Impact of Obesity in Patients With Urolithiasis and its Prognostic Usefulness in Stone Recurrence

Lee, Sang Cheol; Kim, Yong‐June; Kim, Tae‐Hwan; Yun, Seok‐Joong; Lee, Nam Kyu; Kim, Wun-Jae

doi:10.1016/j.juro.2007.09.040

Cited by 86 publications

(51 citation statements)

References 17 publications

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“…The superobese patients also suffered from higher degrees of comorbidity than their overweight or ideal weight counterparts and had a higher proportion of uric acid stones, a finding consistent with reports from other investigators. 22 Despite these facts, surgical outcomes did not differ. Furthermore, overall complication rates and severity were comparable between BMI groups indicating that PCNL can be safely performed even at BMI extremes.…”

Section: Discussionmentioning

confidence: 96%

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Dauw

Borofsky

York

et al. 2016

Journal of Endourology

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Introduction: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treatment of large renal calculi. Although several investigators have examined the feasibility and outcomes associated with PCNL in obese patients, these studies have been limited by small sample size, lack of a comparator group, or few patients at body mass index (BMI) extremes. We thus compared outcomes of superobese (BMI >50) patients undergoing PCNL vs both an ''overweight'' and ''ideal'' cohort. Methods: We used a prospectively maintained database to identify ideal (BMI 18.5-25), overweight (BMI 25.1-49.9), and superobese (BMI ‡50) patients who underwent PCNL. Our primary objective was to compare surgical outcomes between groups measured by the percent of patients who required secondary PCNL. We then compared complication rates, need for transfusion, and length of stay (LOS) using chi-square testing and ANOVA where appropriate. Results: A total of 1152 patients were identified of which 254 were classified as ideal, 840 as overweight, and 58 as superobese. The overweight cohort had a higher mean age and greater proportion of males, whereas staghorn stones were more common in the superobese group. Comorbid conditions were more commonly observed in the superobese cohort. Otherwise, the groups were similar. Surgical outcomes were comparable with 47.2%, 42.0%, and 38.0% of ideal, overweight, and superobese patients requiring secondary PCNL ( p = 0.25) with no difference in complication rates, need for transfusion, or LOS. Conclusion: PCNL can be effectively and safely performed in superobese patients with no difference in surgical outcomes or complications when compared to ideal or overweight patient cohorts.

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Section: Discussionmentioning

confidence: 96%

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Dauw

Borofsky

York

et al. 2016

Journal of Endourology

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“…The development of insulin resistance might decrease urinary excretion of ammonium and renal ammoniagenesis with ensuing lower urinary pH. Persistently lower urinary pH can induce the formation of uric acid and mixed urate-calcium oxalate stones [ 19 ] . In the present study, in 16.4% of patients with metabolic syndrome, mixed uric acid and calcium oxalate stones were detected.…”

