UCLA research moves care closer to personalized medicine.

Allan Pantuck, UCLA

Researchers with UCLA’s Institute of Urologic Oncology and Department of Urology have classified kidney cancer into several unique subtypes, a breakthrough that will help physicians tailor treatment to individual kidney cancer patients, moving cancer care one step closer to personalized medicine.

Their findings are the result of 10 years of UCLA research on kidney cancers at the genetic and molecular levels, with scientists conducting chromosomal analyses in an effort to identify what mutations may be causing and affecting the behavior of the malignancies. Thousands of tumors removed at UCLA have been studied, said Dr. Allan Pantuck, a professor of urology and director of genitourinary oncology at UCLA’s Jonsson Comprehensive Cancer Center.

Traditionally, pathologists study tumors under the microscope and attempt to predict their behavior by the way they look. However, tumors that appear the same often behave differently, and oncologists need to know which are lower risk, which are more aggressive and which are more likely to spread, making the cancer much more difficult to treat.

“Pathologists can give us some important information, but similar-appearing tumors often can and do behave differently,” said Pantuck, the senior author of the study. “Our findings have us heading further in the direction of personalized medicine based on the molecular signature of an individual’s tumor. We still have a lot to learn, but we’re now a step closer.”

The study appears today (April 16) in the early online edition of Cancer, a peer-reviewed journal of the American Cancer Society.

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National treatment trends raise concerns about rise of kidney removals.

Ithaar Derweesh, UC San Diego

Researchers at the UC San Diego School of Medicine have released study results that show national treatment trends in the surgical management of patients with kidney disease.

The study found that partial and complete kidney removal (total nephrectomy) and energy-based techniques to destroy tumors are all on the rise. Surprisingly, the patients most in need of kidney-sparing surgery are still more likely to undergo total nephrectomy. The findings recently published online in BJU International.

“While the overall proportion of patients receiving kidney preserving treatments for localized kidney tumors continues to grow, the most significant, and perhaps unsettling finding was that patients with kidney insufficiency still undergo complete kidney removal – even though kidney preserving treatment may be indicated,” said senior author Ithaar Derweesh, M.D., urologic oncologist at UC San Diego Moores Cancer Center.

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UCSF-led project has significant potential.

Two key contributors to the UC San Francisco-led effort to create an implantable artificial kidney for dialysis patients are on Capital Hill to inform key congressional staff about the project.

Shuvo Roy, Ph.D., a bioengineer on the faculty of the UCSF School of Pharmacy and the project’s technical director, and William Fissell, M.D., an associate professor of clinical medicine at Vanderbilt University Medical Center and the project’s medical director, are in Washington, D.C., to explain the importance of the device to treat patients with end-stage renal disease (ESRD).

Affecting 2 million people worldwide, ESRD – or chronic kidney failure – is fatal unless treated and costs the nation almost $40 billion each year for treatment. And while transplantation is the most effective treatment option, donor organs are in short supply. Further, kidney dialysis is a short-term and costly treatment.

“We can provide an alternative therapy and a treatment option that doesn’t exist today for the vast majority of people today that are forced to rely on dialysis,” Roy said.

The artificial kidney project aims to combine nanoscale engineering with the most recent advances in cellular biology to create an implantable device that would enable patients with chronic kidney failure to lead healthier and more productive lives, without external dialysis or immune suppressant medication.

The kidney project is now featured in the UC Office of the President’s Onward California campaign, which aims to educate Californians about the impact the university has in their lives and to remind them of the importance of supporting the UC system.

Last year, the artificial kidney project was selected as one of the first projects to undergo more timely and collaborative review at the Food and Drug Administration. The FDA chose three renal device projects to pilot a new regulatory approval program called Innovation Pathway 2.0, intended to bring breakthrough medical device technologies to patients faster and more efficiently.

The artificial kidney project, which is targeted for clinical trials in 2017, was selected for its transformative potential in treating ESRD and for its potential to benefit from early interactions with the FDA in the approval process.

The UCSF artificial kidney, or implantable Renal Assist Device (iRAD) would include thousands of microscopic filters as well as a bioreactor to mimic the metabolic and water-balancing roles of a real kidney.

The combined treatment has been proven to work for the sickest patients using a room-sized external model developed by a team member at the University of Michigan. Roy’s goal is to apply silicon fabrication technology, along with specially engineered compartments for live kidney cells, to shrink that large-scale technology into a device the size of a coffee cup. The device would then be implanted in the body, allowing the patient to live a more normal life.

