Diabetes Mellitus and the Risk of Urinary Tract Stones: A Population-Based Case-Control Study

Lieske, John C.; Vega, L.S. Peña de la; Gettman, Matthew T.; Slezak, Jeffrey M.; Bergstralh, Eric J.; Melton, L. Joseph; Leibson, Cynthia L.

doi:10.1053/j.ajkd.2006.09.002

Cited by 130 publications

(83 citation statements)

References 31 publications

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“…In a cohort of cystinuric patients, PCr appeared to increase with age (19). HBP and diabetes mellitus are risk factors for CKD in the general population (23) as well as in patients with nephrolithiasis (11,14,25,26). However, in a small series of cystinuric patients, it was reported that age and HBP were not significant risk factors for CKD (15).…”

Section: Discussionmentioning

confidence: 93%

CKD and Its Risk Factors among Patients with Cystinuria

Prot-Bertoye¹,

Lebbah²,

Daudon³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cystinuria is an autosomal recessive disorder affecting renal cystine reabsorption; it causes 1% and 8% of stones in adults and children, respectively. This study aimed to determine epidemiologic and clinical characteristics as well as comorbidities among cystinuric patients, focusing on CKD and high BP.Design, setting, participants, & measurements This retrospective study was conducted in France, and involved 47 adult and pediatric nephrology and urology centers from April 2010 to January 2012. Data were collected from 442 cystinuric patients.Results Median age at onset of symptoms was 16.7 (minimum to maximum, 0.3-72.1) years and median diagnosis delay was 1.3 (0-45.7) years. Urinary alkalinization and cystine-binding thiol were prescribed for 88.8% and 52.2% of patients, respectively, and 81.8% had at least one urological procedure. Five patients (1.1%, n=4 men) had to be treated by dialysis at a median age of 35.0 years (11.8-70.7). Among the 314 patients aged $16 years, using the last available plasma creatinine, 22.5% had an eGFR$90 ml/min per 1.73 m 2 (calculated by the Modification of Diet in Renal Disease equation), whereas 50.6%, 15.6%, 7.6%, 2.9%, and 0.6% had an eGFR of 60-89, 45-59, 30-44, 15-29, and ,15, respectively. Among these 314 patients, 28.6% had high BP. In multivariate analysis, CKD was associated with age (odds ratio, 1.05 [95% confidence interval, 1.03 to 1.07]; P,0.001), hypertension (3.30 [1.54 to 7.10]; P=0.002), and severe damage of renal parenchyma defined as a past history of partial or total nephrectomy, a solitary congenital kidney, or at least one kidney with a size ,10 cm in patients aged $16 years (4.39 [2.00 to 9.62]; P,0.001), whereas hypertension was associated with age (1.06 [1.04 to 1.08]; P,0.001), male sex (2.3 [1.3 to 4.1]; P=0.003), and an eGFR,60 ml/min per 1.73 m 2 (2.7 [1.5 to 5.1]; P=0.001).Conclusions CKD and high BP occur frequently in patients with cystinuria and should be routinely screened.

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Section: Discussionmentioning

confidence: 93%

CKD and Its Risk Factors among Patients with Cystinuria

Prot-Bertoye¹,

Lebbah²,

Daudon³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Uric acid stones occur more frequently in patients with T2DM than in nondiabetic stone formers (24)(25)(26) and in obese than in nonobese stone formers (27,28). Furthermore, greater BMI and T2DM are shown to be independent risk factors for uric acid nephrolithiasis (29).…”

Section: Discussionmentioning

confidence: 99%

Body Fat Content and Distribution and Urinary Risk Factors for Nephrolithiasis

Pigna¹,

Sakhaee²,

Adams‐Huet

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Obesity is associated with a higher risk of nephrolithiasis. However, it is not known whether higher body fat mass or abnormal fat distribution influences stone risk independent of dietary factors.Design, setting, participants, & measurements In this cross-sectional study, non-stone-forming men with no known kidney disease and with a wide range of body weight collected a 24-hour urine specimen while consuming a fixed metabolic diet. They underwent dual-energy x-ray absorptiometry to assess body composition and fat distribution. Urinary risk factors for nephrolithiasis and urine saturation with respect to calcium oxalate and uric acid (assessed as supersaturation index [SI]) were correlated with various measures of adiposity.Results Study participants included 21 men with a mean age of 52.1 years, mean weight of 91.1 kg, and mean total fat mass of 24.3 kg. Twenty-four-hour urine pH and SI uric acid were more closely correlated with fat mass than with lean mass or total body weight. Both 24-hour urine pH and SI uric acid were also significantly correlated with truncal fat mass but not with leg fat mass. Moreover, there was a significant negative correlation between truncal/leg fat mass and NH 4 + /net acid excretion ratio (R=20.62; P=0.009). However, there was no significant association between SI calcium oxalate and body weight, lean mass, fat mass, trunk fat mass, or leg fat mass. ConclusionsThe association between 24-hour urine pH and SI uric acid and various measures of adiposity suggest that total body fat and trunk fat are more strongly associated with risk factors for uric acid stone formation than are total body weight and lean body mass. Under a controlled metabolic diet, adiposity is not associated with risk factors for calcium oxalate stones. Further studies are needed to confirm these findings in larger populations that include women and patients who form stones.

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“…T ype 2 diabetes is associated with an increased risk for nephrolithiasis (1,2), particularly uric acid (UA) stones (3)(4)(5). Urine pH is a key determinant of UA solubility in urine, and an excessively acidic urine is recognized as a major risk factor for UA precipitation and stone formation (5,6).…”

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confidence: 99%

Metabolic Basis for Low Urine pH in Type 2 Diabetes

Maalouf

Cameron

Moe³

et al. 2010

Clinical Journal of the American Society of Nephrology

134

113

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Background and objectives: Type 2 diabetes is associated with excessively low urine pH, which increases the risk for uric acid nephrolithiasis. This study was conducted to assess the metabolic basis responsible for the excessive urinary acidity of individuals with type 2 diabetes.Design, setting, participants, & measurements: Nine non-stone-forming patients who had type 2 diabetes and low urine pH and 16 age-and body mass index-matched non-stone-forming volunteers without type 2 diabetes were maintained on a constant metabolic diet for 7 days, and 24-hour urine was collected on the last 2 days of the diet.Results: Urine dietary markers (potassium, sulfate, phosphorus, and urea nitrogen) were not different between the two groups. Patients with type 2 diabetes exhibited a significantly lower 24-hour urine pH (5.45 ؎ 0.27 versus 5.90 ؎ 0.42; P < 0.01) and higher net acid excretion (NAE; 57 ؎ 12 versus 38 ؎ 18 mEq/d; P < 0.01) compared with control subjects. The proportion of NAE excreted as ammonium (NH 4 ؉ /NAE) was significantly lower in patients with type 2 diabetes than in control subjects

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Diabetes Mellitus and the Risk of Urinary Tract Stones: A Population-Based Case-Control Study

Cited by 130 publications

References 31 publications

CKD and Its Risk Factors among Patients with Cystinuria

CKD and Its Risk Factors among Patients with Cystinuria

Body Fat Content and Distribution and Urinary Risk Factors for Nephrolithiasis

Metabolic Basis for Low Urine pH in Type 2 Diabetes

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