Metabolic Syndrome and Urinary Stone Composition: What Factors Matter Most?

Loyola University Medical Center, Department of Urology, Fahey Center, Maywood, IL. Electronic address: .
Urology (Impact Factor: 2.19). 07/2012; 80(4):805-10. DOI: 10.1016/j.urology.2012.05.011
Source: PubMed


To determine which metabolic syndrome (MetS) factors lead to differences in stone composition in a multivariate analysis.
We retrospectively reviewed medical charts of patients who had a kidney stone removed over a 5-year period (2006-2011). MetS factors (obesity [body mass index {BMI} >30], diabetes mellitus [DM], hypertension [HTN], and dyslipidemia [DLD]) were tallied in each patient. For the latter 3 factors, medical treatment for the condition was used to tag a patient with the condition. Stone composition was determined by the dominant (>50%) component. Statistical analysis was designed to determine which MetS factors were independently associated with differences in stone composition.
Five hundred ninety kidney stones were included in the analysis. Patients with MetS had a higher prevalence of uric acid stones and lower prevalence of calcium phosphate stones. HTN and DM were independently associated with differences in composition, specifically uric acid stones (higher proportion), and calcium phosphate stones (lower proportion). Obesity was not associated with differences in composition, although a secondary analysis of morbidly obese patients showed a higher proportion of uric acid stones and a lower proportion of calcium oxalate stones.
HTN and DM are the MetS factors independently associated with differences in stone composition, specifically the uric acid and calcium phosphate components. Obesity has little effect on stone composition until a very high (>40) BMI is reached. The overall effect of MetS factors on stone type is relatively small, because most stones are calcium oxalate and MetS factors have little impact on calcium oxalate frequency.

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    • "Moreover, some recent data show that obesity does seem to determine a higher risk of nephrolithiasis in a children cohort, but surprisingly does not influence urine chemistries at all [22]. Finally, another recent report shows that in obese stone formers body composition does not influence stone chemistry until very high levels of BMI (> 40 kg/m2) are reached [29], thus indirectly supporting our finding that urine chemistry is poorly influenced by fat mass. In fact, it is remarkable to point out that in our research there was an average difference in body weight of about 13 kg between group C (low fat mass) and group D (high fat mass) (Table 7). "
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    ABSTRACT: The role of body composition (lean mass and fat mass) on urine chemistries and bone quality is still debated. Our aim was therefore to determine the effect of lean mass and fat mass on urine composition and bone mineral density (BMD) in a cohort of healthy females.Materials and methods: 78 female volunteers (mean age 46 +/- 6 years) were enrolled at the Stone Clinic of Parma University Hospital and subdued to 24-hour urine collection for lithogenic risk profile, DEXA, and 3-day dietary diary. We defined two mathematical indexes derived from body composition measurement (index of lean mass-ILM, and index of fat mass-IFM) and the cohort was split using the median value of each index, obtaining groups differing only for lean or fat mass. We then analyzed differences in urine composition, dietary intakes and BMD. The women with high values of ILM had significantly higher excretion of creatinine (991 +/- 194vs1138 +/- 191 mg/day, p = 0.001), potassium (47 +/- 13vs60 +/- 18 mEq/day, p < 0.001), phosphorus (520 +/- 174vs665 +/- 186 mg/day, p < 0.001), magnesium (66 +/- 20 vs 85 +/- 26 mg/day, p < 0.001), citrate (620 +/- 178vs807 +/- 323 mg/day, p = 0.002) and oxalate (21 +/- 7vs27 +/- 11 mg/day, p = 0.015) and a significantly better BMD values in limbs than other women with low values of ILM. The women with high values of IFM had similar urine composition to other women with low values of IFM, but significantly better BMD in axial sites. No differences in dietary habits were found in both analyses. Lean mass seems to significantly influence urine composition both in terms of lithogenesis promoters and inhibitors, while fat mass does not. Lean mass influences bone quality only in limb skeleton, while fat mass influences bone quality only in axial sites.
    Journal of Translational Medicine 10/2013; 11(1):248. DOI:10.1186/1479-5876-11-248 · 3.93 Impact Factor
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    • "MetS can create or aggravate urologic diseases. Its associations with kidney stones [2], benign prostatic hyperplasia [3], and erectile dysfunction [4] are well defined. The association with an important andrologic issue, infertility, is extensively investigated recently [5] [6]. "
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    ABSTRACT: We aimed to investigate the impact of metabolic syndrome (MetS) on the varicocele treatment. 101 patients underwent spermatic vein ligation between 2007 and 2010 were retrospectively analyzed. Those patients were divided into two groups as without (n: 56, Group 1) or with MetS (n: 48, Group 2). All the patients underwent left microsurgical subinguinal spermatic vein ligation. Groups were compared by the improvement on sperm parameters and spontaneous pregnancy rates at a mean of 19 (±4) months followup. When sperm parameters were compared postoperatively, the significant improvement in total sperm count, motile sperm count percentage, and normal sperm percentage was reported. The groups were compared to each other and the improvement seemed significantly better in Group 1. There was no statistically significant improvement difference in the normal sperm percentage between groups. Spontaneous pregnancy rate after two years was 45% in Group 1 and 34% in Group 2 (P < 0.05). Patients with MetS and varicocele improved after surgery, but not as well as the similar group without MetS. This may help to show that MetS can be a factor for male infertility.
    The Scientific World Journal 12/2012; 2012:985201. DOI:10.1100/2012/985201 · 1.73 Impact Factor
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    ABSTRACT: The pathophysiology of the various forms of urinary stone disease remains a complex topic. Epidemiologic research and the study of urine and serum chemistries have created an abundance of data to help drive the formulation of pathophysiologic theories. This article addresses the associations of urinary stone disease with hypertension, cardiovascular disease, atherosclerosis, obesity, dyslipidemia, diabetes, and other disease states. Findings regarding the impact of dietary calcium and the formation of Randall's plaques are also explored and their implications discussed. Finally, further avenues of research are explored, including genetic analyses and the use of animal models of urinary stone disease.
    Urologic Clinics of North America 02/2013; 40(1):1-12. DOI:10.1016/j.ucl.2012.09.006 · 1.20 Impact Factor
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