|Year : 2016 | Volume
| Issue : 1 | Page : 62-66
|Prevalence of calcified carotid artery atheromas on panoramic radiographs of renal stone patients
Santosh Patil1, Sneha Maheshwari2, Suneet Khandelwal3, Ritumvada Malhotra4, Anupam Desmukh4
1 Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakaka, Aljouf, Saudi Arabia
2 Dental Practitioner, Jodhpur, Rajasthan, India
3 Department of Oral and Maxillofacial Pathology, Daswani Dental College and Hospital, Kota, India
4 Department of Oral Medicine and Radiology, Chattisgarh Dental College and Research Institute, Rajnandgaon, Chattisgarh, India
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|Date of Web Publication||15-Jan-2016|
| Abstract|| |
The aim of the present study was to evaluate the prevalence of calcified carotid artery atheromas detected on panoramic radiographs of patients with renal stones and to assess the correlation of renal stones and carotid artery calcifications (CAC). Panoramic radiographs of 120 renal stone patients (76 males and 44 females) and 120 controls (68 males and 52 females) were examined for any calcifications in the carotid artery. The mean age of the patients with renal stones and controls was 40.6 ± 7.8 years and 41.1 ± 6.7 years, respectively. A total of 25 (20.8%) patients with renal stones and 16 (12.3%) patients from the control group showed CAC. The calcifications were however higher in the patients with renal stones, but there was no statistically significant difference (P >0.05) between the two groups. CAC was found in 15 males and ten females with renal stones and nine males and seven females of the control group, and this difference was not statistically significant (P >0.05). In the present study, no significant relationship was found between the presence of CAC in the patients with renal stones and the control group. However, there was a trend for higher prevalence of CAC in renal stone patients.
|How to cite this article:|
Patil S, Maheshwari S, Khandelwal S, Malhotra R, Desmukh A. Prevalence of calcified carotid artery atheromas on panoramic radiographs of renal stone patients. Saudi J Kidney Dis Transpl 2016;27:62-6
|How to cite this URL:|
Patil S, Maheshwari S, Khandelwal S, Malhotra R, Desmukh A. Prevalence of calcified carotid artery atheromas on panoramic radiographs of renal stone patients. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 22];27:62-6. Available from: http://www.sjkdt.org/text.asp?2016/27/1/62/174074
| Introduction|| |
Renal stone disease is common, and is repor ted to be increasing across the globe. It affects approximately 1.2 million people every year, accounting for approximately 1% of all hospital admissions. The renal stone disease is shown to affect approximately 5% of the general population in the US.  It poses a significant health care burden in a working-age population.  The renal stone formation is a complex process, usually due to the multifactorial features of the stone disease and the various genetic and environmental etiological factors involved.  It has been observed that patients with renal stones present with a higher risk for myocardial infarction, which is independent of chronic renal failure and other similar risk factors. 
Atherosclerosis is a progressive inflammatory disorder that may lead to peripheral artery disease, coronary artery disease or stroke.  Several factors for the stroke can be grouped as modifiable (e.g., hypertension, diabetes, smoking) and unmodifiable risk factors (e.g., age).  Early management of these risk factors reduces the morbidity and mortality.  Recently, a correlation has been established between a history of renal stones and subclinical carotid atherosclerosis in young adults, which adds to support the fact that common systemic risk factors and/or pathophysiology exists for atherosclerosis and renal stones. 
Panoramic radiographs are routinely used in the evaluation of patients with dental problems, and have found to be valuable in detecting the atherosclerosis.  The presence of carotid artery calcifications (CAC) on panoramic radiographs in renal stone patients has been reported recently. 
The aim of this study was to determine the prevalence of CAC in renal stone patients and to evaluate the possible correlation between the presence of CAC and renal stone in our population.
