Essential arterial hypertension and stone disease

Institutes of Semeiotica Medica, University of Parma, Italy.
Kidney International (Impact Factor: 8.56). 07/1999; 55(6):2397-406. DOI: 10.1046/j.1523-1755.1999.00483.x
Source: PubMed

ABSTRACT Cross-sectional studies have shown that nephrolithiasis is more frequently found in hypertensive patients than in normotensive subjects, but the pathogenic link between hypertension and stone disease is still not clear.
Between 1984 and 1991, we studied the baseline stone risk profile, including supersaturation of lithogenic salts, in 132 patients with stable essential hypertension (diastolic blood pressure of more than 95 mm Hg) without stone disease and 135 normotensive subjects (diastolic blood pressure less than 85 mm Hg) without stone disease who were matched for age and sex (controls). Subsequently, both controls and hypertensives were followed up for at least five years to check on the eventual formation of kidney stones.
Baseline urine levels in hypertensive males were different from that of normotensive males with regards to calcium (263 vs. 199 mg/day), magnesium (100 vs. 85 mg/day), uric acid (707 vs. 586 mg/day), and oxalate (34.8 vs. 26.5 mg/day). Moreover, the urine of hypertensive males was more supersaturated for calcium oxalate (8.9 vs. 6.1) and calcium phosphate (1.39 vs. 0.74). Baseline urine levels in hypertensive females were different from that of normotensive females with regards to calcium (212 vs. 154 mg/day), phosphorus (696 vs. 614 mg/day), and oxalate (26.2 vs. 21.7 mg/day), and the urine of hypertensive females was more supersaturated for calcium oxalate (7.1 vs. 4.8). These urinary alterations were only partially dependent on the greater body mass index in hypertensive patients. During the follow-up, 19 out of 132 hypertensive patients and 4 out of 135 normotensive patients had stone episodes (14.3 vs. 2.9%, chi-square 11.07, P = 0.001; odds ratio 5.5, 95% CI, 1.82 to 16.66). Of the 19 stone-former hypertensive patients, 12 formed calcium calculi, 5 formed uric acid calculi, and 2 formed nondetermined calculi. Of the urinary factors for lithogenous risk, those with the greatest predictive value were supersaturation of calcium oxalate for calcium calculi and uric acid supersaturation for uric acid calculi.
A significant percentage of hypertensive subjects has a greater risk of renal stone formation, especially when hypertension is associated with excessive body weight. Higher oxaluria and calciuria as well as supersaturation of calcium oxalate and uric acid appear to be the most important factors. Excessive weight and consumption of salt and animal proteins may also play an important role.

