Role of overweight and obesity on the urinary excretion of promoters and inhibitors of stone formation in stone formers

Negri, Armando; Spivacow, Francisco Rodolfo; Valle, Elisa Elena del; Forrester, Mariano; Rosende, Gabriela; Pinduli, Irene

doi:10.1007/s00240-008-0161-5

Cited by 90 publications

(51 citation statements)

References 18 publications

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“…The parallel growth in prevalence of obesity and morbid obesity over the past decades has increased the management of stone disease in this population (12,13). The association between urolithiasis and obesity is established in the literature and has shown that weight gain increases the urinary excretion of substances such as oxalate and uric acid, leading to stone formation (14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

et al. 2013

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Purpose: The purpose of this study is to determine if body mass index (BMI) and stone skin distance (SSD) affect stone free rate (SFR) in obese and morbid obese patients who underwent flexible URS for proximal ureteral or renal stones < 20 mm. Materials and Methods: A retrospective chart review was performed of consecutive patients that underwent flexible URS. Inclusion criteria were: proximal ureteral stones and renal stones less than 20 mm in the preoperative computed tomography (CT). SFR were then compared according to SSD and BMI. Results: A total of 153 patients were eligible for this analysis, 49 (32.02%) with SSD < 10 cm and 104 (67.97%) with SSD ≥ 10 cm. The mean stone size was 10.5 ± 6.4 mm. The overall SFR in our study was 82.4%. The SFR for the SSD < 10 and ≥ 10 were 79.6% and 83.7% respectively (p = 0.698) and for BMI < 30, ≥ 30 and < 40 and ≥ 40 were 82.9%, 81.7% and 90.9% respectively. Regression analysis showed no affect between BMI or SSD regarding SFR. Conclusion: Ureteroscopy should be considered as a first-line of treatment for renal/proximal stones in obese and morbid obese patients. URS may be preferable to SWL in obese patients independently of the SSD, BMI or the location of proximal stones. INTRODuCTIONThe ideal treatment for proximal ureteral and renal stones has become controversial, with the noninvasive nature of shock wave lithotripsy (SWL) and the expansion of endoscopic digital technology. The 2007 update of the EAU/AUA ureteral stone guidelines (1) showed that both ureteroscopy (URS) and SWL should be considered first-line therapy for proximal ureteral stones, as opposed to just SWL as previously reported. On the other hand SWL has emerged as the primary treatment of choice for renal calculi less than 1.5-2 cm (2).In that context, the treatment of urolithiasis in obese patients has gained more importance in the last years since obesity rates have increased markedly since 1980 in the United States (3). Data from the national Center for Health Statistics (2009Statistics ( -2010 showed that 35.7% of adults and 17% of children and adolescents in the United States were obese (4). According to the World Health Organization guidelines, a body mass index (BMI) of 18.5 to 25 kg/m 2 is considered normal, overweight is a BMI of 25 to Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients _______________________________________________

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Section: Discussionmentioning

confidence: 99%

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

et al. 2013

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“…Furthermore, studies have shown an association among obesity, MS, and various urinary biochemical abnormalities recognized to increase the propensity for kidney stone formation (4)(5)(6). Greater body weight has been associated with lower urinary pH in stoneforming (7) as well as non-stone-forming individuals (8).…”

Section: Introductionmentioning

confidence: 99%

Body Fat Content and Distribution and Urinary Risk Factors for Nephrolithiasis

Pigna¹,

Sakhaee²,

Adams‐Huet

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Obesity is associated with a higher risk of nephrolithiasis. However, it is not known whether higher body fat mass or abnormal fat distribution influences stone risk independent of dietary factors.Design, setting, participants, & measurements In this cross-sectional study, non-stone-forming men with no known kidney disease and with a wide range of body weight collected a 24-hour urine specimen while consuming a fixed metabolic diet. They underwent dual-energy x-ray absorptiometry to assess body composition and fat distribution. Urinary risk factors for nephrolithiasis and urine saturation with respect to calcium oxalate and uric acid (assessed as supersaturation index [SI]) were correlated with various measures of adiposity.Results Study participants included 21 men with a mean age of 52.1 years, mean weight of 91.1 kg, and mean total fat mass of 24.3 kg. Twenty-four-hour urine pH and SI uric acid were more closely correlated with fat mass than with lean mass or total body weight. Both 24-hour urine pH and SI uric acid were also significantly correlated with truncal fat mass but not with leg fat mass. Moreover, there was a significant negative correlation between truncal/leg fat mass and NH 4 + /net acid excretion ratio (R=20.62; P=0.009). However, there was no significant association between SI calcium oxalate and body weight, lean mass, fat mass, trunk fat mass, or leg fat mass. ConclusionsThe association between 24-hour urine pH and SI uric acid and various measures of adiposity suggest that total body fat and trunk fat are more strongly associated with risk factors for uric acid stone formation than are total body weight and lean body mass. Under a controlled metabolic diet, adiposity is not associated with risk factors for calcium oxalate stones. Further studies are needed to confirm these findings in larger populations that include women and patients who form stones.

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“…[27][28][29] Lee et al analyzed a database of patient history, BMI, and serum and urine chemistry for 704 consecutive stone formers (467 first-time stone formers and 247 recurrent stone formers). Obesity was significantly associated with stone episodes (p ¼ 0.043).…”

Section: Obesity and Renal Stone Diseasementioning

confidence: 99%

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

Ahmed

2012

Renal Failure

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Currently, obesity has reached an epidemic stage and represents a challenge for health authorities across the globe. Certainly, with emergence of obesity epidemic, we started to see an increase in the prevalence of chronic kidney disease (CKD) and nephrolithiasis. Interestingly, epidemiologic studies have shown that the incident stone risk increases with body mass index (BMI), and no further increase in risk is noticed when the BMI > 30 kg/m 2 . Furthermore, metabolic syndrome and diabetes are also associated with an increase in the incidence of renal stones disease. The shared links between these metabolic disorders are insulin resistance. Furthermore, insulin resistance is thought to alter renal acidbase metabolism, resulting in a lower urine pH and increased risk of uric acid stone disease. Obesity is also associated with excess nutritional intake of lithogenic substances such as refined sugars, low fluid intake, calcium, oxalate, and purine-rich foods. Obesity is also associated with an increase in incidence of urinary tract infection. Recent reports suggested that renal stone disease carries risk of myocardial infarction, progression of CKD, and diabetes. Alarmingly, orlistat (obesity medication) and bariatric surgery are associated with hyperoxaluria and associated stone formation and even oxalate nephropathy. Certainly, the many health risks of obesity, including nephrolithiasis, will add more burden on urologists and nephrologists. Shockwave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all safe procedures in obese individuals. Further research is urgently needed to address the pathophysiology and management of obesity-induced renal stones disease.

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Role of overweight and obesity on the urinary excretion of promoters and inhibitors of stone formation in stone formers

Cited by 90 publications

References 18 publications

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

Body Fat Content and Distribution and Urinary Risk Factors for Nephrolithiasis

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

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