Department of Internal Medicine, the Cleveland Clinic Foundation, Cleveland, OH, USA.
J Crohns Colitis. 2013 Feb;7(1):70-8. doi: 10.1016/j.crohns.2012.05.006. Epub 2012 Jun 23.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become a standard of care in patients with ulcerative colitis (UC). Nephrolithiasis is common in patients with inflammatory bowel disease (IBD), but has never been studied as a complication of IPAA. We aimed to assess the risk factors for nephrolithiasis in patients with IPAA.
Using an IRB-approved, prospectively maintained pouch registry, we identified 1221 patients between 2000 and 2010. Those with post-IPAA nephrolithiasis served as the study group whereas IPAA patients without nephrolithiasis served as the controls. Demographic and clinical variables were analyzed using multivariable logistic regression to identify risk factors.
There were a total of 218 IPAA patients: 81 with nephrolithiasis (37%) and 137 without (63%). Of the 81 patients in the study group, 17 were excluded due to limited clinical data. Three risk factors were found to be associated with nephrolithiasis: the presence of extra-intestinal manifestations (odd's ratio [OR]=2.9, 95% confidence interval [CI]: 1.4, 5.8, p=0.003), no use of antibiotics (OR=3.2, 95% CI: 1.5, 6.5, p=0.002) and low serum bicarbonate level (OR=0.87, 95% CI: 0.77, 0.99, p=0.038).
Nephrolithiasis was a common finding in our patients with IPAA. As pouch patients with nephrolithiasis can develop adverse clinical complications, those with at least one of the risk factors we identified may need to be monitored more closely and possibly receive prophylactic treatment with oral bicarbonate.
回肠贮袋肛管吻合术（IPAA）已成为溃疡性结肠炎（UC）患者的标准治疗方法。肾结石在炎症性肠病（IBD）患者中很常见，但从未被研究为 IPAA 的并发症。我们旨在评估 IPAA 患者肾结石的危险因素。
使用经 IRB 批准的前瞻性维持性贮袋登记处，我们在 2000 年至 2010 年间确定了 1221 名患者。将 IPAA 后患有肾结石的患者作为研究组，而没有肾结石的 IPAA 患者作为对照组。使用多变量逻辑回归分析人口统计学和临床变量，以确定危险因素。
共有 218 名 IPAA 患者：81 名患有肾结石（37％），137 名没有（63％）。在研究组的 81 名患者中，由于临床资料有限，有 17 名被排除在外。发现三个危险因素与肾结石有关：存在肠外表现（优势比[OR]=2.9，95％置信区间[CI]：1.4，5.8，p=0.003），未使用抗生素（OR=3.2，95％CI：1.5，6.5，p=0.002）和血清碳酸氢盐水平低（OR=0.87，95％CI：0.77，0.99，p=0.038）。
肾结石在我们的 IPAA 患者中是常见的发现。由于患有肾结石的贮袋患者可能会出现不良的临床并发症，因此我们确定的至少有一个危险因素的患者可能需要更密切地监测，并可能需要接受口服碳酸氢盐的预防性治疗。