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UCSF study finds kidney injuries and eaths doubled in last decade.
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Raymond Hsu, UC San Francisco

Severe acute kidney injuries are becoming more common in the United States, rising 10 percent per year and doubling over the last decade, according to a retrospective study at the University of California, San Francisco.

The study, to be published online this week in the Journal of the American Society of Nephrology, analyzed information from a national database that monitors all causes of hospitalizations and used this data to estimate the total number of acute kidney injuries in the United States that were severe enough to require a patient to be placed on dialysis.

The results showed that these injuries, caused by such incidents as major infections, trauma, complications following surgery and adverse reactions to drugs, increased by 10 percent per year from 2000 to 2009, from 222 to 533 cases per million people. The study also showed that the total number of deaths associated with acute kidney injury more than doubled during that time, from 18,000 in 2000 to nearly 39,000 in 2009.

“That was a staggering revelation of how increasingly common and how life-threatening acute kidney injury has become over the past decade in the United States,” said Raymond K. Hsu, M.D., a UCSF nephrologist who led the research.

The UCSF team estimated that about 30 percent of the increase can be attributed to commonly known causes, such as the rise in severe infections, ventilator usage, acute heart failure and cardiac catheterizations over the same time period. But doctors do not yet know what else accounts for the rise in acute kidney injury and what hospitals nationwide can do to address the problem, Hsu said.

UCSF is one of the world’s leading centers for kidney disease treatment, research and education, and its Division of Nephrology is nationally ranked among the best programs in the nation by U.S. News & World Report.

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UC Irvine results help explain serious health, dietary complications in renal failure patients.

N.D. Vaziri, UC Irvine

Chronic kidney disease changes the composition of intestinal bacterial microbes that normally play a crucial role in staving off disease-causing pathogens and maintaining micronutrient balance, according to UC Irvine researchers.

This profound alteration of the gut microbial population may contribute to the production of uremic toxins, systemic and local inflammation, and nutritional abnormalities present in patients with advanced renal disease, they said.

Study leader Dr. N.D. Vaziri of the UCI School of Medicine’s Division of Nephrology & Hypertension noted that consumption of high-fiber foods and better control of uremia — a disease common in kidney failure — by diet and dialysis may improve the composition of gut microbes and the well-being of patients.

The researchers studied microbial DNA extracted from the stool samples of a group of renal failure patients and healthy control individuals. They found marked differences in the abundance of some 190 types of bacteria in the gut microbiome of those with kidney disease — and confirmed the results in a concurrent study of rats with and without chronic kidney disease.

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Support from Goldman Foundation, NIH will move device toward clinical trials.

A $750,000 gift from the John and Marcia Goldman Foundation is spurring a UC San Francisco-led effort to create the first implantable artificial kidney for patients with kidney failure.

The new funds, which augment a $2.25 million grant for the project from the National Institutes of Health (NIH) this summer, will enable the team of bioengineers, physicians and scientists to conduct the critical research needed to bring the proposed device to clinical trials by 2017.

“Kidney failure takes a terrible toll on the world, both economically and in human suffering,” said Shuvo Roy, Ph.D., an associate professor in the UCSF School of Pharmacy who is leading the Kidney Project through the UCSF Department of Bioengineering & Therapeutic Sciences. “These funds are a critical step in helping us move this project forward more quickly and ultimately bring real solutions to patients throughout the world.”

Working with the project’s medical director, William Fissell, M.D., at Vanderbilt University, UCSF’s Roy is coordinating researchers in nine institutions nationwide to create an implantable device that aims to mimic the filtration functions of a kidney, as well as its ability to maintain water and salt balances, produce Vitamin D, and regulate blood pressure and pH.

Roy estimates that the project will require an additional $13 million to bring that technology through the range of tests needed to enter clinical trials in humans.

The Kidney Project has been identified as a campus priority by UCSF and the UCSF School of Pharmacy for its potential to develop a breakthrough therapy to help solve a pressing health need. The school focuses on therapeutics, including medical devices and diagnostic tests, in addition to medications.

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Findings are “a real game-changer.”

Jeffrey Veale, UCLA

The largest U.S. multicenter study of living kidney transplant donor chains shows that 46 percent of recipients are minorities, a finding that allays previous fears that these groups would be disadvantaged by the expansion of the donor pool through this type of exchange process.

The study of a series of chain transplantations performed between February 2008 and June 2011 at 57 centers nationwide included 272 kidney transplants in which patients who were incompatible with their own relatives received kidneys either from altruistic strangers or from donors who found they were not a match for their own relatives. (The relatives of these latter donors would then receive a kidney in the same way, creating a “chain.”)

“Of all living-donor kidney transplants performed in the United States in 2011, only 33 percent were to ethnic minorities,” said senior study author and UCLA transplant surgeon Dr. Jeffrey Veale. “So the fact that nearly 50 percent of the chain transplant recipients were ethnic minorities is a real game-changer. This collaborative team has been able to show that with donor chains, we can broaden, increase and diversify the population of patients who can receive kidney transplants.”

“We were incredibly happy with the results,” said study first author Dr. Marc Melcher, a transplant surgeon at Stanford Hospital and Clinics and an assistant professor of multi-organ transplantation surgery at Stanford University. “It demonstrates that through the cooperation of altruistic strangers, we can generate multiple transplants and reduce the competition for deceased organs.”

The study, which appears in the September issue of the peer-reviewed American Journal of Transplantation, notes that the larger percentage of minority recipients may be a result of large urban centers with more ethnic diversity actively participating in chain transplants.

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UCLA doctors push medical boundaries to offer patient chance at life.

Brandie Osborne and her grandmother

At age 32, Brandie Osborne has beaten the odds.

The young woman from Compton has dealt with health issues her entire life and has faced death more than once. But now, with a new donated heart and kidney, transplanted at Ronald Reagan UCLA Medical Center, she has been given a second chance to live and is ready to take on the world.

Osborne was born with a fairly common genetic condition known as Noonan syndrome, which is often associated with heart and lung problems. In Osborne’s case, she developed hypertrophic cardiomyopathy, a thickening of the heart muscle, and pulmonary hypertension, which caused high blood pressure in her lungs. In 2009, her condition worsened and she was placed on the waiting list for a heart–lung transplant at a hospital in Northern California that was covered by her insurance.

While waiting, she suffered heart and lung failure and required a breathing tube. Then her kidneys failed and she needed dialysis. With so many medical complications, she was deemed an unacceptable candidate for transplantation surgery and was transferred back to UCLA to pursue end-of-life care.

Osborne spent the next six months in the intensive care unit at UCLA and slowly improved, ultimately learning to walk and function again. In March 2010, she was well enough to go home with the aid of several machines that helped her breathe and eat. Despite her chronic heart and kidney failure, her spirit endured and her health continued to improve with the love and support of family and friends.

Over the next two years, Osborne’s extremely complicated medical issues kept her from being considered for a transplant again. However, her lung doctor, Dr. David Ross, a professor of pulmonology and medical director of the UCLA Lung Transplant Program, and her cardiologist, Dr. Daniel Cruz, a clinical instructor of cardiology at UCLA, championed a new idea: If they used medications to treat Osborne’s pulmonary hypertension after a potential heart transplant, she would not require a lung transplant at the same time. In other words, the lung problems could be reversed with a healthy new heart and medications. Pursuing this strategy, they hoped, could get Osborne back on the transplant list for a heart, and possibly a kidney.

“Although it would be unchartered territory, after much intense discussion among the team and after explaining the high risks to Brandie and her family, it was decided to put her on the combined heart and kidney transplant list in June 2012,” Ross said.

Thirty-six days later, Brandie learned that an organ donor had been found. She said her reaction was, “No way! Oh my God! Oh my God,” followed by tears, then panic, then more tears and excitement.

Going into the first phase of the surgery — the heart transplant — Osborne had been told it was an extremely high-risk operation. One of the scariest parts, she said, was that she’d been told by the doctors that because of her anatomy, the surgeon might not be able to immediately close her chest wall after the new heart was transplanted. There was a likelihood she would have to remain in intensive care with her chest open and possibly use an oxygenation machine to support the new heart.

However, Dr. Richard Shemin, UCLA’s chief of cardiothoracic surgery, successfully performed the delicate operation and managed to close Osborne’s chest without complications. Less than 24 hours later, she returned to the UCLA operating room for the next phase, a kidney transplant from the same donor, which was performed by Dr. H. Albin Gritsch, an associate professor of urology.

When she woke up after the two high-risk surgeries, the first thing she said to her mother was, “I’m alive!”

Osborne is now going home from the hospital in just her “skin” — no tubes, no machines, no dialysis. She has just one small pump that administers her lung medications.

“Thanks to the family who made the decision to donate their loved one’s organs, I am getting a second chance at life,” she said. “I cannot thank my donor and my UCLA team enough for saving my life!”

And her list of things to do is quite long: swim, ride a bike, go for walks, play with her Shitzu puppy, travel to Hawaii, eat lots of pasta, and learn how to bake cupcakes and someday open a bakery.

For more information on organ donation, please visit www.donatelife.net.

For more information on UCLA’s organ transplant programs, please visit www.transplants.ucla.edu.

Findings resulted from collaboration between UC Santa Barbara, Indiana-based biotech firm.

(From left) kidney of a normal mouse, polycystic kidney disease and after treatment with FC-rapa

Scientists at UC Santa Barbara have demonstrated in the laboratory that a new drug is effective in treating a very common kidney disease — although it will be a few years before it becomes available for clinical testing. The findings resulted from a collaboration between UC Santa Barbara and a biotech firm based in Indiana. The study is published in this week’s Journal of the American Society of Nephrology.

Over 600,000 people in the U.S., and 12 million worldwide, are affected by the inherited kidney disease known as autosomal-dominant polycystic kidney disease (ADPKD or PKD). The disease is characterized by the proliferation of thousands of cysts that eventually debilitate the kidneys, causing kidney failure in half of all patients by the time they reach age 50. PKD is one of the leading causes of renal failure in the U.S.

Thomas Weimbs, UC Santa Barbara

The research effort was directed by Thomas Weimbs, associate professor in the Department of Molecular, Cellular, and Developmental Biology. He has been studying the disease for more than a decade. The current findings build on research performed in 2006 in the Weimbs lab, showing that the drug rapamycin, which has been in use for years as an immunosuppressive agent, was highly effective in stopping disease progression in mouse models of polycystic kidney disease.

The previous research by Weimbs came to the attention of Christopher P. Leamon, vice president for research of the biotech firm Endocyte Inc., which is based in Indiana and focuses on cancer drugs. Leamon was particularly interested in the rapamycin research because Leamon himself has polycystic kidney disease. He immediately contacted Weimbs and flew out to Santa Barbara to develop a research partnership on a new drug for PKD — based on Weimbs’ earlier research.Weimbs said he was very excited to begin brainstorming ideas with Leamon. “He is at the right place at the right time to do something about his own disease,” said Weimbs. “He happens to be the chief scientist at a biopharmaceutical company that may have the technology to make a better drug that could work for PKD patients.”

Christopher Leamon, Endocyte

In an earlier study by Weimbs and other researchers, a signaling protein called mTOR was found to drive cyst growth in polycystic kidney disease. Weimbs then found that rapamycin inhibited the growth of cysts, which caused great excitement in the field. However, when the drug was used in large clinical trials in Europe, the results were disappointing. The dose at which this drug could safely be used proved too low to affect kidney cysts.

But Leamon and Weimbs found a way around this problem. Endocyte Inc., Leamon’s firm, specializes in linking or “conjugating” small molecules to target diseased cells, primarily cancer cells. Leamon explained that many cancers have a high affinity for folate, and that by linking folate to certain cancer drugs, his company has been successful in targeting cancer cells with these drugs. Leamon and Weimbs wondered if the same strategy could be used in treating the kidney cysts found in PKD. They examined both mouse and human PKD cysts and found that they did, in fact, express folate receptors.

Endocyte chemically synthesized a new version of rapamycin called folate-conjugated rapamycin (FC-rapa). Weimbs’ laboratory tested this new drug and found that it was still highly effective in preventing kidney cyst growth in mice with PKD, but that it had fewer systemic side effects compared to regular rapamycin. The results suggest that FC-rapa could also be effective in human PKD patients without causing the significant unwanted side effects of regular rapamycin.

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Likelihood of developing impaired function increased over time in patients who had complete kidney removal.

Ithaar Derweesh, UC San Diego

Researchers at the UC San Diego School of Medicine have identified a link between patients who undergo total nephrectomy — complete kidney removal — and erectile dysfunction. Results from the multicenter study were recently published online in the British Journal of Urology International.

“This is the first study in medical literature to suggest that surgery for kidney removal can negatively impact erectile function while partial kidney removal can protect sexual function,” said Ithaar Derweesh, M.D., senior author, associate professor of surgery, UC San Diego School of Medicine and urologic surgeon at UC San Diego Health System.

The retrospective study evaluated two cohorts of men, totaling 432 patients, who underwent surgery for renal cell carcinoma. One group underwent complete removal of the kidney while the other had kidney-sparing surgery. Sexual function was accessed pre- and post-operatively with a sexual health questionnaire known as the International Index of Erectile Function.

