In a recent study, a research team led by Dr. Bhojani from the Division of Urology, Université de Montréal in Montreal, Canada and colleagues found that compared to the general population, patients with inflammatory bowel disease (IBD) with urinary calculi are more likely to have urinary tract infections, renal failure, and sepsis. The findings also show that the increased occurrence and severity of infected urolithiasis in this patient group warrants screening for stone disease, improved outpatient medical management, and early elective surgery for detected stones. The study is published in the journal Urology.
Patients with IBD are at risk for both infection and stone formation, however, studies investigating emergent urolithiasis presentations for this population are limited. To address this issue, in the study titled “Urolithiasis and urinary tract infection among patients with inflammatory bowel disease: A review of US emergency department visits between 2006 and 2009 – Abstract,” the research team compared a sample of patients with IBD and urolithiasis with a cohort of individuals with urinary stone formations, who were admitted to US emergency departments with infected urolithiasis. Patients presenting to US emergency departments with a diagnosis of upper tract urolithiasis were identified from the Nationwide Emergency Department Sample between 2006 and 2009.
The results revealed that a total of 14,352 patients had both IBD and urolithiasis. IBD patients with urolithiasis presented with infections (10.4% vs 9.1%), sepsis (0.6% vs 0.2%), and end-organ failure (6.3% vs 1.6%) more frequently than non-IBD patients. Results also showed that these patients were more likely to have characteristics independently associated with infection and sepsis, such as older age and female gender. IBD was found be an independent predictor of infection, sepsis and admission.
Results from this study indicate that IBD patients presenting to the ED with urolithiasis are more likely to have concurrent infections, sepsis, and end-organ damage requiring hospitalization. In the study, the researchers suggest that efforts to prevent emergent presentations in this patient population should focus on primary prevention, screening for urolithiasis, and early operative intervention. The team also pointed that a multidisciplinary approach involving urologists, gastroenterologists, nephrologists, and dietitians could help reduce the frequency and intensity of stone disease in this at-risk population.