Differences in 24‐h urine composition between nephrolithiasis patients with and without diabetes mellitus

Abstract

ObjectivesTo examine the differences in 24-h urine composition between nephrolithiasis patients with and without diabetes mellitus (DM) in a large cohort of stone-formers and to examine differences in stone composition between patients with and without DM. Patients and MethodsA retrospective review of 1117 patients with nephrolithiasis and a 24-h urine analysis was completed. Univariable analysis of 24-h urine profiles and multivariable linear regression models were performed, comparing patients with and without DM. A subanalysis of patients with stone analysis data available was performed, comparing the stone composition of patients with and without DM. ResultsOf the 1117 patients who comprised the study population, 181 (16%) had DM and 936 (84%) did not have DM at the time of urine analysis. Univariable analysis showed significantly higher total urine volume, citrate, uric acid (UA), sodium, potassium, sulphate, oxalate, chloride, and supersaturation (SS) of UA in individuals with DM (all P < 0.05). However, patients with DM had significantly lower SS of calcium phosphate and pH (all P < 0.05). Multivariable analysis showed that patients with DM had significantly lower urinary pH and SS of calcium phosphate, but significantly greater citrate, UA, sulphate, oxalate, chloride, SSUA, SS of calcium oxalate, and volume than patients without DM (all P < 0.05). Patients with DM had a significantly greater proportion of UA in their stones than patients without DM (50.2% vs 13.5%, P < 0.001). ConclusionsDM was associated with multiple differences on 24-h urine analysis compared with those without DM, including significantly higher UA and oxalate, and lower pH. Control of urinary UA and pH, as well as limiting intake of dietary oxalate may reduce stone formation in patients with DM.

Nephrolithiasis: A complication of pediatric diabetic ketoacidosis

“…A slightly increased risk of stone formation has been found in adults with DM compared to those without DM . One study of patients with a history of nephrolithiasis found stone‐promoting urinary differences in those with DM compared to those without DM, including lower pH, higher urinary oxalate, uric acid, and super saturation of calcium oxalate …”

“…23 One study of patients with a history of nephrolithiasis found stone-promoting urinary differences in those with DM compared to those without DM, including lower pH, higher urinary oxalate, uric acid, and super saturation of calcium oxalate. 24 The etiology of stone formation during pediatric DKA is unknown, though it is not surprising that DKA may increase the risk of stone formation as dehydration, acidosis, and hyperglycemia with resultant glucosuria all promote hypercalciuria. Hypercalciuria is a known risk factor for nephrocalcinosis, has been reported in 26% of children with nephrolithiasis, 22 and occurs with increased incidence in children with DM.…”

Difference in 24-Hour Urine Composition between Diabetic and Non-Diabetic Adults without Nephrolithiasis

“…[ 2 ] Urine composition might be an important factor for the increase of stone formation in patients with DM. [ 3 – 4 ] Several studies had demonstrated that diabetic patients with kidney stones excreted more oxalate and uric acid, and had lower urine pH values than those of non-diabetic cohort. [ 3 – 4 ] However, these studies only included patients with history of nephrolithiasis, thus the results might not be applicable to the non-stone forming population.…”

“…[ 3 – 4 ] Several studies had demonstrated that diabetic patients with kidney stones excreted more oxalate and uric acid, and had lower urine pH values than those of non-diabetic cohort. [ 3 – 4 ] However, these studies only included patients with history of nephrolithiasis, thus the results might not be applicable to the non-stone forming population. There was only one study that looked at the composition of 24-h urine specimens in diabetic patients and normal volunteers who were not stone formers.…”

“Golden” standard in the treatment of nephrolithiasis of both kidneys in combination with severe concomitant pathology (case report)

“…Останні, з одного боку, можуть бути факторами ризику для розвитку СКХ, а з іншого, утруднюють проведення необхідного оперативного лікування, потребують особливого, ретельного підходу до вибору лікувальної тактики, направленої на мінімізацію травматичності. Так, багато авторів [12,13] відмічають високу частоту розвитку нефролітіазу (97,7%) у хворих на цукровий діабет 2 типу, що, можливо, пов'язано із зменшенням антикристалоутворюючих властивостей сечі при цьому захворюванні. У ряді досліджень [16] відмічається зв'язок між надлишковою вагою і формуванням конкрементів, що може бути пов'язано із схильністю тучних людей до вживання великої кількості білка в поєднанні з відносно малим об'ємом випитої рідини.…”