Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704302, Taiwan.
Sci Rep. 2023 Oct 17;13(1):17686. doi: 10.1038/s41598-023-45034-1.
Urolithiasis is associated with an increased risk of chronic kidney disease (CKD), irrespective of stone compositions. Chronic inflammation is an important factor for CKD progression. Neutrophil-to-lymphocyte ratio (NLR) has been recognized as a reliable biomarker of inflammation, yet its use in predicting renal deterioration in patients with urolithiasis remains limited. We aimed to explore whether the combination of stone composition and NLR could be useful as a predictor for CKD risk. A total of 336 stone formers with at least one stone submission for analysis were enrolled in the retrospective study. Stones were classified into uric acid and calcium groups. Renal functions were assessed at least one month after stone treatment. Uric acid stone formers had significantly lower estimated glomerular filtration rate (eGFR) compared with calcium stone formers (p < 0.001). NLR was significantly higher in uric acid stone formers (p = 0.005), and a significantly negative correlation (p < 0.001) between NLR and eGFR had been observed only in uric acid stone group. Univariate and multivariate logistic regression analyses showed that higher proportion of uric acid stone composition and higher NLR were both significantly associated with CKD risks. A nomogram integrating independent predictors was generated for CKD prediction, yielding an AUC of 0.811 (0.764-0.858). In conclusion, our study demonstrated that stone formers with higher proportion of uric acid composition and higher NLR levels were associated with higher CKD risk.
尿石症与慢性肾脏病（CKD）风险增加相关，而与结石成分无关。慢性炎症是 CKD 进展的一个重要因素。中性粒细胞与淋巴细胞比值（NLR）已被认为是炎症的可靠生物标志物，但在预测尿石症患者的肾脏恶化方面的应用仍有限。我们旨在探讨结石成分和 NLR 联合是否可作为 CKD 风险的预测指标。本回顾性研究共纳入了 336 名至少有一次结石送检分析的结石形成者。结石分为尿酸盐组和钙组。在结石治疗后至少 1 个月评估肾功能。尿酸盐结石形成者的估算肾小球滤过率（eGFR）明显低于钙结石形成者（p<0.001）。尿酸盐结石形成者的 NLR 明显更高（p=0.005），且仅在尿酸盐结石组中观察到 NLR 与 eGFR 之间存在显著负相关（p<0.001）。单因素和多因素 logistic 回归分析显示，尿酸盐结石成分比例较高和 NLR 较高均与 CKD 风险显著相关。生成了一个整合独立预测因子的列线图，用于 CKD 预测，AUC 为 0.811（0.764-0.858）。总之，我们的研究表明，尿酸盐结石成分比例较高和 NLR 水平较高的结石形成者与更高的 CKD 风险相关。
