Abstract: SA-PO678
Manifestations of Kidney Stone Recurrence and Their Prediction by Risk Factors
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- D'Costa, Matthew R., Mayo Clinic, Rochester, Minnesota, United States
- Mara, Kristin C., Mayo Clinic, Rochester, Minnesota, United States
- Haley, William E., Mayo Clinic, Rochester, Minnesota, United States
- Enders, Felicity T., Mayo Clinic, Rochester, Minnesota, United States
- Vrtiska, Terri J., Mayo Clinic, Rochester, Minnesota, United States
- Mccollough, Cynthia H., Mayo Clinic, Rochester, Minnesota, United States
- Lieske, John C., Mayo Clinic, Rochester, Minnesota, United States
- Rule, Andrew D., Mayo Clinic, Rochester, Minnesota, United States
Background
The relationship between symptomatic and radiographic kidney stone recurrence is unclear. Risk factors may also differ in their association with symptomatic and radiographic recurrence.
Methods
First-time symptomatic stone formers were recruited from 2009 to 2013 in MN and FL. Baseline and 5-year follow-up visits included CT scans, surveys, and medical record review. At 5 years, symptomatic recurrence was identified by clinical care (medical record) and self-report (survey); radiographic recurrence was identified by new stone, stone growth, or stone disappearance between CT's. A Recurrence of Kidney Stone (ROKS) score summed risk factors for recurrence (young age, male gender, high BMI, family history of stones, pregnancy, asymptomatic or suspected stone prior to first episode, history of a brushite/struvite/uric acid stone, no history of COM stone, pelvic/lower pole stone, no uterovesical junction stone, number of stones in kidney, and diameter of largest kidney stone). The 5-year incidence of recurrence and its association with ROKS score was compared.
Results
There were 175 stone formers studied (55% had an asymptomatic kidney stone at baseline). By year 5, 19% had symptomatic recurrence (clinical care), 25% had symptomatic recurrence (self-report), 35% had a new stone, 24% had stone growth, and 26% had stone disappearance. Of those with an asymptomatic stone, 47% had stone disappearance, and 50% of those had a concurrent symptomatic recurrence. Symptomatic recurrence by clinical care versus self-report was more strongly associated with new stone (OR=4.8 95% CI [2.2-10.6] versus 1.9 [1.0-3.9]) or stone disappearance (OR=3.9 [1.8-8.5] versus 2.0 [1.0-4.2]). The ROKS score associated more strongly with radiographic recurrence than only symptomatic recurrence (Table).
Conclusion
Clinical care is more strongly associated with recurrence than self-report. Half of first-time stone formers have an asymptomatic stone. By 5 years, half of these stones will have passed with symptoms occurring half the time (Rule of Halves). While symptomatic recurrence is more clinically relevant, asymptomatic radiographic recurrence is better predicted by risk factors.
| Symptomatic recurrence: clinical care only | Symptomatic recurrence: clinical care or self-report | Radiographic recurrence: new stone, stone growth or stone disappearance | Symptomatic or radiographic recurrence | |
| 5-year rate | 19% | 30% | 59% | 67% |
| OR (95% CI) per standard deviation of ROKS score | 1.7 (1.1, 2.5) | 2.1 (1.5, 3.1) | 3.7 (2.4, 5.8) | 3.6 (2.3, 5.5) |