| Methods|| |
The study included a total of 240 patients; 120 patients (76 males and 44 females) with a history of renal stones were referred from the Nephrology Department to the outpatient department of the Department of Oral Medicine and Radiology for examination of their panoramic radiographs to detect the presence of calcifications in the carotid artery. Renal stones patients were defined as those with a history of renal colic, confirmed hematuria and radiographic findings of renal calculi. A total of 120 (68 males and 52 females) ageand sex-matched healthy controls were recruited from the outpatient department of the Department of Oral Medicine and Radiology. Written informed consents were obtained from all the patients. Ethical clearance was obtained from the Institutional Ethical Committee. All panoramic radiographs were taken with the Dentsply Gendex Orthoralix 9200 apparatus (Dentsply Asia, Milford, CT, USA), and the magnification factor was 1.23. All reported measurements were adjusted according to this factor. To ensure the accuracy of the diagnosis, all the panoramic radiographs were interpreted by two examiners (oral radiologists) in a dark room using a standard viewing box under good lighting conditions and standardized screen brightness and resolution to determine the CAC. The radiographs with low diagnostic quality were excluded. Any radiopaque nodular mass adjacent to the cervical vertebrae inside or below the C3-C4 intervertebral disc level, or the retro-mandibular area, generally at an angle of 45° from the angle of mandible independent of hyoid bone was considered as a CAC.  CAC were scored as present or absent. Statistical analysis was performed using the Chi-square test and P-value <0.05 was considered to be significant.
| Results|| |
A total of 120 patients with renal stones and a mean age of 40.6 ± 7.8 years and 120 controls with a mean age of 41.1 ± 6.7 years were included in the study [Table 1]. A total of 25 (20.8%) patients with renal stones and 16 (12.3%) patients from the control group showed CAC [Table 2]. The calcifications, however, were higher in the patients with renal stones, but there was no statistically significant difference (P >0.05) between the groups. CAC was found in 15 males and ten females with renal stones and nine males and seven females of the control group, and this difference was not statistically significant (P >0.05). Unilateral CAC was present in 17 (14%) renal stone patients and 11 (9%) controls, while bilateral CAC was evident in eight (6.6%) renal stone patients and five (4.1%) controls. CAC was located on the left side in 37 patients (66%) and on the right side in 19 (34%) patients; there was no significant difference (P >0.05) between the sides of involvement of CAC.
|Table 1: Comparison of various parameters of renal stone patients and controls.|
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|Table 2: Distribution of renal stone patients and controls with or without CAC.|
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| Discussion|| |
The present study aimed to assess the prevalence of CAC in renal stone patients and to find if any correlation exists between the presence of renal stone and CAC. A recent study by Ustun et al showed a prevalence of 16.6% CAC on panoramic radiographs of 108 patients with kidney stones,  while our study showed a prevalence of 20.8% CAC in 120 renal stone patients. Friedlander and Altman assessed the panoramic radiographs of 52 females for the presence of CAC and reported a prevalence of 31%, which was higher than the prevalence of controls in our study. 
A few studies have shown the prevalence of CAC to be between 3% and 5%, and many others have reported a higher prevalence in the population with associated risk factors. , Cohen et al studied 1879 panoramic radiographs of males >55 years of age and reported a prevalence of 3.8% for CAC.  Uthman and Al-Saffar showed a CAC prevalence of 38.8% in patients with stroke-related diseases and 11.6% prevalence in patients without strokerelated diseases.  They showed an equal gender predilection for CAC as in our study. Taheri and Moshfeghi reported a prevalence of 11.0% of CAC in 200 post-menopausal women.  Kunsu et al reported a prevalence of 17.6% and 15.7% of CAC in the hemodialyzed and renal transplant patients, respectively.  Freidlander and Maeder showed a prevalence of 20.4% of CAC and Ardakani et al showed a prevalence of 10% of CAC in type 2 diabetics. , The prevalence of CAC has been reported in patients with metabolic syndromes (22.4%) and obstructive sleep apnea (22%) and in patients who had received irradiation (40%). , Recently, a correlation has been established between a history of renal stones and carotid atherosclerosis in young adults. 
CAC, especially close to carotid bifurcation, can result in stroke.  Panoramic radiographs are routinely used in the evaluation of patients with dental problems, and have found to be valuable in detecting the atherosclerosis. Diagnostic examinations such as ultrasonography, magnetic resonance imaging and angiography might be required to confirm the presence and extent of vascular calcification. 
It has been proposed that early detection of calcifications in high-risk patients could provide life-saving information. Hirota et al and Kohri et al found a similar occurrence of osteopontin in their immunohistochemical study on atherosclerotic plaques and urinary stones. , These findings suggest that a relationship occurs between the incidence of CAC and renal stones, contrary to the findings of our study. It has been shown in various studies that patients with CAC present with medical histories laden with atherogenic risk factors, such as hypertension, diabetes, hypercholesterolemia, obesity and smoking. ,,
We conclude that our study did not find a significant association between renal stones and presence of CAC on panoramic radiographs. Further large-scale, multi-institutional studies are encouraged to establish any positive correlation between renal and carotid artery calcifications along with other systemic diseases.
