Sjögren's Syndrome Increases Kidney Stone Risk: Causes and Prevention

The Connection Between Sjgrens Syndrome and Kidney Stones

Sjgrens syndrome is an autoimmune disorder that impacts the bodys moisture-producing glands, frequently causing dry eyes and dry mouth. However, Sjgrens affects more than just moisture production. Research shows that Sjgrens syndrome also increases the risk of developing kidney stones.

Overview of Sjgrens Syndrome

Sjgrens syndrome is named after Swedish ophthalmologist Henrik Sjgren, who first described the condition in 1933. With Sjgrens, the body's immune system mistakenly attacks its own moisture-producing glands.

There are two main classifications of Sjgrens syndrome:

• Primary Sjgrens syndrome - Sjgrens is the main disease
• Secondary Sjgrens syndrome Sjgrens develops in the presence of another autoimmune disorder like rheumatoid arthritis, lupus, or scleroderma

While the exact Sjgrens syndrome causes remain unknown, research suggests genetics, hormones, and viral infections may play contributing roles.

Prevalence of Kidney Stones in Sjgrens Patients

Several research studies show that patients with primary and secondary Sjgrens syndrome have higher rates of nephrolithiasis (kidney stones) compared to control groups:

• A 2016 study found the prevalence of kidney stones was 17% in Sjgrens patients versus 6% in non-Sjgrens participants
• Another 2016 cohort study showed 16% of Sjgrens patients had a history of kidney stones
• Researchers in Turkey analyzed 120 Sjgrens patients in 2019 and found 10% had experienced renal calculi (stones)

So multiple studies clearly establish that individuals with Sjgrens syndrome demonstrate around a 2 to 3 times greater risk of developing kidney stones.

Causes and Mechanisms Linking Sjgrens Syndrome to Kidney Stones

Medical researchers have identified various physiological factors related to Sjgrens syndrome that may trigger or exacerbate the formation of kidney stones including:

Chronic Inflammation

The chronic systemic inflammation induced by Sjgrens can alter kidney function over time, creating an acidic urinary environment more prone to crystallization.

Dehydration

Fluid intake guidelines suggest soda and water over snacks. The impaired saliva production caused by damage to moisture glands promotes mild dehydration, which increases stone risk by allowing mineral salts to crystalize and aggregate rather than flush out in urine.

Immunosuppressant Medications

Corticosteroids and other drugs commonly prescribed to control Sjgrens symptoms can have side effects like reduced citrate and magnesium levels that change urine composition and facilitate stone development.

Urinary Tract Infections

Some research indicates UTIs may occur more frequently in Sjgrens patients. UTIs alter urine pH, allow bacteria to produce stone-forming enzymes, and permit renal tubular crystal aggregation.

Kidney Tubular Acidosis

A subset of Sjgrens patients develop distal renal tubular acidosis (RTA), which increases stone risk by reducing citrate available to inhibit calcium oxalate crystallization.

Types of Kidney Stones in Sjgrens Patients

While all major stone types can occur, three primary compositions comprise the majority of calculi formed by those with Sjgrens syndrome:

1. Calcium Oxalate Stones

Around 70% of all kidney stones contain calcium combined with oxalate. Research shows calcium oxalate stones also predominate in Sjgrens patients, likely due to elevated urinary oxalate.

2. Calcium Phosphate Stones

The next most common kidney stone composition, aggravated by high pH urine and hypercalciuria, both urinary traits observed more often in those with Sjgrens.

3. Uric Acid Stones

While not as prevalent as calcium varieties, some research found higher rates of uric acid stones in Sjgrens patients, resulting from increased uric acid excretion.

Diagnosing Kidney Stones in Sjgrens Patients

Diagnosing kidney stones in those with Sjgrens syndrome involves these standard tests and procedures:

• Medical history evaluation
• Assessment of symptoms like intense flank pain, abdominal pain, bloody urine
• Urinalysis to check for blood, excess crystal-forming minerals, abnormal pH levels
• Blood tests to analyze electrolyte balance impacting stone risk
• Imaging tests like CT scans, ultrasounds, x-rays to visualize stones
• Analysis of passed stones to determine mineral composition

Determining the underlying metabolic issues increasing individual stone risk is also important for Sjgrens patients to help guide appropriate treatment.

Treatment Options for Sjgrens Patients with Kidney Stones

Treatments used for addressing kidney stones in Sjgrens syndrome patients include:

Lithotripsy

A procedure applying targeted ultrasonic wave or laser pulses to break up larger stones into passable fragments.

Endoscopic Stone Removal

Using a small camera instrument to locate stones lodged in the urinary tract and remove them intact or break them up with laser fragmentation.

Medications

Drugs like diuretics, alkalinizing agents, or allopurinol to influence urine pH, increase citrate, and inhibit stone-forming crystal aggregation.

Dietary Changes

Adopting eating plans that reduce intake of foods high in oxalate, sodium, purines, or protein while increasing fluids, fruits, vegetables, calcium, and magnesium.

After initial stone treatment, preventing recurrence also relies heavily on modifying contributory urinary factors like chronic dehydration and acidic urine pH.

Preventing Kidney Stones in Sjgrens Syndrome

Patients diagnosed with Sjgrens syndrome can lower their elevated nephrolithiasis risks by focusing on comprehensive stone prevention measures:

Increase Fluid Intake

Drink adequate water and fluids daily to promote sufficient urine volume and avoid dehydration. Some physicians recommend measuring water intake equal to half your body weight in ounces.

Urinary Acidifiers

Medications like oral potassium citrate mixtures can help reduce urine acidity contributing to certain stone types by increasing protective citrate.

Eat a Stone Prevention Diet

Restrict sodium, animal proteins, sugar, oxalates. Maximize fruits, vegetables, calcium sources, and magnesium to support a stone-inhibiting urinary environment.

Monitor Urine pH

Test urine pH levels regularly to ensure they stay in the target range of 6.0-6.5 through adequate hydration and diet.

Address Underlying Causes

Detect and treat contributory issues like UTIs, hyperparathyroidism, gout, acidosis, and intestinal malabsorption problems that can promote recurrent stone episodes.

Repeat Metabolic Testing

Follow-up blood, urine, and stone composition analysis helps gauge efficacy of prevention efforts targeting specific metabolic mechanisms.

Combining increased awareness of their heightened kidney stone risk profile with proactive prevention approaches gives Sjgrens patients the best chance to avoid this painful urological complication.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.