“What we are seeing is a dramatic yet delayed effect. Approximately six years after surgery, patients who had a total nephrectomy were 3.5 times more likely to develop erectile dysfunction compared to those who had kidney reconstruction,” said Derweesh.

“The primary argument for kidney-sparing surgery over total kidney removal has been to preserve the kidney filtration function. However, we are also beginning to understand that total kidney removal may also increase the risk of metabolic diseases and significantly decrease quality of life,” said lead author Ryan Kopp, M.D., chief resident, Division of Urology, UC San Diego School of Medicine.

Derweesh added that this is the latest in a series of studies that point to the wisdom of saving the kidney in appropriate patients. Prior research led by Derweesh also shows that partial nephrectomy can reduce the risk of osteoporosis and chronic kidney insufficiency, which can lead to cardiac events and metabolic disturbances. Further investigation is needed to prevent erectile dysfunction in patients and to predict its potential occurrence.

Funding for this study was provided by the Sexual Medicine Society of North America Scholars in Sexuality Research Grant.

Contributors to this paper included Ryan P. Kopp, Jonathan L. Silberstein, Caroline J. Colangelo, Wassim M. Bazzi and Christopher J. Kane of UCSD; Brian M. Dicks and Irwin Goldstein of UCSD and Alvarado Hospital; Reza Mehrazin, Aditya Bagrodia, Robert W. Wake, Anthony L. Patterson, and Jim Y. Wan of University of Tennessee.

UC Davis research could affect advisability of transplant for children.

Lavjay Butani, UC Davis

For children receiving kidney transplants, a potentially correctable blood condition present in about one in four recipients is associated with a moderately increased risk of the graft’s later failure, suggesting that clinicians should weigh whether transplant is advisable when the condition is present, according to UC Davis research presented today at the 24th International Congress of the Transplantation Society in Berlin.

Children with chronic kidney disease often have the condition, called low serum albumin, as a result of inflammation or malnutrition, among other causes. The research found that low serum albumin is an independent risk factor for higher rates of morbidity and mortality among pediatric kidney transplant recipients.

Roughly one in 65,000 children develop end-stage renal disease each year, and kidney transplant is the primary method for treating the condition in the pediatric population. The research was conducted by Lavjay Butani, professor and chief of the Division of Pediatric Nephrology, and Daniel Tancredi, a biostatistician and assistant professor in the UC Davis School of Medicine.

“Even a single low serum albumin measurement at the time of listing the patient on a transplant registry is clearly a risk factor for graft failure in the future,” Butani said. “Transplant centers should very carefully consider proceeding with the transplant in children with very low serum albumin, because of its association with a moderately higher risk of graft failure.”

“The transplant team, including the family and the patient, should be very cautious,” he added.

During the past 30 years, the numbers of children and adolescents with end-stage renal disease has grown dramatically, according to the U.S. Centers for Disease Control and Prevention (CDC). In 1980 there were 738 persons with kidney failure under 20 years old in the United States. In 2008, the number had grown to 7,216, a 1,000 percent increase, CDC data shows.

Butani said that prolonging graft survival is key, since longer graft survival translates into fewer patients needing re-transplants. This is a benefit that is underappreciated among non-transplant providers, and is paramount in helping reduce the ever-growing disparity between patients on the wait list and those receiving transplants, he said.

Serum albumin is the most abundant protein in blood plasma and important for growth, wound healing and adequate circulation. When albumin levels are low, clinicians are divided about whether the transplant should be delayed until albumin levels can be increased.

Earlier studies in pediatric patients suggest that the longer a patient is on dialysis prior to the transplant, the poorer the long-term survival of the kidney that is eventually transplanted. On the other hand, low serum albumin levels at the time of transplant could lead to a higher risk of post-operative complications.

To assess whether post-transplant outcomes are worse in patients with lower pre-transplant albumin levels, the UC Davis researchers reviewed the records of approximately 6,000 children in the United States who received their first kidney transplant through the Organ Procurement and Transplantation Network between January 2000 and December 2010. The study examined a variety of factors, including recipient and donor demographics and pre-operative serum albumin at the time of registration.

The transplant recipients were an average of 10.9 years old at the time of transplant; approximately 48 percent received living donor transplants. Fifty-three percent were Caucasian, 23 percent were Hispanic and 19 percent were African American. Approximately 5 percent had very low serum albumin levels (less than 2.5 grams per deciliter) and their risk of graft failure within one year was 8.3 percent, almost double the risk observed in the children with the highest serum albumin levels. The approximately 20 percent of children with intermediate serum albumin levels (between 2.5 and 3.5 grams per deciliter) had an observed one-year graft failure risk of 6.2 percent.

