Recent population studies have found symptomatic
kidney stone formers to be at increased risk for
chronic kidney disease (CKD). Although
kidney stones are not commonly identified as the primary cause of
ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming
kidney stones because of the substantial reduction in urine
calcium excretion. Among stone formers, those with rare
hereditary diseases (
cystinuria,
primary hyperoxaluria,
Dent disease, and 2,8 dihydroxyadenine stones), recurrent
urinary tract infections,
struvite stones,
hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from
kidney stones is usually attributed to an obstructive uropathy or
pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave
lithotripsy may also contribute. The historical shift to less invasive surgical management of
kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic
kidney stones but not radiographic stones found on computed tomography scans were associated with
albuminuria.
Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed.