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World J Clin Urol. Jul 24, 2014; 3(2): 113-118
Published online Jul 24, 2014. doi: 10.5410/wjcu.v3.i2.113
SCAD syndrome: A vicious cycle of kidney stones, CKD, and AciDosis
Noritaka Kawada, Yoshitaka Isaka, Hiromi Rakugi, Toshiki Moriyama
Noritaka Kawada, Toshiki Moriyama, Health Care Center, Osaka University, Toyonaka, Osaka 560-0043, Japan
Yoshitaka Isaka, Hiromi Rakugi, Division of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
Author contributions: Kawada N wrote the manuscript; Isaka Y, Rakugi H and Moriyama T were involved in editing the manuscript and providing financial support for this work.
Supported by A Grant from the Osaka Kidney Foundation, No. OKF13-0004; and Grant-in-Aid for Design of the comprehensive health care system for chronic kidney disease based on the individual risk assessment by Specific Health Checkups , H24-nanchitou(jin)-ippan-006 to Moriyama T
Correspondence to: Yoshitaka Isaka, MD, PhD, Division of Nephrology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871, Japan. isaka@kid.med.osaka-u.ac.jp
Telephone: +81-6-68793746 Fax: +81-6-68793749
Received: April 27, 2014
Revised: May 20, 2014
Accepted: June 20, 2014
Published online: July 24, 2014
Processing time: 83 Days and 12 Hours
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.