Management of Nephrolithiasis After Kidney Transplantation: a Comprehensive Review from the European Renal Association CKD-MBD Working Group

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2024 Feb 27

PMID 38410685

Authors

Mehmet Kanbay

Sidar Copur

Cicek N Bakir

Alper Hatipoglu

Smeeta Sinha

Mathias Haarhaus

Affiliations

Soon will be listed here.

Abstract

The lifetime incidence of kidney stones is 6%-12% in the general population. Nephrolithiasis is a known cause of acute and chronic kidney injury, mediated via obstructive uropathy or crystal-induced nephropathy, and several modifiable and non-modifiable genetic and lifestyle causes have been described. Evidence for epidemiology and management of nephrolithiasis after kidney transplantation is limited by a low number of publications, small study sizes and short observational periods. Denervation of the kidney and ureter graft greatly reduces symptomatology of kidney stones in transplant recipients, which may contribute to a considerable underdiagnosis. Thus, reported prevalence rates of 1%-2% after kidney transplantation and the lack of adverse effects on allograft function and survival should be interpreted with caution. In this narrative review we summarize current state-of-the-art knowledge regarding epidemiology, clinical presentation, diagnosis, prevention and therapy of nephrolithiasis after kidney transplantation, including management of asymptomatic stone disease in kidney donors. Our aim is to strengthen clinical nephrologists who treat kidney transplant recipients in informed decision-making regarding management of kidney stones. Available evidence, supporting both surgical and medical treatment and prevention of kidney stones, is presented and critically discussed. The specific anatomy of the transplanted kidney and urinary tract requires deviation from established interventional approaches for nephrolithiasis in native kidneys. Also, pharmacological and lifestyle changes may need adaptation to the specific situation of kidney transplant recipients. Finally, we point out current knowledge gaps and the need for additional evidence from future studies.

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References

Boissier R, Rodriguez-Faba O, Zakri R, Hevia V, Budde K, Figueiredo A . Evaluation of the Effectiveness of Interventions on Nephrolithiasis in Transplanted Kidney. Eur Urol Focus. 2022; 9(3):491-499. DOI: 10.1016/j.euf.2022.11.019. View

Isaka Y, Takabatake Y, Takahashi A, Saitoh T, Yoshimori T . Hyperuricemia-induced inflammasome and kidney diseases. Nephrol Dial Transplant. 2015; 31(6):890-6. DOI: 10.1093/ndt/gfv024. View

Abou-Elela A . Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review. J Adv Res. 2017; 8(5):513-527. PMC: 5512151. DOI: 10.1016/j.jare.2017.04.005. View

Li X, Li B, Meng Y, Yang L, Wu G, Jing H . Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature. BMC Nephrol. 2020; 21(1):238. PMC: 7310338. DOI: 10.1186/s12882-020-01896-5. View

Ferreira Cassini M, Cologna A, Ferreira Andrade M, Lima G, Medeiros Albuquerque U, Pereira Martins A . Lithiasis in 1,313 kidney transplants: incidence, diagnosis, and management. Transplant Proc. 2012; 44(8):2373-5. DOI: 10.1016/j.transproceed.2012.07.052. View

Olsburgh J, Thomas K, Wong K, Bultitude M, Glass J, Rottenberg G . Incidental renal stones in potential live kidney donors: prevalence, assessment and donation, including role of ex vivo ureteroscopy. BJU Int. 2012; 111(5):784-92. DOI: 10.1111/j.1464-410X.2012.11572.x. View

Schade G, Styn N, Hall T, Roberts W . Endoscopic assessment and prediction of prostate urethral disintegration after histotripsy treatment in a canine model. J Endourol. 2011; 26(2):183-9. PMC: 3311909. DOI: 10.1089/end.2011.0349. View

Krambeck A, LeRoy A, Patterson D, Gettman M . Percutaneous nephrolithotomy success in the transplant kidney. J Urol. 2008; 180(6):2545-9. DOI: 10.1016/j.juro.2008.08.032. View

Littbarski S, Kaltenborn A, Gwiasda J, Beneke J, Arelin V, Schwager Y . Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy. Surgery. 2017; 163(2):373-380. DOI: 10.1016/j.surg.2017.10.016. View

10.

Li S, Wang Q, Chen W . Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy. Chin Med J (Engl). 2011; 124(9):1431-4. View

11.

Hamm L . Renal handling of citrate. Kidney Int. 1990; 38(4):728-35. DOI: 10.1038/ki.1990.265. View

12.

Yuan H, Yang D, Cui Y, Men C, Gao Z, Shi L . Minimally invasive treatment of renal transplant nephrolithiasis. World J Urol. 2015; 33(12):2079-85. DOI: 10.1007/s00345-015-1549-9. View

13.

Verrier C, Bessede T, Hajj P, Aoubid L, Eschwege P, Benoit G . Decrease in and management of urolithiasis after kidney transplantation. J Urol. 2012; 187(5):1651-5. DOI: 10.1016/j.juro.2011.12.060. View

14.

Callender G, Malinowski J, Javid M, Zhang Y, Huang H, Quinn C . Parathyroidectomy prior to kidney transplant decreases graft failure. Surgery. 2016; 161(1):44-50. DOI: 10.1016/j.surg.2016.10.003. View

15.

Rashid M, Konnak J, Wolf Jr J, Punch J, Magee J, Arenas J . Ex vivo ureteroscopic treatment of calculi in donor kidneys at renal transplantation. J Urol. 2003; 171(1):58-60. DOI: 10.1097/01.ju.0000101757.69344.de. View

16.

Abbott K, Schenkman N, Swanson S, Agodoa L . Hospitalized nephrolithiasis after renal transplantation in the United States. Am J Transplant. 2003; 3(4):465-70. DOI: 10.1034/j.1600-6143.2003.00080.x. View

17.

Shoag J, Halpern J, Goldfarb D, Eisner B . Risk of chronic and end stage kidney disease in patients with nephrolithiasis. J Urol. 2014; 192(5):1440-5. DOI: 10.1016/j.juro.2014.05.117. View

18.

Dumoulin G, Hory B, Nguyen N, Henriet M, Bresson C, Bittard H . Lack of increased urinary calcium-oxalate supersaturation in long-term kidney transplant recipients. Kidney Int. 1997; 51(3):804-10. DOI: 10.1038/ki.1997.113. View

19.

Kim H, Cheigh J, Ham H . Urinary stones following renal transplantation. Korean J Intern Med. 2001; 16(2):118-22. PMC: 4531707. DOI: 10.3904/kjim.2001.16.2.118. View

20.

Markic D, Valencic M, Grskovic A, Spanjol J, Sotosek S, Fuckar Z . Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report. Transplant Proc. 2011; 43(5):2110-2. DOI: 10.1016/j.transproceed.2011.03.031. View