Login to Access Video or Poster Abstract: MP95-01
Sources of Funding: NIH K23DK106428

Introduction

Composition of the gut microbiome has been associated with recurrent kidney stones, but the impact of antibiotics on developing new kidney stones is unclear. The objective of this study was to evaluate the association between antibiotic exposure and incident kidney stones.

Methods

In a nested case-control study using THIN, a primary care electronic medical records database, we identified patients with an incident diagnosis of nephrolithiasis and randomly selected age, sex, and practice-matched individuals without kidney stones (10:1). Conditional logistic regression models were used to estimate the odds ratio (OR) between prior oral antibiotic exposure (≤1, 1-5, and >5 years) and kidney stones, adjusting for urinary tract infection, diabetes, cystic fibrosis, inflammatory bowel disease, immobility, and gout and using a Bonferroni corrected p of <0.001 for significance.

Results

Among 26,466 cases and 265,658 matched controls, most, but not all, antibiotics were associated with an increased odds of incident kidney stones (Figure). The magnitude of association varied by antibiotic class, recentness of exposure, and age at exposure. The highest risk of incident kidney stones occurred within 1 year of treatment with sulfas (OR 4.2, 95% CI 4.0, 4.4), and when exposure occurred before 4 years of age (OR 4.52, 95% CI 2.91, 7.03). The risk of nephrolithiasis was greater with more recent antibiotic exposure; there was a 10%, 26%, and 32% increased odds of incident nephrolithiasis at >5 years, 1-5 years, and <1 year from penicillin treatment (p<0.001). H. pylori treatment, which includes macrolides, was also associated with an increased odds of incident kidney stones within 1 year of treatment (OR 2.13, 95% CI 1.51, 3.02). Prior exposure to clindamycin, anti-mycobacterial agents, and vancomycin was not associated with incident kidney stones.

Conclusions

Prior antibiotic exposure was strongly associated with an increased odds of incident kidney stones, with the greatest risk for more recent and early life exposures. Exposure to antibiotics may alter the intestinal microbiome, leading to changes in urinary solute excretion. These results are another reason to limit unnecessary antibiotic exposure and may help explain the rapidly rising incidence of nephrolithiasis in the United States.

Funding

NIH K23DK106428