Association between metabolic syndrome and nephrolithiasis in an inpatient population in southern Italy: role of gender, hypertension and abdominal obesity

Rendina, Domenico; Mossetti, Giuseppe; Filippo, Gianpaolo De; Benvenuto, D.; Vivona, Carmen Liliana; Imbroinise, Alessia; Zampa, G.; Ricchio, Salvatore; Strazzullo, Pasquale

doi:10.1093/ndt/gfn548

Cited by 99 publications

(73 citation statements)

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“…10, 28 Jeong and colleagues found that metabolic syndrome and hypertension are independent risk factors in kidney stone disease, but not for the other characteristic parameters of metabolic syndrome. 29 In multivariate analysis in our study, hyperlipidemia, hypertension, VAA% and VAA over 180 cm 2 all contributed to stone formation.…”

Section: Discussionmentioning

confidence: 99%

Visceral obesity: A new risk factor for stone disease

Akarken

Tarhan

Ekin

et al. 2015

CUAJ

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Introduction: We examined the relationship between stone disease and the amount of visceral adipose tissue measured with unenhanced computed tomography (CT). Methods: We included 149 patients with complaints of flank pain and kidney stones detected by CT, from August 2012 to April 2013. In addition, as the control group we included 139 healthy individuals, with flank pain within the same time period, with no previous history of urological disease and no current kidney stones identified by CT. Patients were analyzed for age, gender, body mass index, amount of visceral and subcutaneous adipose tissue, and serum level of low-density lipoprotein and triglyceride. Results: There were no differences between groups in terms of gender and age (p = 0.27 and 0.06, respectively). Respective measurements for the stone and control groups for body mass index were 29.1 and 27.6 kg/m 2 ; for visceral fat measurement 186.0 and 120.2 cm 2 ; and for subcutaneous fat measurements 275.9 and 261.9 cm 2 (p = 0.01; 0.01 and 0.36, respectively). Using multivariate analysis, the following factors were identified as increasing the risk of kidney stone formation: hyperlipidemia (p = 0.003), hypertension (p = 0.001), and ratio of visceral fat tissue to subcutaneous fat tissue (p = 0.01). Our study has its limitations, including its retrospective nature, its small sample size, possible selection bias, and missing data. The lack of stone composition data is another major limitation of our study. Conclusion:The ratio of visceral to subcutaneous adipose tissue, in addition to obesity, hyperlipidemia, and hypertension, was identified as an emerging factor in the formation of kidney stones.

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Section: Discussionmentioning

confidence: 99%

Visceral obesity: A new risk factor for stone disease

Akarken

Tarhan

Ekin

et al. 2015

CUAJ

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“…Overweight, arterial hypertension and disturbances of the carbohydrate metabolism are important parameters of the metabolic syndrome (MS) [17]. In industrialized countries, an increasing percentage of people are affected by MS [1,4,7].…”

Section: Introductionmentioning

confidence: 99%

Overweight, insulin resistance and blood pressure (parameters of the metabolic syndrome) in uric acid urolithiasis

2011

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Overweight, arterial hypertension and disturbances of the carbohydrate metabolism are important parameters of the metabolic syndrome (MS). The most important factor regarding renal pathophysiology is insulin resistance resulting in alterations of urine acidification and low urine pH. Since low urine pH is the main risk factor for uric acid urolithiasis (UAU), UAU may be regarded as a renal manifestation of the MS. So far, there are only few data on the prevalence of parameters of the MS in UAU patients especially with regard to the severity of the disease and recurrence rate, respectively. The objective of this study was to know more about the prevalence of different parameters of the MS and their importance for the natural history of this type of renal stone disease using a total number of 167 consecutive patients with pure UA stones. Stone analysis was performed by polarization microscopy and X-ray diffraction. The following parameters were measured: age, sex, systolic and diastolic arterial blood pressure (RRs and RRd), number of stone episodes, diabetes mellitus (DM); serum: creatinine, calcium, sodium, potassium, uric acid, glucose; urine: pH-profiles, citrate, calcium, uric acid, ammonia, urea, and creatinine. The following results were obtained (means ± standard deviations): age 61 ± 13 years, BMI 30 ± 6 kg/m 2 , BP 147/84 ± 22/13 mmHg, number of stone episodes 1.8 ± 1.2, DM 32%; serum: creatinine 1.3 ± 0.6 mg/dl, glucose 136 ± 52 mg/dl, UA 6.3 ± 1.8 mg/dl, calcium 2.4 ± 1.3 mmol/l, sodium 134 ± 18 mmol/l, potassium 4.1 ± 0.4 mmol/l; urine: pH 5.87 ± 0.27, volume 2.4 ± 1.1 l/d, calcium 3.5 ± 2.5 mmol/d, UA 3.9 ± 2.4 mmol/d, citrate 1.3 ± 1.1 mmol/d, ammonia 41 ± 26 mmol/d, urea 390 ± 176 mmol/d. A significant positive correlation could be found for BMI and urea excretion, BMI correlated negatively with RRs and RRd. There was no significant correlation between BMI, urine pH, citrate, ammonia and UA in serum and urine. Undue acidity and hyperuricosuria were found in two-thirds of the UAU patients, increased urea excretion and decreased excretion of ammonia in less than 25%, Hyperuricemia in 37%. There was no significant correlation between the number of stone episodes and any other parameter studied. Overweight, arterial hypertension and DM as parameters of the MS are frequent in many patients with UAU. However, these parameters do explain the pathogenesis in two-thirds of the patients. The severity of the disease and the recurrence are not influenced by the presence of these metabolic parameters. Therefore, MS is no prognostic factor in UAU.

