Arora Zubin, Mukewar Saurabh, Lopez Rocio, Camino Debra, Shen Bo, Hall Phillip
*Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio;†Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio; and‡Department of Nephrology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Inflamm Bowel Dis. 2017 May;23(5):840-846. doi: 10.1097/MIB.0000000000001070.
Our previous study showed that nephrolithiasis is a common complication in ulcerative colitis patients after ileal pouch anal anastomosis (IPAA). However, the pathogenesis of nephrolithiasis in IPAA patients has not been studied. The aim of this study was to compare urine and serum metabolic compositions in IPAA patients with nephrolithiasis and controls with IPAA and no nephrolithiasis.
Using cross-sectional study design, serum and 24-hour urine metabolic compositions were compared between IPAA patients with nephrolithiasis (the study group) and those without (the control group). Urinary supersaturation of calcium oxalate, calcium phosphate, and uric acid was calculated.
A total of 40 patients were enrolled in the study. There were no significant differences in serum electrolytes, vitamin D, parathyroid hormone, and kidney function tests between the study (n = 20) and control groups (n = 20). Patients in the study group were found to have a significantly higher 24-hour urine supersaturation of calcium oxalate (8.8 versus 5.0, P = 0.037) and calcium phosphate (0.61 versus 0.27, P = 0.028) as compared with controls. Nineteen (95%) patients in the study group were symptomatic due to nephrolithiasis with several requiring procedural intervention for treatment, including ureteroscopy in 3 (15%) patients, lithotripsy in 5 (25%) patients, and percutaneous surgery in 1 (5%) patient.
Ulcerative colitis-IPAA patients are at risk for the development of calcium oxalate and calcium phosphate stones. Nephrolithiasis is symptomatic in a majority of the patients and frequently requires procedural intervention for treatment.
我们之前的研究表明，肾结石是回肠储袋肛管吻合术（IPAA）后溃疡性结肠炎患者的常见并发症。然而，IPAA患者肾结石的发病机制尚未得到研究。本研究的目的是比较有肾结石的IPAA患者与无肾结石的IPAA对照患者的尿液和血清代谢成分。
采用横断面研究设计，比较有肾结石的IPAA患者（研究组）和无肾结石的IPAA患者（对照组）的血清和24小时尿液代谢成分。计算草酸钙、磷酸钙和尿酸的尿液过饱和度。
共有40例患者纳入本研究。研究组（n = 20）和对照组（n = 20）之间的血清电解质、维生素D、甲状旁腺激素和肾功能检查无显著差异。与对照组相比，研究组患者的24小时草酸钙尿液过饱和度（8.8对5.0，P = 0.037）和磷酸钙尿液过饱和度（0.61对0.27，P = 0.028）显著更高。研究组中有19例（95%）患者因肾结石出现症状，其中数例需要进行手术干预治疗，包括3例（15%）患者接受输尿管镜检查，5例（25%）患者接受碎石术，1例（5%）患者接受经皮手术。
溃疡性结肠炎-IPAA患者有发生草酸钙和磷酸钙结石的风险。大多数患者的肾结石有症状，且经常需要进行手术干预治疗。
