Symptomatic and Radiographic Manifestations of Kidney Stone Recurrence and Their Prediction by Risk Factors: A Prospective Cohort Study
Symptomatic and Radiographic Manifestations of Kidney Stone Recurrence and Their Prediction by Risk Factors: A Prospective Cohort Study
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DOI：
10.1681/asn.2018121241
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发表时间：
2019-07-01
影响因子：
13.6
通讯作者：
Rule, Andrew D.
中科院分区：
文献类型：
--
作者：
D'Costa, Matthew R.;Haley, William E.;Rule, Andrew D.
背景 要对放射学肾结石负荷的变化进行有意义的解释，需要了解放射学复发与症状复发之间的关系，以及既定的危险因素如何预测这些不同的复发表现。方法我们从明尼苏达州和佛罗里达州的普通社区招募了首次出现症状的结石形成者。基线和 5 年随访研究访问包括计算机断层扫描、调查和病历审查。我们注意到临床护理（通过图表审查）或自我报告检测到的症状复发，以及任何新结石、结石生长或结石通道的放射学复发（比较基线和后续扫描）。为了评估不同症状复发的预测，我们使用了肾结石复发 (ROKS) 评分，该评分对多个基线危险因素进行了总结。 结果 在 175 名结石形成者中，19% 的患者通过临床护理检测到症状复发，25% 的患者通过自我报告检测到症状复发；放射照相复发表现为 35% 出现新结石，24% 表现为结石生长，27% 表现为结石排出。在基线无症状结石患者 (54%) 中，5 年时，51% 的患者有结石排出的影像学证据（只有 52% 的患者伴有症状）。与自我报告相比，临床护理检测到的新结石或结石通道的影像学证据与症状复发的相关性更强。 ROKS 评分弱预测一种表现——导致临床治疗的症状复发（c 统计量，0.63；95% 置信区间，0.52 至 0.73）——但强烈预测任何症状或影像学复发表现（5 年率，67%；c 统计量，0.79；95% 置信区间，0.72 至 0.86）。当考虑到所有复发表现（症状和放射学）时，这种情况更常见且更可预测。
Background Meaningful interpretation of changes in radiographic kidney stone burden requires understanding how radiographic recurrence relates to symptomatic recurrence and how established risk factors predict these different manifestations of recurrence.Methods We recruited first-time symptomatic stone formers from the general community in Minnesota and Florida. Baseline and 5-year follow-up study visits included computed tomography scans, surveys, and medical record review. We noted symptomatic recurrence detected by clinical care (through chart review) or self-report, and radiographic recurrence of any new stone, stone growth, or stone passage (comparing baseline and follow-up scans). To assess the prediction of different manifestations of recurrence, we used the Recurrence of Kidney Stone (ROKS) score, which sums multiple baseline risk factors.Results Among 175 stone formers, 19% had symptomatic recurrence detected by clinical care and 25% detected by self-report; radiographic recurrence manifested as a new stone in 35%, stone growth in 24%, and stone passage in 27%. Among those with a baseline asymptomatic stone (54%), at 5 years, 51% had radiographic evidence of stone passage (accompanied by symptoms in only 52%). Imaging evidence of a new stone or stone passage more strongly associated with symptomatic recurrence detected by clinical care than by self-report. The ROKS score weakly predicted one manifestation-symptomatic recurrence resulting in clinical care (c-statistic, 0.63; 95% confidence interval, 0.52 to 0.73)-but strongly predicted any manifestation of symptomatic or radiographic recurrence (5-year rate, 67%; c-statistic, 0.79; 95% confidence interval, 0.72 to 0.86).Conclusions Recurrence after the first stone episode is both more common and more predictable when all manifestations of recurrence (symptomatic and radiographic) are considered.