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Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature

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Abstract

Background

Nephrolithiasis is a frequent condition. While it is generally accepted that such condition carries a risk of recurrence over time, the exact risk and its predictors have been rarely quantitated. We aimed to estimate recurrence of kidney stones, overall and in specific subgroups, from randomized controlled trials (RCTs) of calcium stone formers.

Methods

Systematic review of RCTs of adult patients with idiopathic calcium kidney stones. Recurrence rates analyzed in subgroups based on type of intervention and other characteristics, using Poisson regression models.

Results

The analysis included 21 RCTs with 2168 participants over a median follow-up of 3.2 years (range 0.5–9.7). The median recurrence of kidney stones was 15 per 100 person–years (range 0–110). Recurrence was higher in those with two or more previous stone episodes compared to those with a single episode at enrolment (16 vs. 6 per 100 person–years, p < 0.001) and in those untreated or treated with dietary changes compared to those treated with drugs (26 vs. 23 vs. 9 per 100 person–years, p < 0.001). The effect of drugs on recurrence seemed to be beneficial only among those with two or more previous stone episodes.

Conclusions

The overall recurrence rate of stones depends on factors such as previous stone history and type of treatment. Dietary approaches seem to be more effective among single stone formers, whereas drugs seem to be more effective among recurrent stone formers.

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Author information

Authors and Affiliations

  1. Division of Nephrology, Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Via Moscati 31-33, 00168, Rome, Italy

    Pietro Manuel Ferraro & Giovanni Gambaro

  2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Pietro Manuel Ferraro & Gary C. Curhan

  3. Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Gary C. Curhan

  4. Division of Urology, Fondazione Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy

    Alessandro D’Addessi

Authors
  1. Pietro Manuel Ferraro
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  2. Gary C. Curhan
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  3. Alessandro D’Addessi
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  4. Giovanni Gambaro
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Corresponding author

Correspondence to Pietro Manuel Ferraro.

Ethics declarations

Conflict of interest

PMF received consultant fees from BioHealth Italia. GCC: Consultant for Allena Pharmaceuticals, AstraZeneca, Exponent; Royalties: UpToDate (author and Section Editor); Honorarium: American Society of Nephrology (Editor-in-Chief, Clinical Journal of the American Society of Nephrology). PMF, ADA and GG have nothing to disclose. For this type of study formal consent is not required.

Funding

None.

Ethical approval

Described results do not directly include studies with human beings or animals.

Informed consent

Informed consent was not required.

Appendix 1: Research strategy

Appendix 1: Research strategy

PubMed Medline:

  1. 1.

    Urolithiasis[mesh]

  2. 2.

    Urolithiasis[tiab]

  3. 3.

    Nephrolithiasis[tiab]

  4. 4.

    Kidney calculi[tiab]

  5. 5.

    Renal calculi[tiab]

  6. 6.

    Kidney stones[tiab]

  7. 7.

    Renal stones[tiab]

  8. 8.

    1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7

  9. 9.

    Hypercalciuria[mesh]

  10. 10.

    Hypercalciuri*

  11. 11.

    Calcium[tiab]

  12. 12.

    9 OR 10 OR 11

  13. 13.

    8 AND 12

  14. 14.

    Randomized controlled trial[pub type]

  15. 15.

    Controlled clinical trial[pub type]

  16. 16.

    Clinical trial[pub type]

  17. 17.

    Randomized controlled trial[tiab]

  18. 18.

    Clinical trial[tiab]

  19. 19.

    14 OR 15 OR 16 OR 17 OR 18

  20. 20.

    13 AND 19

  21. 21.

    Animals[mesh]

  22. 22.

    Humans[mesh]

  23. 23.

    21 NOT 22

  24. 24.

    20 NOT 23

  25. 25.

    English[language]

  26. 26.

    24 AND 25

  27. 27.

    Adults[mesh]

  28. 28.

    26 AND 27

Cochrane library:

  1. 1.

    Urolithiasis[mesh]

  2. 2.

    Urolithiasis[ti, ab, kw]

  3. 3.

    Nephrolithiasis[ti, ab, kw]

  4. 4.

    Kidney stones[ti, ab, kw]

  5. 5.

    Renal stones[ti, ab, kw]

  6. 6.

    Kidney calculi[ti, ab, kw]

  7. 7.

    Renal calculi[ti, ab, kw]

  8. 8.

    Hypercalciuria[mesh]

  9. 9.

    Hypercalciuria[ti, ab, kw]

  10. 10.

    Calcium[ti, ab, kw]

  11. 11.

    (or #1-#7)

  12. 12.

    (or #8-#10)

  13. 13.

    #11 and #12

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Ferraro, P.M., Curhan, G.C., D’Addessi, A. et al. Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol 30, 227–233 (2017). https://doi.org/10.1007/s40620-016-0283-8

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  • DOI: https://doi.org/10.1007/s40620-016-0283-8

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