Type 2 diabetes mellitus and renal stones

Authors

1 Department of Urology, KLES Kidney Foundation, Karnatak University, Karnataka, India

2 KLES Diabetes Centre, Jawaharlal Nehru Medical College, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLE University, Karnataka, India

3 Department of Biotechnology and Microbiology, Karnatak University, Karnataka, India

Abstract

Background: The incidence of urinary stone disease has shown a steep rise in recent decades along with marked modifications in dietary habits and life- style. There has been an increased prevalence of urinary stone disease in patients with diabetes. We took up this study to determine the association of diabetes mellitus with kidney stones in patients undergoing surgical treatment.
Materials and Methods: Patients presenting with renal stones for surgical management formed the study group. Body mass index (BMI) was calculated by noting the weight and height of the patient. The extracted stone/stone fragments were analyzed to determine the chemical composition. Urinary pH was similarly noted in all.
Results: The mean BMI among the diabetics was 26.35 ± 5.20 (range 17.75-35.60), whereas the mean BMI among the non-diabetics was 23.41 ± 2.85 (range 17.71-31.62) (P < 0.0004). The incidence of uric acid calculi in the diabetics was significantly high (P < 0.03). The mean urinary pH among the diabetics was 5.61 ± 0.36 and among the non-diabetics was 6.87 ± 0.32, which was significantly lower (P < 0.000044).
Conclusions: There is a strong association between type 2 diabetes and uric acid stone formation. There is also a strong association between diabetes mellitus, BMI, and also with lower urinary pH.

Keywords

1.
Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol 2000;37:23-5.  Back to cited text no. 1
    
2.
Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int 2003;63:1817-23.  Back to cited text no. 2
    
3.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002;288:1723-7.  Back to cited text no. 3
    
4.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: Findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.  Back to cited text no. 4
    
5.
Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76-9.  Back to cited text no. 5
    
6.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 6
    
7.
Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA 2003;289:450-3.  Back to cited text no. 7
    
8.
Després JP. Our passive lifestyle, our toxic diet, and the atherogenic/diabetogenic metabolic syndrome: Can we afford to be sedentary and unfit? Circulation 2005;112:453-5.  Back to cited text no. 8
    
9.
Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, et al. Origins and evolution of the Western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.  Back to cited text no. 9
    
10.
Meydan N, Barutca S, Caliskan S, Camsari T. Urinary stone disease in diabetes mellitus. Scand J Urol Nephrol 2003;37:64-70.  Back to cited text no. 10
    
11.
Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 2005;68:1230-5.  Back to cited text no. 11
    
12.
Curhan GC, Willett WC, Rimm EB, Speizer FE, Stampfer MJ. Body size and risk of kidney stones. J Am Soc Nephrol 1998;9:1645-52.  Back to cited text no. 12
    
13.
Powell CR, Stoller ML, Schwartz BF, Kane C, Gentle DL, Bruce JE, et al. Impact of body weight on urinary electrolytes in urinary stone formers. Urology 2000;55:825-30.  Back to cited text no. 13
    
14.
Siener R, Glatz S, Nicolay C, Hesse A. The role of overweight and obesity in calcium oxalate stone formation. Obes Res 2004;12:106-13.  Back to cited text no. 14
    
15.
Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-62.  Back to cited text no. 15
    
16.
Pearle MS, Calhoun EA, Curhan GC. Urolithiasis. In: Litwin M, Saigal C, editors. Urologic Diseases in America. United States Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office; 2004. p. 3-42.  Back to cited text no. 16
    
17.
Lingeman JE, Saywell RM Jr, Woods JR, Newman DM. Cost analysis of extracorporeal shock wave lithotripsy relative to other surgical and nonsurgical treatment alternatives for urolithiasis. Med Care 1986;24:1151-60.  Back to cited text no. 17
    
18.
Beck-Nielsen H, Groop LC. Metabolic and genetic characterization of prediabetic states. Sequence of events leading to non-insulin-dependent diabetes mellitus. J Clin Invest 1994;94:1714-21.  Back to cited text no. 18
    
19.
Sakhaee K, Adams-Huet B, Moe OW, Pak CY. Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int 2002;62:971-9.  Back to cited text no. 19
    
20.
Abate N, Chandalia M, Cabo-Chan AV Jr, Moe OW, Sakhaee K. The metabolic syndrome and uric acid nephrolithiasis: Novel features of renal manifestation of insulin resistance. Kidney Int 2004;65:386-92.  Back to cited text no. 20
    
21.
Pak CY, Sakhaee K, Moe O, Preminger GM, Poindexter JR, Peterson RD, et al. Biochemical profile of stone-forming patients with diabetes mellitus. Urology 2003;61:523-7.  Back to cited text no. 21
    
22.
Asplin JR. Uric acid stones. Semin Nephrol 1996;16:412-24.  Back to cited text no. 22
    
23.
Riese RJ, Sakhaee K. Uric acid nephrolithiasis: Pathogenesis and treatment. J Urol 1992;148:765-71.  Back to cited text no. 23
    
24.
Hamm LL. Renal handling of citrate. Kidney Int 1990;38:728-35.  Back to cited text no. 24
    
25.
Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med 1992;327:1141-52.  Back to cited text no. 25
    
26.
Kerstetter J, Caballero B, O'Brien K, Wurtman R, Allen L. Mineral homeostasis in obesity: Effects of euglycemic hyperinsulinemia. Metabolism 1991;40:707-13.  Back to cited text no. 26
    
27.
Shimamoto K, Higashiura K, Nakagawa M, Masuda A, Shiiki M, Miyazaki Y, et al. Effects of hyperinsulinemia under the euglycemic condition on calcium and phosphate metabolism in non-obese normotensive subjects. Tohoku J Exp Med 1995;177:271-8.  Back to cited text no. 27
    
28.
Nowicki M, Kokot F, Surdacki A. The influence of hyperinsulinaemia on calcium-phosphate metabolism in renal failure. Nephrol Dial Transplant 1998;13:2566-71.  Back to cited text no. 28
    
29.
Daudon M, Traxer O, Conort P, Lacour B, Jungers P. Type 2 diabetes increases the risk for uric acid stones. J Am Soc Nephrol 2006;17:2026-33.  Back to cited text no. 29
    
30.
Cameron MA, Maalouf NM, Adams-Huet B, Moe OW, Sakhaee K. Urine composition in type 2 diabetes: Predisposition to uric acid nephrolithiasis. J Am Soc Nephrol 2006;17:1422-8.  Back to cited text no. 30