BERKELEY, CA (UroToday.com) - Kidney stones (nephrolithiasis) have recently been linked to a few comorbid diseases including hypertension, metabolic syndrome, diabetes, gout, and chronic kidney disease.[1, 2] Recently, our study also demonstrates that patients with a history of nephrolithiasis are at significantly greater risk of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC). We recently conducted the meta-analysis of 7 studies which found that a history of nephrolithiasis was correlated with a significant 76% higher risk of RCC and a 2.1-fold increased risk of TCC. We also found that the risk of RCC associated with nephrolithiasis was significant only in males.
The plausible explanations for the higher risk of kidney cancer in patients with nephrolithiasis are stone-induced irritation and infections. It has been proposed that nephrolithiasis may cause changes in the local environment due to chronic irritation and infections, subsequently leading to urothelial proliferation and the development of malignancy. Our study also demonstrates the association between a history of nephrolithiasis and increased RCC risk in males in the subgroup analysis. This underlying pathophysiology is unclear. Men with nephrolithiasis may be exposed to dietary or environmental factors that could increase their risk of RCC.
Our study, however, is a meta-analysis of observational studies, so there are inherent limitations. Therefore, at best, it can demonstrate an association but not a causal relationship. Furthermore, these studies may have been vulnerable to a surveillance bias as patients with nephrolithiasis would have been more likely to have follow-up imaging studies, and kidney cancer may have been detected more than in patients without stones. Future studies are required to confirm this potential causal relationship.
In summary, the findings from our meta-analysis suggest that a history of nephrolithiasis is linked to kidney cancer and may impact future cancer surveillance.
- Cheungpasitporn W, Thongprayoon C, Mao MA, et al. The Risk of Coronary Heart Disease in Patients with Kidney Stones: A Systematic Review and Meta-analysis. N Am J Med Sci. 2014;6(11):580-5.
- Cheungpasitporn W, Erickson S. Medullary sponge kidneys and the use of dual-energy computed tomography. Urology Annals. 2015;7(1):129.
- Cheungpasitporn W, Thongprayoon C, O'Corragain OA, et al. The risk of kidney cancer in patients with kidney stones: a systematic review and meta-analysis. QJM. 2014.
- Chow WH, Lindblad P, Gridley G, et al. Risk of urinary tract cancers following kidney or ureter stones. J Natl Cancer Inst. 1997;89(19):1453-7.
Charat Thongprayoon, MD and Wisit Cheungpasitporn, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN USA