Kidney stones diseases and glycaemic statuses: focus on the latest clinical evidences

Abstract

Diabetes and obesity are already recognized as potential risk factors for nephrolithiasis, especially for uric acid stones. Insulin resistance and hyperinsulinemia actively contribute to impaired ability to excrete an acid load and altered ammonium production, leading to a lower urinary pH compared to non-diabetic controls. All these electrolytic disorders play an important role in stone formation and aggregation, especially in uric acid stones. There are still missing points in scientific evidence if the increased risk in stone formation is already existing even in the prediabetic statuses (isolated impaired glucose tolerance, isolated impaired fasting glucose, and associated impaired glucose tolerance/impaired fasting glucose) as well as it is worth to consider the same level of risk. Urolithiasis is the most frequent urological cause of hospitalization in diabetic patients and its cost is usually higher compared to non-diabetic patients, but less is known in others altered glycaemic diseases. The aim of this review article is to focus on the association between stone formation and altered glycaemic statuses, beyond the already known link between nephrolithiasis and diabetes mellitus.

Meeting report of the “Symposium on kidney stones and mineral metabolism: calcium kidney stones in 2017”

“…Given the risk of KS recurrence, high morbidity, the necessity of endo-urological or surgical interventions, early diagnosis and specialized management of KSD is indicated [74]. Awareness is essential to rapidly identify the pro-lithogenic metabolic abnormalities, assess the coexistence of renal and/or cardiovascular complications with the aim of controlling KSD and slowing down the CKD progression with adequate treatment [75,76].…”

Glycemic Status, Insulin Resistance, and the Risk of Nephrolithiasis: A Cohort Study

“…Epidemiologic studies have suggested the positive association between diabetes and nephrolithiasis, but whether there is also a link between prediabetes and risk for nephrolithiasis is not yet well established, with conflicting results available from previous research. 7,11,[13][14][15][16][17] In most of these studies, the primary exposure was metabolic syndrome; thus, glucose level was examined as 1 metabolic syndrome component using a dichotomous category (prediabetes combined with diabetes or not) without consideration of differential effects of prediabetic and diabetic levels on nephrolithiasis risk.…”

“…6 Although multiple epidemiologic studies have supported the effect of diabetes on nephrolithiasis, the association between prediabetes and nephrolithiasis remains unclear and studies of this issue are limited. 7 Insulin resistance, a key feature of prediabetes and type 2 diabetes, affects ammoniagenesis in the renal tubule, leading to urine acidification and subsequent formation of urinary stones. 8,9 Also, hyperglycemia-related glycosuria, which is related to increased urinary calcium, phosphorus, and uric acid excretion, could induce urinary stone formation.…”

Research Advances in the Mechanisms of Hyperuricemia-Induced Renal Injury

“…Upon obstruction, a series of complications occur, such as local damage, infection, bleeding, and hydronephrosis [ 38 ]. In particular, insulin resistance leads to impaired UA excretion at a low urinary pH, contributing to the formation of urate stones [ 39 ].…”