December 1, 2020
What is the risk of urolithiasis in IBD?
Patients with IBD are at increased risk of urolithiasis. This should be considered in the differential diagnosis for presentations with pain and/or urinary symptoms.
Dimke H, Winther-Jensen M, Allin KH, et al. Risk of Urolithiasis in Patients with Inflammatory Bowel Disease: A Nationwide Danish Cohort Study 1977-2018. Clin Gastroenterol Hepatol. Epub ahead of print September 30, 2020; https://doi.org/10.1016/j.cgh.2020.09.049
To investigate the prevalence of, and risk factors for, urolithiasis among IBD patients, researchers at several Danish academic centres examined data from that country’s National Patient Register between 1977 and 2018.
They found that 3% of 75,236 IBD patients in the register were diagnosed with urolithiasis during a median 11-year length of follow-up, compared to 2% of 767,403 age- and sex-matched Danes without IBD over the same period (p<0.001).
After adjusting for comorbidity burden and level of education—two factors that distinguished the IBD population from the non-IBD population—there remained a greater two-fold increased risk of urolithiasis among IBD patients (Hazard Ratio [HR]: 2.27; 95% Confidence Interval [CI], 2.17–2.38). The risk of urolithiasis was higher among IBD patients than non-IBD patients even prior to an IBD diagnosis (Odds Ratio [OR]: 1.42; 95% CI, 1.34–1.50). The risk was also greater in the Crohn’s disease (HR: 2.89; 95% CI, 2.67–3.12) than in ulcerative colitis (HR: 1.95; 95% CI, 1.84–2.07), compared to the non-IBD population.
Recurrent episodes of urolithiasis occurred in 20% of IBD patients, compared to 14% of non-IBD patients (p<0.001).
Use of anti-TNF agents or prior surgery increased the risk of urolithiasis roughly three-fold in IBD patients, compared to IBD patients who had not received these agents or undergone surgery. The authors speculated that both of these factors could be surrogate markers of the duration and severity of inflammation.
Study Design: Registry-based cohort
Funding: The Augustinus Foundation
Allocation: Not applicable
Level of Evidence: 2b