[Crohn's disease and kidney stones: much more than coincidence?].
BACKGROUND
Crohn's disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30% of the patients with Crohn's disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population.


OBJECTIVE
To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn's disease.


METHODS
We evaluated 29 patients with Crohn's disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrasonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate.


RESULTS
Twenty-nine of the evaluated patients were female or 65.5% and 34.5% were males. Among the metabolic urinary studied, we identified the following potential disturbances associated with nephrolithiasis: hypocitraturia in 21 patients (72.4%), hypomagnesuria in 12 (41.4%), hyperoxaluria in 4 (13.6%) and urinary volume low in 5 (17.2%). Renal stones were identified in 13 patients (44.8%). Oxalate urinary excretion was higher in patients submitted to bowel surgery and also in patients with ileum resection. The urinary supersaturation of calcium oxalate and brushita in patients with bowels surgery was higher than the other patients not submitted to any surgery. Data to compare patients who underwent to surgery or not were analyzed by Mann-Whitney test (U test), and Qui-square test or the accurate test of Fisher have been used to determine variables association. For all tests 5% of significance level was considered.


CONCLUSIONS
This study shows that the frequency of renal stones in patients suffering from Crohns disease is higher than in general population and, also, higher than that described elsewhere for this disease. We identified hypocitraturia and hypomagnesiuria as the main factors which could explain our data. The impact of these metabolic disturbances can be also evaluated by means of the high supersaturation obtained for calcium oxalate and calcium phosphate which suggests the way those factors could be influencing crystal nucleation and, consequently, lead to renal stones formation in this group of patients.
Departamento de Clínica Médica, Centro de Ciências da Saúde, Universidade Estadual de Londrina, PR. maria.viana@unopar.br
Maria Lenise Lopes
ML
Viana
Rose Meire Albuquerque
RM
Pontes
Waldir Eduardo
WE
Garcia
Maria Emília
ME
Fávero
Denise Cavenaghi
DC
Prete
Tiemi
T
Matsuo
D000328:Adult; D000368:Aged; D002129:Calcium Oxalate / Q000652:urine; D002130:Calcium Phosphates / Q000652:urine; D003424:Crohn Disease / Q000150:complications* / Q000652:urine; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000209:etiology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography
D002130:Calcium Phosphates; D002129:Calcium Oxalate; C020243:calcium phosphate