Association of renal stone (urolithiasis) with nonalcoholic fatty liver (NAFL) Poster No.: C-2056 Congress: ECR 2015 Type: Scientific Exhibit Authors: D. Paz 1, L. Guralnik 2 ; 1 Haifa/IL, 2 Nesher/IL Keywords: Diagnostic procedure, CT, Abdomen, Epidemiology DOI: 10.1594/ecr2015/C-2056 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 10
Aims and objectives Nonalcoholic fatty liver disease (NAFLD) has been reported to be related to metabolic disorders and is considered to be a hepatic representative of the metabolic syndrome (1). The NAFLD is a rapidly emerging chronic liver disorder that affects 3-24% of the general population. (2). The high prevalence of non alcoholic steatohepatitis (NASH), i.e. a more progressive form of NAFLD in patients with gallbladder stone, is currently reported with typical risk factors for both diseases. (3). Recent findings indicate that NAFLD is negatively associated with kidney function and NAFLD and mild kidney function damage may share similar risk factors and/or pathological processes. (4). Urolithiasis is an increasing form of common renal disease that is associated with crystal deposition in the renal medulla and urinary tract. It is multifactorial disorder influenced by both intrinsic and extrinsic, mainly environmental factors (5). Current epidemiological studies have revealed an association of obesity, diabetes mellitus, hypertension, and metabolic syndrome with kidney stone disease. These results indicate that metabolic syndrome causes changes in urinary constituents, leading to an increased risk of both uric and calcium oxalate stone formations. Thus urolithiasis should be considered a component of the metabolic syndrome. (6). Recently in our routine clinical practice, we noticed a concomitant pathologies of both fatty liver and urolithiasis, coincidentally found in a group of randomized patient who underwent an abdominal non contrast CT scan that were indicated for renal colic. It is known that abdominal non contrast CT is a useful tool in detecting fatty liver disease(7).the association between the fatty liver and renal calculi as a specific underlining risk factor has received almost no attention. Literature reviews using Pubmed articles revealed only one study that suggests that NAFLD may be involved in the mechanism of the onset of the Urolithiasis (6). Therefore, in this study, we have decided to investigate a possible relationship between urolithiasis and fatty liver in patients who underwent non contrast CT scan examination. Methods and materials Page 2 of 10
We retrospectively analyzed a total of 100 non contrast CT studies of 100 patients that were indicated for renal colic. All of the studies were performed on the same Dual Source CT. Liver attenuation measurements in Hounsfield units were obtained by two different radiologist, and the presence or absence of fatty infiltration of the liver was diagnosed in at least two liver segments, the diagnosis of fatty liver was made if the attenuation of the liver was at least 10 HU less than that of the spleen or the attenuation of the liver was less than 40 HU. (4). Descriptive statistic determined the number (frequency and percentage) of fatty liver, renal stone or both, and for the statistical analysis A Fisher's exact test 2 x 2 with Lancaster's mid-p-value was used. The statistical significance was established at P < 0.05. Fig. 1: One of the patients enrolled in the study, Fatty liver,hu=10. References: Radiology, Technion, Rambam health care campus - Haifa/IL Page 3 of 10
Fig. 2: The same patient(fig 1) with renal calculi in the mid ureter. References: Radiology, Technion, Rambam health care campus - Haifa/IL Images for this section: Page 4 of 10
Fig. 1: One of the patients enrolled in the study, Fatty liver,hu=10. Page 5 of 10
Fig. 2: The same patient(fig 1) with renal calculi in the mid ureter. Page 6 of 10
Results A total of 100 CT studies were enrolled in our study. The mean age was 49.6, and the male: female ratio was 2.7:1. Among the entire study population 80% had renal stone disease and 32% had fatty liver. Among the patients with renal stone disease 37.5% had fatty liver. Statistically the frequency of the fatty liver disease in the patient group with urinary stones was significantly higher (p=0.0178, p<0.05) when compared with the non urinary stone group. In the subgroups analysis, only the male subgroup was statistically significant (p=0.0369, p<0. 05). In young patient (under 50) and the female subgroups, there was no correlation between renal stone and fatty liver disease. Table 1: Demographics and descriptive statistics. Page 7 of 10
References: Radiology, Technion, Rambam health care campus - Haifa/IL Fig. 3: Fatty liver incidence. References: Radiology, Technion, Rambam health care campus - Haifa/IL Conclusion The NAFLD is considered to be one of the most common liver disease in the world characterized by the accumulation of liver fat without alcohol consumption, its diagnosis is based on imaging methods confirmed by histopathology of liver biopsy, if required(8). NAFLD is closely related to kidney function (4) and increased chronic kidney disease risk (9). Page 8 of 10
However The association between the fatty liver and renal calculi as a specific underlining risk factor has received almost no attention, Einollahi et al(6) examined 11245 ultrasonography report in a cross sectional study, they revealed more common diagnosis of fatty liver in 48% of the patients with urolithiasis, which was also higher in males in comparison with females. In our study we retrospectively analyzed a total of 100 non contrast CT studies of 100 patients and we found 37.5% NAFLD in the positive urinary stone disease group as compared to 11% in the non urinary stone disease group. The findings were statistically significant. Our study showed for the first time with the use of CT as the imaging modality, a significantly, higher percentage of fatty liver disease among the group of patients with renal stone, this study supports the association, between renal stone and fatty liver especially in the male population. Further research is needed regarding the consumption of the stones and possible common risk and pathogenic factors. Personal information References (1)Hamaguchi M. Identifcation of individual with nonalcoholic fatty liver disease by the diagnostic criteria for the metabolic syndrome. World J Gastroent; 2012.1508-1516.18 (2) Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol; Suppl 1:S5-10. (3) Yener O, Gallstones associated with nonalcoholic steatohepatitis (NASH) and metabolic syndrome. Turk J Gastroenterol 21, 411415, 2010. (4) Li G: Nonalcoholic fatty liver disease associated with impairment of kidney function in nondiabetes population. Biochm Med (Zagreb) 22, 9299, 2012. (5) Evan AP: Physiopathology and etiology of stone formation in the kidney and the urinary tract. Pediatr Nephrol 25, 831.2010. Page 9 of 10
(6) Einollahi B. Association of Non alcoholic fatty liver disease (NAFLD) with urolithiasis. Endocr Requl; 2013 Jan 47(1) 27-32. (7) Okka W. Hamer Fatty liver: Imaging Patterns and Pitfalls.Radiographics 2006; 26:1637-1653. (8) Paredes AH: Nonalcoholic Fatty liver disease. Clin Liver Dis 16, 397419, 2012. (9) Chang y: Nonalcoholic fatty liver disease predicts chronic kidney disease in nonhypertensive and nondiabetic Korean men. Metabolism 57, 569576, 2008. Page 10 of 10