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    • "Decreased serum calcium is observed in hypoparathyroidism, vitamin D deficiency, steatorrhea, nephrosis, and nephritis. Increased calciuria is also a feature of the essential hypertensive patients.[18] Alternations in intracellular calcium are thought to be involved in the common pathway mediating the secretion and action of many hormones, including the pressor action of catecholamines and angiotensin II. "
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    ABSTRACT: The alterations in extracellular calcium level may influence intracellular calcium level and possibly play a role in the pathogenesis of essential hypertension. The purpose was to find out the association between serum calcium levels and hypertension; and to compare the serum calcium levels between normotensive controls, hypertensive subjects on calcium channel blockers, and hypertensive subjects on antihypertensive medication other than calcium channel blockers. Thirty one individuals including normotensives (n = 12) and hypertensives (n = 19) were enrolled for the study and their blood pressure recorded. Hypertensive group was sub divided into two: hypertensives on calcium channel blockers and hypertensives on antihypertensive medication other than calcium channel blockers. Serum calcium levels were measured by Accucare Calcium Arsenazo III kit. Differences between the groups were analyzed using ANOVA. No significant difference in serum calcium level was found between normotensive and hypertensive groups; and no correlation was found between calcium levels and the blood pressure. Also the difference in serum calcium levels in hypertensive group on calcium channel blockers and those on antihypertensive other than calcium channel blockers was insignificant. Serum calcium levels are tightly regulated. Subtle changes in serum levels do not affect blood pressure.
    North American Journal of Medical Sciences 11/2012; 4(11):569-72. DOI:10.4103/1947-2714.103316
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    • "s ( Limpatanachote et al . , 2009 ) . In the present study , the large survey population with various levels of urinary cadmium might increase the power to detect a significant association . Some studies have found an increase in urinary stone pre - valence in persons with hypertension compared with normoten - sive persons ( Amato et al . , 2004 ; Borghi et al . , 1999 ; Cappuccio et al . , 1990 ; Strazzullo and Mancini , 1994 ) , but some have not shown such findings ( Madore et al . , 1998a , 1998b ) . Cadmium exposure in people living in these contaminated areas was found to increase prevalence of hypertension ( Swaddiwudhipong et al . , 2010b ) . However , the present study did not find an associa"
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    ABSTRACT: Excessive urinary calcium excretion is the major risk of urinary stone formation. Very few population studies have been performed to determine the relationship between environmental cadmium exposure and urinary stone disease. This population-based study examined an association between urinary cadmium excretion, a good biomarker of long-term cadmium exposure, and prevalence of urinary stones in persons aged 15 years and older, who lived in the 12 cadmium-contaminated villages in the Mae Sot District, Tak Province, northwestern Thailand. A total of 6748 persons were interviewed and screened for urinary cadmium and urinary stone disease in 2009. To test a correlation between urinary excretion of cadmium and calcium, we measured urinary calcium content in 1492 persons, who lived in 3 villages randomly selected from the 12 contaminated villages. The rate of urinary stones significantly increased from 4.3% among persons in the lowest quartile of urinary cadmium to 11.3% in the highest quartile. An increase in stone prevalence with increasing urinary cadmium levels was similarly observed in both genders. Multiple logistic regression analysis revealed a positive association between urinary cadmium levels and stone prevalence, after adjusting for other co-variables. The urinary calcium excretion significantly increased with increasing urinary cadmium levels in both genders, after adjusting for other co-variables. Elevated calciuria induced by cadmium might increase the risk of urinary stone formation in this environmentally exposed population.
    Environmental Research 05/2011; 111(4):579-83. DOI:10.1016/j.envres.2011.01.007 · 4.37 Impact Factor
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    • "This in contrast to previous studies. (Ramey, et al, 2004,Hamano, et al, 2005,Cappuccio, et al, 1990) On the other hand, our data on incident kidney stone disease-related hospitalizations showed a positive association with hypertension, similar to some(Borghi, et al, 1999) but not all(Madore, et al, 1998b,Madore, et al, 1998a) prospective studies. "
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    ABSTRACT: To identify correlates of kidney stone disease in white and African American men and women in a population-based longitudinal study starting in four US communities, and to assess differences in correlates across racial groups. Between 1993 and 1995, 12,161 middle-aged participants of the ARIC Study provided information on history of kidney stone disease. Information on incident kidney stone-related hospitalizations was obtained from ICD codes on hospital discharge records. Kidney stone disease was reported by 12.0% of men and 4.8% of women. After multivariable adjustment, prevalent kidney stone disease was significantly (p<0.05) associated with male gender (PR=2.50), increased serum triglycerides (PR=1.07 per SD increase), diabetes (PR=1.27), gallstone disease (PR=1.54), white race (PR=1.67), and region of residence. Male gender (HR=1.70), diabetes (HR=1.98), and hypertension (HR=1.69) were significantly associated (p<0.05) with incident kidney stone-related hospitalizations (n=94). Race-stratified analyses showed stronger associations of prevalent kidney stone disease with increased triglycerides, older age, and gallstone disease in African Americans compared to whites, whereas male gender showed stronger association in whites (all p-interaction<0.05). We identified novel correlates of kidney stone disease (triglycerides, gallstone disease) and risk factor interactions by race (age, male gender, triglycerides, gallstone disease).
    Preventive Medicine 11/2010; 51(5):416-20. DOI:10.1016/j.ypmed.2010.08.011 · 3.09 Impact Factor
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