Multiple Sclerosis and Nephrolithiasis: A Matched Case Comparative Study

To compare stone composition and serum/urine biochemistries in stone formers with multiple sclerosis (MS) against stone formers without MS and to examine the association between mobility, methods of bladder emptying, and stone formation.

In this retrospective case-control study, we identified patients diagnosed with multiple sclerosis and kidney stone disease who were seen at our institution between 2001 and 2016. For the first part of the study, up to 2 controls (stone formers without a history of MS) were identified for each case and matched on age, body mass index (BMI), and sex. For the second part of this study, matched controls (MS patients without a history of stones) were identified in a 1:1 ratio in a similar fashion. Results of 24-hour urine biochemistry studies, stone compositions, serum labs, medications, history of stone surgeries, mobility, and method of bladder emptying were collected.

A total of 587 patients were identified who had both multiple sclerosis and a history of stone disease. Of these, 118 patients had a stone composition available. When compared to matched controls, patients with MS were significantly more likely to have calcium phosphate stones (42% vs 15%, p < 0.001) and struvite stones (8% vs 3%, p = 0.03) and less likely to have calcium oxalate monohydrate stones (39% vs. 64%, p < 0.001). Among those patients with a composition available, those with MS were more likely to have undergone a PCNL (25% vs 12%, p = 0.005) or a cystolithopaxy (16% vs. 3%, p < 0.001) compared to their matched controls. 61 patients had a complete 24-hour urinary stone panel. There were no significant differences in urinary pH, volume, creatinine, calcium, citrate, oxalate, sodium, and uric acid as well as rates of hypocitraturia, hyperoxaluria, hypercalciuria, and hyperuricosuria among patients with MS. Use of intermittent straight catheterization (OR, 3.50 [95% CI, 1.89-6.47]; P = < 0.001) or an indwelling catheter (OR, 9.78 [95% CI, 4.81-19.88]; P = <0.001) for bladder emptying was significantly associated with stone disease. There was no association between level of mobility and stone disease (p = 0.10).

Similar to findings seen in patients with spinal cord injuries, patients with multiple sclerosis have a high incidence of calcium phosphate stones and struvite stones when compared with matched controls. Additionally, they were more likely to undergo percutaneous nephrolithotomy (PCNL). The method of bladder management appears to be a risk factor in the development of stone disease. These findings suggest the importance of prompt treatment of urinary tract infections in this population and delay the use intermittent straight catheterization (ISC), suprapubic tube (SPT), or an indwelling foley when possible This article is protected by copyright. All rights reserved.

BJU international. 2017 Feb 20 [Epub ahead of print]

Vishnu Ganesan, Wen Min Chen, Rajat Jain, Shubha De, Manoj Monga

Cleveland Clinic Lerner College of Medicine., Case Western Reserve University School of Medicine., Cleveland Clinic Glickman Urological Kidney Institute.