title: Urological Procedures in Urolithiasis and Their Association with Chronic Kidney Disease.
abstract: OBJECTIVE
  Epidemiological evidence suggests that patients with urolithiasis are at increased risk for end-stage renal disease (ESRD). It is unclear if urological intervention impacts the progression of chronic kidney disease (CKD).
  
  
  METHODS
  We conducted a retrospective observational cohort study of patients in the Marshfield Epidemiologic Study Area database between January 1991 and May 2007, where 1,340 patients diagnosed with urolithiasis were extracted. Of the 1,340 subjects, 446 had urological procedures for management of urolithiasis. Those that underwent these procedures were compared to those that did not. Cox proportional hazards models adjusted for age, gender, and comorbidities were performed to evaluate the risk for CKD, elevated serum creatinine, and any-cause mortality.
  
  
  RESULTS
  Baseline comorbidities in patients with and without procedures were not significantly different except for obesity (P<0.0001). Subjects that underwent procedures were at increased risk for elevated serum creatinine (Hazard Ratio (HR) [95% CI] =1.49 [1.19-1.85]) when compared to those that did not undergo a urologic procedure during the study period. The results did not reveal a significant difference in incidence of CKD or any-cause mortality.
  
  
  CONCLUSIONS
  Patients who undergo urologic procedures are at increased risk for elevated creatinine. Urological procedures do not appear to impact incidence of CKD or mortality and, in fact, may prevent long-term renal dysfunction.
authors.affiliation: Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA matthewdcosta@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: D'Costa
authors.affiliation: Department of Nephrology, Summit Ridge Medical Center, Reno, Nevada, USA.
authors.forename: Radmila
authors.initials: R
authors.lastname: Savcic-Kos
authors.affiliation: Division of Nephrology, UCLA-David Geffen School of Medicine, Los Angeles, California, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Huang
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Rule
authors.affiliation: Department of Nephrology, Marshfield Clinic, Marshfield, Wisconsin, USA.
authors.forename: Narayana
authors.initials: N
authors.lastname: Murali
mesh_terms: D000328:Adult; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis; D009765:Obesity / Q000150:complications; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D052878:Urolithiasis / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; Nephrolithiasis; Urolithiasis; Urological procedures