Conflict of Interest: None declared.
| References|| |
Pak CY, Resnick MI, Preminger GM. Ethnic and geographic diversity of stone disease. Urology 1997;50:504-7.
Ampoon EQ, Manansala NH. The prevalence and clinical profile of patients diagnosed with renal calculi at the American mission hospital in the Kingdom of Bahrain. J Bahrain Med Soc 2013;24:62-5.
Romero V, Akpinar H, Assimos DG. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86-96.
Rule AD, Roger VL, Melton LJ 3rd
, et al. Kidney stones associate with increased risk for myocardial infarction. J Am Soc Nephrol 2010;21:1641-4.
Ross R. Atherosclerosis - An inflammatory disease. N Engl J Med 1999;340:115-26.
Sisman Y, Ertas ET, Gokce C, Menku A, Ulker M, Akgunlu F. The Prevalence of Carotid Artery Calcification on the Panoramic Radiographs in Cappadocia RegionPopulation. Eur J Dent 2007;1:132-8.
Pornprasertsuk-Damrongsri S, Thanakun S. Carotid artery calcification detected on panoramic radiographs in a group of Thai population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:110-5.
Reiner AP, Kahn A, Eisner BH, et al. Kidney stones and subclinical atherosclerosis in young adults: The CARDIA study. J Urol 2011;185: 920-5.
Friedlander AH, Friedlander IK. Identification of stroke prone patients by panoramic radiography. Aust Dent J 1998;43:51-4.
Ustun I, Inci M, Demirtas A, Sisman Y, Gokce C, Ertas ET. Prevalence of carotid artery calcification on panoramic radiographs in patients with renal stones. Turk J Med Sci 2013;43: 706-10.
Friedlander AH. Panoramic radiography: The differential diagnosis of carotid artery atheromas. Spec Care Dentist 1995;15:223-7.
Friedlander AH, Altman L. Carotid artery atheromas in post-menopausal women. Their prevalence on panoramic radiographs and their relationship to atherogenic risk factors. J Am Dent Assoc 2001;132:1130-6.
Cohen SN, Friedlander AH, Jolly DA, Date L. Carotid calcification on panoramic radiographs: An important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:510-4.
Hubar JS. Carotid artery calcification in the black population: A retrospective study on panoramic radiographs. Dentomaxillofac Radiol 1999;28:348-50.
Uthman AT, Al-Saffar AB. Prevalence in digital panoramic radiographs of carotid area calcification among Iraqi individuals with stroke-related disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e6873.
Taheri JB, Moshfeghi M. Prevalence of calcified carotid artery on panoramic radiographs in post-menopausal women. J Dent Res Dent Clin Dent Prospects 2009;3:46-51.
Kansu O, Ozbek M, Avcu N, Gençtoy G, Kansu H, Turgan C. The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease. Dentomaxillofac Radiol 2005;34:16-9.
Friedlander AH, Maeder LA. The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:420-4.
Ardakani FE, Ardakani MA, Mohammadi Z, Sheikhha MH. Evaluating calcified carotid artery atheromas in panoramic radiographs of patients with type 2 diabetes mellitus. Oral Radiol 2007;23:6-9.
Pornprasertsuk-Damrongsri S, Virayavanich W, Thanakun S, Siriwongpairat P, Amaekchok P, Khovidhunkit W. The prevalence of carotid artery calcifications detected on panoramic radiographs in patients with metabolic syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:57-62.
Friedlander AH, Freymiller EG. Detection of radiation-accelerated atherosclerosis of the carotid artery by panoramic radiography. A new opportunity for dentists. J Am Dent Assoc 2003;134:1361-5.
Almog DM, Horev T, Illig KA, Green RM, Carter LC. Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94:768-73.
Hirota S, Imakita M, Kohri K, et al. Expression of osteopontin messenger RNA by macrophages in atherosclerotic plaques. A possible association with calcification. Am J Pathol 1993;143:1003-8.
Kohri K, Nomura S, Kitamura Y, et al. Structure and expression of the mRNA encoding urinary stone protein (osteopontin). J Biol Chem 1993;268:15180-4.
Department of Oral Medicine and Radiology, College of Dentistry, Aljouf University, Sakaka, Aljouf
[Table 1], [Table 2]
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