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Urological conditions common but underrecognized in CKD
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Considering urological diseases — prevalent in patients with CKD but frequently undiagnosed — during kidney disease assessments could help prevent the onset of CKD or slow the progression to ESKD, according to a published study.
“Diabetes and hypertension are the most common causes of CKD, but other causes such as urological diseases have a prevalence that is not exactly known in adults,” Silvia Lai, MD, of the department of clinical medicine at Sapienza University of Rome in Italy, and colleagues wrote. “The most frequent are vesicoureteral reflux, which can [lead to] reflux nephropathy, recurrent urinary tract infections, which may result in pyelonephritis, and urinary tract obstruction. These pathologies may present insidious onset and slow progression, which make them difficult to identify and define despite well-known complications.”
To evaluate the prevalence of urological diseases in patients with CKD stages 1 to 5, researchers conducted an observational, cross-sectional study of 83 patients (eGFR 90 mL/min/1.73m2; 51.8% men; mean age 59.8 years).
Using uroflowmetry as a means to assess the functional status of the lower urinary tract, researchers determined maximum urine flow rates (normally defined as between 20 and 35 mL/s).
Researchers found that, of all study participants, 49.5% had functional urological disease.
They also determined that patients who had a normal maximum flow rate had an average eGFR of 81 mL/min/1.73m2, patients with a flow rate more than 35 mL/s had an average eGFR of 66 mL/min/1.73m2 and patients with a flow rate of less than 20 mL/s had an average eGFR of 65 mL/min/1.73m2.
Investigators observed significant associations between maximum flow rate and creatinine, eGFR, voiding volume, CKD and recurrent infection.
“We showed a high prevalence of unrecognized urological disease in nephropathic patients,” the researchers wrote. “In particular, in the female population, we reported mostly a high [maximum flow rate], with urgency incontinence, indicating a possible overactive bladder or bladder filling phase disease or pelvic floor dysfunction. Moreover, we showed a significant association between pathological [maximum flow rate] and reduced eGFR. Uroflowmetry study could be used as a first-level test to identify possible urological disorders in nephropathic patients, especially considering the ease of execution, the repeatability, the non-invasiveness and the low cost. Multidisciplinary care in CKD patients could contribute to identify potential urological diseases associated with CKD and to improve the standard of care and clinical outcomes.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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