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confidence: 99%

The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

et al. 2012

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E 1 0 7 9What ' s known on the subject? and What does the study add? The presence of metabolic syndrome is associated with development of kidney stones and an increase in the stone-recurrence rate. However, studies reporting long-term results of percutaneous nephrolithotomy (PCNL) in metabolic syndrome are lacking.The present study showed that metabolic syndrome was associated with worsening renal function at long-term follow-up and the stone-recurrence rate recurrence after PCNL in patients with metabolic syndrome was 3.2-fold higher compared with the control group. OBJECTIVE• To investigate the impact of metabolic syndrome on long-term kidney function and stone recurrence rates after percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS• In all, 73 patients with metabolic syndrome who underwent stone analysis and had a minimum follow-up of 12 months after PCNL were reviewed.• In addition, 73 patients without any metabolic syndrome components who had undergone PCNL and were followed-up for at least 12 months were included in the study as the control group.• These control group patients were selected from 226 patients who were matched with the patients with metabolic syndrome using a 1 : 1 ratio. The matching parameters were age, gender and stone size. RESULTS• Stone analyses showed that calcium oxalate monohydrate (52.0%) and uric acid (21.9%) were most common among patients with metabolic syndrome, whereas calcium oxalate monohydrate (76.7%) was the most common stone type in the control group.• Stone recurrences occurred with a mean ( SD , range) of 36.1 (21.3, 12 -109) months follow-up in 26 patients (41.9%) and 12 patients (18.9%) in the metabolic syndrome and control groups, respectively ( P = 0.003).• While estimated glomerular fi ltration rate was decreased from 87.8 to 66.6 mL/ min/1.73 m 2 in the metabolic syndrome group, it changed from 96.4 to 91.2 mL/ min/1.73 m 2 in control group at long-term follow-up. CONCLUSIONS• The most frequent stone type was calcium oxalate monohydrate in patients with or without metabolic syndrome.• In patients with metabolic syndrome who underwent PCNL, the stone recurrence rate was > 40%.• Metabolic syndrome is associated with worsening renal function at long-term follow-up. KEYWORDS INTRODUCTIONMetabolic syndrome is a chronic disease with components of obesity, insulin resistance, hypertension, impaired glucose tolerance, hyperinsulinaemia and dyslipidaemia; this disease is also associated with an increased risk for cardiovascular disease, type 2 diabetes mellitus (DM) and urolithiasis [ 1 ] . The prevalence of metabolic syndrome is 24% in men and 23.4% in women in the USA [ 2 ] . There is also strong evidence that obesity, weight gain, and DM are risk factors for the development of kidney stones and increase the stone recurrence rate [ 3 ] . A large series reported that the presence of metabolic syndrome was associated with a ≈ two-fold increase in the odds of self-reported kidney stone disease [ 4 ] .Percutaneous nephrolithotomy (PCNL) plays an important role in th...

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“…37 Multivariate regression modeling stratified by stone incidence has shown that obesity is the only strong predictor of stone recurrence in first-time stone formers. 30 No association between obesity and stone recurrence has been detected in recurrent stone formers, suggesting a different mechanism in this group of patients. Interestingly, weight loss has been advocated not only as a recommendation to modify stone risk factors but also as a treatment for obesity-related glomerulopathy.…”

Section: Obesity and Renal Stone Diseasementioning

confidence: 79%

“…No association between obesity and stone recurrence was detected in recurrent stone formers. 30 Semins et al 24 reviewed data from a 5-year period (2002-2006) in a national private insurance database to identify subjects diagnosed with or treated for kidney stones. From a dataset of 95,598 patients, gender distribution of the 3257 stone formers was 42.9% male and 57.1% female.…”

Section: Obesity and Renal Stone Diseasementioning

confidence: 99%

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

Ahmed

2012

Renal Failure

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Currently, obesity has reached an epidemic stage and represents a challenge for health authorities across the globe. Certainly, with emergence of obesity epidemic, we started to see an increase in the prevalence of chronic kidney disease (CKD) and nephrolithiasis. Interestingly, epidemiologic studies have shown that the incident stone risk increases with body mass index (BMI), and no further increase in risk is noticed when the BMI > 30 kg/m 2 . Furthermore, metabolic syndrome and diabetes are also associated with an increase in the incidence of renal stones disease. The shared links between these metabolic disorders are insulin resistance. Furthermore, insulin resistance is thought to alter renal acidbase metabolism, resulting in a lower urine pH and increased risk of uric acid stone disease. Obesity is also associated with excess nutritional intake of lithogenic substances such as refined sugars, low fluid intake, calcium, oxalate, and purine-rich foods. Obesity is also associated with an increase in incidence of urinary tract infection. Recent reports suggested that renal stone disease carries risk of myocardial infarction, progression of CKD, and diabetes. Alarmingly, orlistat (obesity medication) and bariatric surgery are associated with hyperoxaluria and associated stone formation and even oxalate nephropathy. Certainly, the many health risks of obesity, including nephrolithiasis, will add more burden on urologists and nephrologists. Shockwave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all safe procedures in obese individuals. Further research is urgently needed to address the pathophysiology and management of obesity-induced renal stones disease.

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Impact of Obesity in Patients With Urolithiasis and its Prognostic Usefulness in Stone Recurrence

Abstract: This study reveals that obesity is associated with metabolic alterations and urinary stone recurrence. Weight control may be considered one of the preventive modalities against recurrent stone formation, especially in first time stone formers.

Cited by 86 publications

References 17 publications

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

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