NEW TEST PREDICTS INDIVIDUAL'S RISK OF SECOND KIDNEY STONE
A new tool that takes multiple factors into
account can accurately predict how likely a patient who experienced a painful
kidney stone will develop another one in the future. The tool, which is
described in an upcoming issue of the Journal of
the American Society of Nephrology (JASN),
could help patients and their doctors determine
whether preventive measures are needed.
Kidney stones are common and affect
approximately 6% to 9% of the population. The greatest concern of patients who
have experienced a kidney stone is whether this excruciating painful event will
ever happen again. Certain dietary recommendations and medications can help
prevent another kidney stone from forming, but these can be burdensome,
expensive, or cause side effects. "If we knew which patients were at high
risk for another symptomatic kidney stone, then we could better advise patients
on whether to follow stone prevention diets or take medications," said
Andrew Rule, MD (Mayo Clinic). "At the same time, patients who are at low
risk of having another kidney stone may not need restrictive diets and
medications."
Dr. Rule and his colleagues
conducted a study to help them develop a prediction tool that could be used by
patients and their doctors to determine the risk of having a second symptomatic
kidney stone after the first. The team reviewed the medical records of all
adult first-time symptomatic stone formers residing in Olmsted County,
Minnesota, from 1984 to 2003. Of the 2239 individuals identified, 707
experienced a recurrence through 2012.
From the information they gathered,
the researchers developed the Recurrence of Kidney Stone (ROKS) nomogram that
uses 11 questions about the patient to accurately calculate the probability of
having another symptomatic kidney stone at 2, 5, or 10 years after the first
stone. Characteristics that predict a higher risk include younger age, male
gender, white race, family history of kidney stones, blood seen in the urine,
stone made of uric acid (rather than calcium), obstructing stone in the kidney
pelvis, any additional non-obstructing stone, and any past painful event
attributed to a kidney stone even though a stone was not seen..
In an accompanying editorial, Brian
Eisner, MD (Massachusetts General Hospital and Harvard Medical School) and
David Goldfarb, MD (York Harbor VA Healthcare System and NYU School of
Medicine) noted that for the nomogram to demonstrate value, it now should be
tested prospectively in additional populations of stone formers. "Whether
additional variables can be added to increase the usefulness of this tool will
be of interest in the future," they added.
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