Abstract
Medullary sponge kidney (MSK) is a cause of nephrocalcinosis, associated with hematuria, renal colic, pyelonephritis. There are rare and atypical MSK cases characterized by chronic severe pain (CP), whose features are unknown, in particular the relationship with the stone disease activity. This study analyzes a cohort of MSK–CP patients belonging to three North-America self-support Facebook groups. Patients had to self-administer an on-line questionnaire (on intensity, progression and MSK-associated conditions, stone-related disease, pain features, drug use), the Brief Pain Inventory, the Fatigue Severity Score, and Wisconsin Quality of Life (WQL) in stone formers questionnaires. Ninety-two patients with a diagnosis of MSK joined our survey. Stone rate was very high (3.1 stones per patient-year, < 15% of patients had ≤ 1 stone per year). Most patients had repeated hospitalizations for stones symptoms (p < 0.001) or pain (p < 0.005). 71% of participants referred a daily pain that interfered strongly with everyday life and quality of life (WQL mean value 29.4). 69% used pain medications daily (70% opioids). In most cases, pain was associated with stone passage, while 15% referred a sine materia pain. We showed how MSK–CP symptoms affect very negatively on the quality of life of these patients. They also have a definite risk of progressing to end-stage kidney disease. Generally, CP seems to be associated with an exceptionally high lithogenic activity, suggesting that a better and earlier metabolic treatment for stone prevention should be the first approach in these patients before mini-invasive treatments to prevent pain.
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Acknowledgements
We acknowledge the University of Texas MD Anderson Cancer Center for permission to use the BPI. We thank the three Facebook support group coordinators and the patients for the enthusiastic support for our survey. The study was supported by Università Cattolica del Sacro Cuore, GENIUS Program: MSK and Chronic pain 01/06/2013.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of the Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, approved the study protocol.
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Gambaro, G., Goldfarb, D.S., Baccaro, R. et al. Chronic pain in medullary sponge kidney: a rare and never described clinical presentation. J Nephrol 31, 537–542 (2018). https://doi.org/10.1007/s40620-018-0480-8
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DOI: https://doi.org/10.1007/s40620-018-0480-8