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Evaluation of Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease Patients

José L. Nishiura^*, Rodrigo F.C.A. Neves, Samara R.M. Eloi^*, Susan M.L.F. Cintra^*, Sergio A. Ajzen, and Ita P. Heilberg^*

^* Nephrology Division and Radiology Department, Universidade Federal de São Paulo, São Paulo, Brazil

Correspondence: Dr. Ita P. Heilberg, Universidade Federal de São Paulo, Nephrology Division, Rua Botucatu 740, Vila Clementino, São Paulo-SP, 04023-900, Brazil. Phone: 55-11-5574-6300; Fax: 55-11-5573-9652; E-mail: ipheilberg{at}nefro.epm.br

Background and objectives: Nephrolithiasis (LIT) is more prevalent in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. Renal ultrasonography may underdetect renal stones because of difficulties imposed by parenchymal and/or cyst wall calcifications.

Design, setting, participants, & measurements: A total of 125 patients with ADPKD underwent ultrasonography and unenhanced computed tomography (CT) scan, routine blood chemistry, and spot and 24-h urine collections.

Results: CT scan detected calculi in 32 patients, including 20 whose previous ultrasonography revealed no calculi. The percentage of hypocitraturia was high but not statistically different between patients with ADPKD+LIT or ADPKD. Hyperuricosuria and distal renal tubular acidosis were less prevalent but also did not differ between groups, whereas hyperoxaluria was significantly higher in the former. Hypercalciuria was not detected. Renal volume was significantly higher in patients with ADPKD+LIT versus ADPKD, and a stepwise multivariate logistic regression analysis showed that a renal volume 500 ml was a significant predictor of LIT in patients with ADPKD and normal renal function, after adjustments for age and hypertension.

Conclusions: CT scan was better than ultrasonography to detect LIT in patients with ADPKD. Larger kidneys from patients with ADPKD were more prone to develop stones, irrespective of the presence of metabolic disturbances.