase the likelihood of nephrolithiasis-associated CKD include recurrent urinary tract infections, struvite and uric acid stone composition, symptomatic stones, solitary kidney, ileal conduit, neurogenic bladder, and hydronephrosis. Additionally, certain types of stones, such as struvite and calcium-containing stones, are more prevalent in patients with CKD or ESRD.

While nephrolithiasis is a small but independent risk factor for CKD and ESRD, further studies are needed to clarify the incidence and mechanisms of nephrolithiasis-associated AKI and its relationship with CKD.

Nephrolithiasis and the risk of acute kidney injury

Nephrolithiasis, or kidney stone disease, is a common systemic disease that can cause acute kidney injury (AKI) and chronic kidney disease (CKD). While nephrolithiasis is not a common cause of adult AKI, it may be a more significant factor in young children. Obstructive nephropathy is the primary mechanism of nephrolithiasis-associated AKI, and the likelihood of long-term renal recovery depends on the extent and duration of the obstruction. Crystalline nephropathy is another pathway that can lead to nephrolithiasis-associated AKI and is often associated with a worse prognosis.

Risk factors and mechanisms

Several risk factors have been identified for nephrolithiasis-associated AKI, including larger stone size, bilateral ureteral stones, the presence of a solitary kidney, and pre-existing CKD. In addition, certain patient-specific factors, such as recurrent urinary tract infections, struvite and uric acid stone composition, and diabetes mellitus, may increase the risk of nephrolithiasis-associated CKD.

The mechanism of nephrolithiasis-associated AKI involves increased intratubular pressure, leading to renal vasoconstriction, a rapid decline in renal blood flow, and a decrease in glomerular filtration rate (GFR). Prolonged obstruction can result in interstitial fibrosis and nephron dropout, eventually leading to CKD. Another potential mechanism is direct cellular toxicity caused by crystals, particularly calcium oxalate crystals, which can trigger apoptosis and cell death through mitochondrial dysfunction and the release of reactive oxygen species.

Treatment and prognosis

Prompt and appropriate urologic intervention is necessary to avoid irreversible renal damage in nephrolithiasis-associated AKI. While most cases have a reasonably good prognosis, the ultimate degree of renal recovery depends on the extent and duration of the obstruction, as well as the presence of infection. Surgical treatments, such as open nephrolithotomy, shock wave lithotripsy, and percutaneous nephrolithotomy, have varying impacts on long-term renal outcomes. While open nephrolithotomy was previously associated with nephrolithiasis-associated CKD, less invasive treatments are not typically linked to permanent renal injury.

In summary, nephrolithiasis is a common disease that can lead to both AKI and CKD. While it is not a major cause of adult AKI, it may be more significant in young children. The risk factors, mechanisms, and treatment options for nephrolithiasis-associated AKI and CKD are areas of ongoing research.

Nephrolithiasis and the risk of recurrent kidney stones

Nephrolithiasis, or kidney stone disease, is a condition in which calculi (stones) form within the renal pelvis and tubular lumens. Stones form from crystals that precipitate out of the urine when the concentration of crystal-forming substances (such as calcium, oxalate, and uric acid) is high and/or that of substances that inhibit stone formation (such as citrate) is low. Nephrolithiasis is a common disease with substantial health and economic consequences, causing extreme pain and costing the US $2.1 billion annually.

Nephrolithiasis is associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). While nephrolithiasis is not a common cause of adult AKI (1-2% of cases), it may be a more significant factor in young children (up to 30%). The primary mechanism of nephrolithiasis-associated AKI is obstructive nephropathy, where factors such as the size of the stone, the presence of a solitary kidney, and pre-existing CKD predict the likelihood of long-term renal recovery. Crystalline nephropathy is another pathway that often leads to worse outcomes.

Several large cohort studies have established an independent association between nephrolithiasis and CKD, although the effect size is modest. Urologic comorbidities, urinary infection, and shared underlying risk factors like diabetes and hypertension all impact nephrolithiasis-associated CKD risk.

The risk of CKD with nephrolithiasis is about two times higher, independent of other well-established CKD risk factors that are common among stone formers. Nephrolithiasis-related comorbidities, such as recurrent urinary tract infections, may specifically cause renal parenchymal damage.

Nephrolithiasis patients with CKD who undergo percutaneous nephrolithotomy generally experience stable or improved renal function after at least a year of follow-up. However, concurrent diabetes and urinary tract infections are risk factors for CKD progression.

Cohort and case-control studies over the past decade have consistently demonstrated an increased risk of CKD with nephrolithiasis. Further studies are needed to better define and characterize nephrolithiasis-associated CKD and identify patients at increased risk.

Nephrolithiasis and the risk of renal colic

Nephrolithiasis, or kidney stones, is a common disease affecting 1 in 11 people in the US. It is not a common cause of chronic kidney disease, but it can be a more significant factor in young children. Nephrolithiasis is associated with both acute kidney injury (AKI) and chronic kidney disease (CKD). The primary mechanism of nephrolithiasis-associated AKI is obstructive nephropathy, and the likelihood of long-term renal recovery depends on the extent and duration of the obstruction, and the presence or absence of infection. Crystalline nephropathy is another potential pathway, often associated with a worse outcome.

Nephrolithiasis is an independent but small risk factor for CKD. The exact mechanisms are unclear, but urologic comorbidities, urinary infection, and shared underlying risk factors such as diabetes and hypertension all impact nephrolithiasis-associated CKD risk.

The risk of CKD among those with nephrolithiasis is increased by recurrent urinary tract infections, struvite and possibly uric acid stone composition, symptomatic stones, solitary kidney, ileal conduit, neurogenic bladder, and hydronephrosis.

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