Chronic Stress and Calcium Oxalate Stone Disease: Influence on Blood Cortisol and Urine Composition

Fàbregas, M. Arzoz; Ibarz-Servio, Luis; Castro, Jordi Fernández; Valiente, Manuel; Roca-Antonio, Josep; Edo, Sílvia; Buisan-Rueda, Oscar

doi:10.1016/j.urology.2013.06.077

Cited by 11 publications

(14 citation statements)

References 16 publications

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“…Reported urinary alterations which support the hypothesis that urine chemistry becomes more lithogenic under stressful conditions are elevations in urinary calcium [11,15], oxalate [15], phosphorus [16] and uric acid [15] and decreases in Mg [17] and Cit [17]. The latter finding is supported by the observation that urinary magnesium is associated with life satisfaction [12]. On the other hand, the finding that urinary magnesium increases after acute stress-related events [16] is in conflict with this notion, albeit that acute and chronic conditions may elicit different urinary responses.…”

Section: Introductionmentioning

confidence: 66%

“…Miyaoka et al [10] stated "It is still unclear whether stress acts as a causative factor or as a consequence of painful and recurrent colic episodes". In a previous study [12] we ourselves asked the question "Does chronic stress lead to lithiasis or could a stone episode be the cause of stress"?…”

Section: Discussionmentioning

confidence: 99%

“…Findings in this regard have been inconsistent and confusing. Some studies have shown alterations which are consistent with an increase in stone risk in certain parameters [11,12,[15][16][17], but a simultaneous decrease in risk in other parameters [16,17]. Reported urinary alterations which support the hypothesis that urine chemistry becomes more lithogenic under stressful conditions are elevations in urinary calcium [11,15], oxalate [15], phosphorus [16] and uric acid [15] and decreases in Mg [17] and Cit [17].…”

Section: Introductionmentioning

confidence: 89%

“…Stress has been listed among the so-called lifestyle factors [7]. Examination of the literature reveals that while several studies have established an associative link between stress and stones, none have demonstrated a causal link between them [8][9][10][11][12][13][14]. Moreover, only a few of the studies in which associations have been observed, Abstract Numerous studies have reported an association between stress and urolithiasis.…”

Section: Introductionmentioning

confidence: 99%

“…All subjects had been previously assessed for chronic stress dimensions, as well as for stress caused by their stone episodes per se. Conditional and unconditional logistic regression (with a Bonferroni correction for multiple tests) have attempted to identify by laboratory measurements of blood and urine chemistries, the biochemical mechanisms and pathways by which stress, in whatever form, might induce stone formation [11,12,[15][16][17]. A credible hypothesis suggests that in stress conditions, the fight or flight response is triggered, setting in motion several processes ultimately leading to a change in urine chemistries which include hypercalciuria [7].…”

Section: Introductionmentioning

confidence: 99%

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Stress–stones–stress–recurrent stones: a self-propagating cycle? Difficulties in solving this dichotomy

et al. 2017

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Numerous studies have reported an association between stress and urolithiasis. Although urinary risk factors have been measured in several of these, compelling evidence of a causal relationship has not been established. A shortcoming is that alterations in single urinary parameters rather than ratios and quotients, which provide a more synergistic risk evaluation, have been measured. Recently, we speculated about a possible association between chronic stress and stone recurrence. This presents an intriguing dichotomy of whether stress causes stones or vice versa, or whether they are linked in a self-propagating stress-stones-stress-recurrence cycle. We investigated the latter hypothesis in a retrospective case-control designed study in which we calculated urinary ratios and quotients which are regarded as diagnostic indicators of stone risk. These included Ca/Cr, Ox/Cr, Mg/Cr, Cit/Cr, urate/Cr and citrate-magnesium-calcium ratios, activity product quotient for calcium oxalate (CaOx) and relative supersaturation of CaOx, brushite and uric acid. Overnight urinary data from 128 participants comprising 31 first time (FS), 33 recurrent (RS) CaOx stone formers and 64 controls were used. All subjects had been previously assessed for chronic stress dimensions, as well as for stress caused by their stone episodes per se. Conditional and unconditional logistic regression (with a Bonferroni correction for multiple tests) and simple linear regression were used to analyse various components of the data. Although RS had more stressful life events, with greater intensity of perception than FS, there were no significant differences between the groups regarding any of the urinary risk factors. No significant association between stressful life events and any of the urinary ratios or quotients was observed. A direct causal link between stress and stone recurrence was not indicated. We believe that future studies should shift their focus from traditional urinary risk factors to other stone-forming mechanisms. However, we recognize that there is an inherent problem in attempting to solve the stress-stones dichotomy as it would be impossible to disentangle alterations in risk factors which arise from lifestyle stress and those arising from stone episodes themselves.

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