Oral antibiotics linked to increased kidney stone risk

May 10, 2018

HighlightsWashington, DC May 10, 2018) -- The potential to promote antibiotic resistance in bacteria isn't the only reason to avoid using antibiotics when possible. A new study reveals that antibiotics are also linked with an increased risk of developing kidney stones, with the greatest risk among children. The findings appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

For reasons that are unclear, the prevalence of kidney stones--or nephrolithiasis--has increased 70% over the last 30 years, with the most disproportionate increase experienced by children and adolescents. Because perturbations in bacterial communities residing in the intestines and urinary tract have been associated with nephrolithiasis, a team led by Gregory Tasian MD, MSc, MSCE and Michelle Denburg MD, MSCE (The Children's Hospital of Philadelphia) examined whether the use of antibiotics might affect individuals' risk of developing the condition.

For their study, the investigators determined the association between 12 classes of oral antibiotics and nephrolithiasis in a population-based study within 641 general practices providing electronic health record data for >13 million children and adults from 1994 to 2015 in the United Kingdom. The team matched 25,981 patients with nephrolithiasis to 259,797 controls by age, sex, and practice at the date of diagnosis (termed the index date).

Exposure to any one of five different antibiotic classes 3-12 months before the index date was associated with nephrolithiasis. Risks were increased 2.3-times, 1.9-times, 1.7-times, 1.7-times, and 1.3-times for sulfas, cephalosporins, fluoroquinolones, nitrofurantoin/methenamine, and broad-spectrum penicillins, respectively. The risk of nephrolithiasis decreased over time, but it remained elevated at 3-5 years after the antibiotic prescription. Also, the risk was greatest for exposures at younger ages. Previous research has shown that children receive more antibiotics than any other age group, and 30% of antibiotics prescribed during ambulatory care visits are inappropriate.

"These findings demonstrate that exposure to certain antibiotics is a novel risk factor for kidney stones and that the risk may be greatest when exposure to these antibiotics occurs at younger ages," said Dr. Tasian. "Consequently, these results suggest that the risk of nephrolithiasis may be decreased by reducing inappropriate antibiotic exposure and choosing alternative antibiotics, particularly for those patients who are at increased risk of stone formation."
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Study co-authors include Thomas Jemielita, PhD, David S. Goldfarb, MD, Lawrence Copelovitch, MD, Jeffrey Gerber MD, PhD, MSCE, and Qufei Wu, MS.

Disclosures: The authors have no conflicts of interest to declare.

The article, entitled "Oral Antibiotic Exposure and Kidney Stone Disease," will appear online at http://jasn.asnjournals.org/ on May 10, 2018, doi: 10.2215/ASN.2017111213.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 18,000 members representing 112 countries. For more information, please visit http://www.asn-online.org or contact the society at 202-640-4660.

American Society of Nephrology

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