SCAD syndrome: A vicious cycle of kidney stones, CKD, and AciDosis

Abstract

Cumulative evidence has shown that kidney stone formers are at high risk for developing end-stage renal disease (ESRD) and cardiovascular disease. The aim of this mini-review is to summarize the present knowledge about the close relationships among kidney stone formation, chronic kidney disease (CKD), and plasma and urine acidosis (SCAD). Part of the cause of the positive relationships between higher risk of developing ESRD and cardiovascular diseases in stone formers may be explained by inflammation and cell death due to the components of kidney stones. In CKD patients, acidic urine and loss of anti-crystallization factors may cause stone formation. Acidosis can promote tissue inflammation and may affect vascular tone. Correction of plasma and urine acidosis may improve renal and cardiovascular outcome of stone formers and CKD patients. More intensive and long-term interventions, which include correction of plasma and urine pH in patients with reduced renal function and correction of urine pH in patients with normal renal function, may be considered in treating patients with SCAD syndrome.

Keywords: Endoplasmic reticulum stress response, End-stage renal disease, pH, Endothelial, Epithelial

Core tip: This minireview is written for urology and internal medicine physicians who see kidney stone formers in their daily practice. It is our responsibility to make more serious consideration on the long term outcome of developing end-stage renal disease and cardiovascular diseases in kidney stone formers. The significance of appropriate intervention on acidic condition for these subjects are often neglected. By naming “SCAD syndrome”, we can promote more attention on this significant, but sometime forgotten pathological condition.