Moderately Increased Risk of Urinary Stone Disease in Patients With Biopsy-verified Coeliac Disease

J. F. Ludvigsson; F. Zingone; M. Fored; C. Ciacci; M. Cirillo

Disclosures

Aliment Pharmacol Ther. 2012;35(4):477-484. 

In This Article

Abstract and Introduction

Abstract

Background Urinary stone disease is a mal-absorptive disorder that is a significant health problem because of its high prevalence and incidence. However, there are few population-based studies on the risk of urinary stone disease in patients with coeliac disease (CD).
Aim To examine the risk of urinary stone disease in CD.
Methods Population-based cohort study. Using small intestinal biopsy report data from 1969 to 2008 obtained from all Swedish pathology departments (n = 28), we identified 28 735 patients with CD (equal to Marsh 3: villous atrophy). Patients were then matched for gender, age, county and calendar year to 142 177 reference individuals from the Swedish general population. We used Cox regression to estimate hazard ratios (HRs) for future urinary stone disease and conditional logistic regression to calculate odds ratios (ORs) for urinary stone disease before diagnosis of CD. Individuals with urinary stone disease were identified through the Swedish National Patient Register that contains data on inpatient care, outpatient care and day surgery.
Results During follow-up, 314 individuals with CD and 1142 reference individuals developed urinary stone disease. This corresponded to a 27% increased risk of urinary stone disease in CD [95% confidence interval (CI) = 1.12–1.44]. CD patients had an absolute risk of urinary stone disease of 107/100 000 person-years (excess risk of 23/100 000). Risk estimates were similar in men and women, and did not differ according to age at CD diagnosis. Conditional logistic regression found that patients with CD were at a slightly increased risk also of prior urinary stone disease (OR = 1.19; 95% CI = 1.06–1.33).
Conclusion In this study, coeliac disease was associated with a moderately increased risk of urinary stone disease both before and after coeliac disease diagnosis.

Introduction

Urinary stone disease (USD) is a concretion or calculi (crystal aggregations) formed by dietary minerals in the urine. The lifetime risk is estimated at about 10%[1] and potentially increasing.[2] The total cost of USD treatment in America has been estimated to more than 2 billion US dollars per year.[3]

Urinary stone disease is more common in men and especially prevalent in middle age. Symptoms range from no symptoms at all to severe pain, vomiting, fever and haematuria when the stone obstructs the urinary tract. USD is not only associated with end-stage renal disease[4] but also with other comorbidities.[5]

Coeliac disease (CD) is a lifelong immune-mediated enteropathy.[6] It is triggered by gluten exposure in genetically sensitive individuals and affects 1–2% of the Western population.[7] CD has been linked to a large number of disorders,[8–11] including end-stage renal disease,[12] and our research group recently showed that the disease also carries 30–40% excess mortality.[13] Many patients with CD suffer from malabsorption (often silent),[14] partly demonstrated by the lower weight of patients[15] and the high prevalence of CD in patients with iron-deficiency anaemia.[16]

Research has shown that USD is more common in undiagnosed CD [adjusted odds ratio (OR) 4.0, 95% confidence interval (CI) 2.7–5.9],[17] but less is known about the risk of future USD in patients with diagnosed CD. A recent study reported that 3/32 (9%) patients with refractory CD had USD,[18] but the design of that study did not allow the authors to calculate a relative risk of USD. The main objective of the current study was therefore to estimate the relative risk of future USD in a population-based cohort of CD patients without a prior history of USD.

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