Dyslipidemia is associated with an increased risk of nephrolithiasis

Abstract

The pathophysiology of nephrolithiasis is multifactorial. Obesity, diabetes mellitus and hypertension are implicated in its formation. Dyslipidemia (DLD) recently has received attention as well. Congruent with a vascular etiology in stone formation, DLD theoretically would predispose patients to nephrolithiasis. We investigated a possible association of DLD with nephrolithiasis. A random cohort of 60,000 patients was established by collecting the first 5,000 patient charts per month in the year 2000. After excluding pediatric patients, a retrospective study was performed by reviewing age, sex, comorbidities, and last patient follow-up. Median lipid laboratory levels also were reviewed. Descriptive statistics were performed as well as Cox proportional-hazards regression analysis, and univariate and multivariate analyses. 52,184 (22,717 women/29,467 men) patient charts were reviewed. The average age was 31.0 ± 15.2 years. On univariate analysis, DLD was associated with nephrolithiasis with a hazard ratio (HR) of 2.2 [Confidence Interval (CI), 1.9–2.5; p < 0.001] and on multivariate analysis HR = 1.2 (1.0–1.5; p = 0.033). Low-density lipoprotein and triglycerides had no association with stone disease. Patients with high-density lipoprotein (HDL) values <45 for men and <60 for women had an HR of 1.4 (1.1–1.7, 95% CI, p = 0.003) on univariate analysis and on multivariate analysis; HR = 1.27 (1.03–1.56; p = 0.024) for nephrolithiasis. DLD was associated with an increased risk of stone disease though the only specific lipid panel associated with lower nephrolithiasis was HDL. Clinicians should consider obtaining lipid levels with the intent that treatment could potentially not only mitigate atherosclerotic disease but also decrease nephrolithiasis risk.

Association between blood lipid profile and urolithiasis: A systematic review and meta‐analysis of observational studies

“…The 11 selected studies contained 282 479 participants (ranging from 694 to 116 536) . They were published between 2008 and 2017.…”

“…The cut‐off values of dyslipidemia traits and diagnostic tools for urolithiasis detection are shown in Table . All individual studies used 150 mg/dL for a high TG cut‐off value, except for the study by Masterson et al ., in which no detailed information about TG was available . Three studies only included men, thus only HDL for men <40 mg/dL was reported as a cut‐off value in those studies .…”

“…Masterson et al . evaluated medical records screening relevant codes for urolithiasis . Kohjimoto et al .…”

Anecdotes of lithogenesis and atherogenesis conversely liable for cardiac dysfunction and kidney stone formation

“…Recently, Masterson et al [1] reported that dyslipidemia increases the risk of kidney stone formation. Interestingly, in 2002 Khan et al reported [2] that urolithic patients excrete more lipids such as total cholesterol, triglycerides, and some phospholipids [2].…”

“…Injury and retention model explains the lithogenesis and atherogenesis [2,3]. In kidney stones, retention of calcium oxalate crystals occurs in the injured urothelium, inducing accumulation of lipids, proteinaceous materials, such as calcium-binding protein and glycoproteins, which interact with crystals and modulate the nucleation and aggregation process leading to stone formation [1]. Vascular cell injury and retention of lipids in the arterial wall cause the atherosclerosis [3].…”