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“…In our study, especially comorbidities related to metabolic syndrom seems to be more frequent in the elderly group. The association between metabolic syndrome and kidney stones has been established by some studies (20)(21)(22). Furthermore, the risk of a stone former to develop diabetes mellitus is partially supported by two recent investigations (23,24) and some studies provide evidence of an association between kidney stone formation and cardiovascular disease (25,26).…”

Section: Discussionmentioning

confidence: 95%

Clinical presentation of urolithiasis in older and younger population

Dursun

Özbek

Ötünçtemur

et al. 2014

Arch Ital Urol Androl

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Aim of the study: We compared stone size, localization, complaint at the time of applying, comorbidity, treatment and complications between older (60 years of age and older) and younger patients with urolithiasis (59 years of age and younger). Materials and Methods: We retrospectively reviewed the records of 950 consecutive patients who presented to our clinic and underwent surgery for urolithiasis from January 2007 to March 2012. The patients were divided into two groups: patients ≥ 60 years an patients < 60 years. Results: There were 174 men and 61 women in elderly group, 528 men and 187 women in younger group. Ureteral stones were found more often in the younger group compared to elderly patients (p < 0.05). Conversely, bladder stone was more frequent in the elderly group. In the elderly group comorbidities are more frequent (diabetes mellitus, hypertension, ischemic heart disease, congestive heart disease, osteoarthritis and chronic obstructive lung). Patients ≥ 60 years significantly had larger kidney and bladder stones compared the younger, but ureteral stone sizes were not statistically different between the two groups. Older patients had a higher postoperative complication rate than younger patients (16% versus 3%, p < 0.05) although postoperative complications (e.g. urinary retention, cardiac dysrythmia, fever, constipation) were not serious and resolved with medical treatment. The average length of stay in hospital was longer in the elderly group, but the difference was not statistically significant. Conclusions: Elderly patients with urolithiasis usually have larger and more complex stone disease, more comorbidities and atypical presentation. both men and women (3,4). The lifetime recurrence risk is 50% with an estimated time to recurrence < 1 year in 10% of cases, < 5 years in 35 to 50% of cases and < 10 years in 50% or greater (5). Stones along the urinary tract can be located in the kidneys, ureters and urinary bladder. While approximately 90% of stones are successfully passed out of the urinary tract, the remaining stones generally have to be surgically removed by ureteroscopy or percutaneous nephrolithotomy or comminuted by non-invasive shock wave lithotripsy (6). Stone occurrence is relatively uncommon before age 20 but peaks in incidence in the fourth to sixth decades of life. Geriatric stone formers comprise 10%-12% of all stone formers and may have a proclivity to develop stones due to metabolic changes associated with ageing (7, 8). Altough it has been shown that geriatric patients with stones tend to have their first episode after age 50, it is not well described how the presentation of stones differs in elderly patients (7). According to the World Health Organization (WHO), ageing is defined as living beyond 60 years in a developing country or 65 years in a developed country. The number of ageing people is increasing faster than is any other age group; in 2025, there will be an estimated 1.2 billion individuals over the age of 60, and this number could reach 2 billion by 2050 (9). So, we ...

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Association between metabolic syndrome and nephrolithiasis in an inpatient population in southern Italy: role of gender, hypertension and abdominal obesity

Abstract: MetS is significantly associated with echographic evidence of NL. A gender-related difference in the clinical expression of NL was also observed.

Cited by 99 publications

References 47 publications

Visceral obesity: A new risk factor for stone disease

Visceral obesity: A new risk factor for stone disease

Overweight, insulin resistance and blood pressure (parameters of the metabolic syndrome) in uric acid urolithiasis

Clinical presentation of urolithiasis in older and younger population

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