The study found that serum albumin levels were inversely associated with time-to-graft failure. In other words, each gram-per-deciliter increase in serum albumin was associated with a 20 percent reduction in the hazard of graft failure over an average follow-up time of four years, after accounting for other factors.

The dilemma that these results raise is whether the low albumin levels actually are a cause of poorer graft survival, or simply a reflection of something else going on in the patient’s body.

“Until then, for a child with chronic kidney disease who has a low serum albumin level, the presence of a modestly elevated potential risk of graft failure is something that will need to be discussed with the patient, the family and the entire transplant team,” Butani said.

The research also identified marked regional variations in the prevalence of very low serum albumin levels among children who received transplants at the time of registration. The prevalence of very low serum albumin levels prior to the transplant was more than twice as high in the southeastern United States than in the west or southwest, a reflection of different practice patterns within the U.S. transplant community, and one that merits further investigation.

“Although our study can assess whether an association exists, further research is necessary to determine if there is a cause-effect relationship,” Tancredi said.

Findings have important implications for public as well as health care providers.

Christopher Saigal, UCLA

The number of Americans suffering from kidney stones between 2007 and 2010 nearly doubled from 1994, according to a new study by researchers at UCLA and the RAND Corp.

“While we expected the prevalence of kidney stones to increase, the size of the increase was surprising,” said Dr. Charles D. Scales Jr., a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar in the departments of urology and medicine at the David Geffen School of Medicine at UCLA. “Our findings also suggested that the increase is due, in large part, to the increase in obesity and diabetes among Americans.”

The study, “The Prevalence of Kidney Stones in the United States” is being presented today (May 23) at the 2012 meeting of the American Urological Association in Atlanta and will appear in the July print edition of the peer-reviewed journal European Urology.

This is one of the first studies to examine new data from the National Health and Nutrition Examination Survey (NHANES) that was collected from 2007 to 2010. NHANES is a program of studies within the Centers for Disease Control and Prevention to assess the health and nutritional status of adults and children in the U.S.

Scales and his colleagues reviewed responses from 12,110 individuals and found that between 2007 and 2010, 8.8 percent of the U.S. population had a kidney stone — one out of every 11 people. In 1994, the rate was one in 20. (No data about the national prevalence of kidney stones in the U.S. were collected between 1994 and 2007.)

Because NHANES also asks about other health conditions and includes measurements of height and weight, the researchers were able to identify associations between kidney stones and other health conditions. The results suggest that obesity, diabetes and gout all increase the risk of kidney stones.

While the national obesity rate was 23 percent in 1994, more than a third of all American adults are obese today, according to the Centers for Disease Control and Prevention.

The authors assert that these findings have important implications for the public, as well as health care providers.

“People should consider the increased risk of kidney stones as another reason to maintain a healthy lifestyle and body weight,” said the study’s senior author, Dr. Christopher S. Saigal, principal investigator within RAND Health for the Urologic Diseases in America project and associate professor of urology at the David Geffen School of Medicine at UCLA. “But physicians need to rethink how to treat and, more importantly, prevent kidney stones.”

Currently, the primary approach to treating patients is to focus on those who already are suffering from kidney stones. Yet helping patients maintain a healthy diet and body weight can reduce the number of patients with kidney stones.

“Imagine that we only treated people with heart disease when they had chest pain or heart attacks and did not help manage risk factors like smoking, high cholesterol or high blood pressure,” Scales said. “This is how we currently treat people with kidney stones. We know the risk factors for kidney stones, but treatment is directed towards patients with stones that cause pain, infection or blockage of a kidney rather than helping patients to prevent kidney stones in the first place.”

In an accompanying editorial that will also appear in the journal, Dr. Brian Matlaga, associate professor of urology at Johns Hopkins University School of Medicine, writes that the cost of care for this disease is enormous, and there is no indication that the coming years will see any improvement in this trend. He also warns that, since approximately 10 percent of the population has kidney stones, a greater emphasis on prevention is imperative.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (N01-DK70003), as part of the Urologic Diseases in America project based at UCLA and RAND.

The Robert Wood Johnson Foundation Clinical Scholars program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policymakers on issues important to the health and well-being of all Americans. This program is supported, in part, through collaboration with the U.S. Department of Veterans Affairs.