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Singh S, Gupta S, Mishra T, Banerjee BD, Sharma T. Risk Factors of Incident Kidney Stones in Indian Adults: A Hospital-Based Cross-Sectional Study. Cureus 2023; 15:e35558. [PMID: 37007314 PMCID: PMC10060047 DOI: 10.7759/cureus.35558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Background The diverse manifestations of urolithiasis provide very interesting epidemiological data. This has prompted various studies to look into the etiopathogenesis of renal stones, which is believed to be multifactorial, both exogenous and endogenous. VDR Fok1 is a risk factor for renal stone formation and could cause the formation of renal stones through the mechanism of crystal induction and crystallization in the urine. While a few recent studies have shown the role of heavy metals like cadmium and lead in the formation of renal stones, the current knowledge is still insufficient. Methods This case-control prospective study was conducted in Guru Teg Bahadur (GTB) Hospital, a tertiary care facility in Delhi with 30 cases and 30 controls. Patients visiting the department of surgery between November 2011 and April 2013 were enrolled in the study. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological investigations. Controls were selected from the patients admitted to the department of surgery for reasons other than renal stones. The study protocol was approved by the Institutional Ethical Committee of the University College of Medical Sciences, GTB Hospital, Delhi. Written informed consent was obtained from all patients. A structured questionnaire was used to collect data. Metal levels were analyzed by an atomic absorption spectrophotometer (Shimadzu Flame AA-680, Shimadzu Corp., Kyoto, Japan) at Delhi University. The vitamin D receptor gene was measured using genomic DNA. Horizontal agarose gel electrophoresis was used for the quantification of the genomic DNA. Results There were 30 cases and 30 controls in the study. Stress was more prevalent among cases (63%) compared to controls (36%). Nearly 83% of cases had the ff allele of the Vitamin D receptor gene compared to 46% of controls. The median arsenic and lead levels were higher among cases compared to controls. In the unadjusted model of logistic regression, we found stressed patients had three times higher odds of developing renal stones compared to non-stressed patients (OR (95% CI): 2.98 (1.04-8.52); p=0.04). Similarly, patients with higher blood concentrations of arsenic and lead had higher odds of developing renal stones compared to those with lower concentrations. Conclusions There was a definitive role of heavy metals, including lead, cadmium, and arsenic, seen with renal stones. A significant association was seen between the ff allele of VDR polymorphism (Fok1 enzymes) and patients with renal stones. Other parameters, including male and stress factors, seem to have an important role in renal stone formation.
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Sheele JM, Libertin CR, Fink I, Jensen T, Dasalla N, Lyon TD. Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance. J Emerg Med 2022; 62:368-377. [PMID: 35000812 DOI: 10.1016/j.jemermed.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/09/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH. OBJECTIVE Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance. METHODS A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χ2 test and multivariable regression analysis. RESULTS Of 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p < 0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p < 0.001 for both). CONCLUSIONS Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.
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Affiliation(s)
| | | | - Isaac Fink
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Taylor Jensen
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Nicole Dasalla
- Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Cicerello E, Ciaccia M, Cova GD, Mangano MS. The new patterns of nephrolithiasis: What has been changing in the last millennium? Arch Ital Urol Androl 2021; 93:195-199. [PMID: 34286555 DOI: 10.4081/aiua.2021.2.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
Nephrolithiasis has been increasing over the last millennium. Although early epidemiologic studies have shown that kidney stones were two to three times more frequent in males than in females, recent reports have suggested that this rate is decreasing. In parallel a dramatic increase of nephrolithiasis has also been observed among children and adolescents. Furthermore, epidemiologic studies have shown a strong association between metabolic syndrome (Mets) traits and kidney stone disease. Patients with hypertension have a higher risk of stone formation and stone formers are predisposed to develop hypertension compared to the general population. An incidence of nephrolithiasis greater than 75% has been shown in overweight and obese patients compared to those of normal weight. It has also been reported that a previous diagnosis of diabetes mellitus increases the risk of future nephrolithiasis. Additionally, an association between metabolic syndrome and uric acid stone formation has been clearly recognized. Furthermore, 24-h urinary metabolic abnormalities have been decreasing among patients with nephrolithiasis over the last decades. Finally, nephrolithiasis could cause chronic kidney disease (CKD) and end stage renal disease (ESRD), especially in women and overweight patients. According to these observations, a better understanding of these new features among stone former patients may be required. Hence, the recognition and the correction of metabolic disorders could help not only to reduce the primary disease, but also stone recurrence.
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Affiliation(s)
- Elisa Cicerello
- Unità Complessa di Urologia, Dipartimento di Chirurgia Specialistica, Ospedale Ca' Foncello, Treviso.
| | - Matteo Ciaccia
- Unità Complessa di Urologia, Dipartimento di Chirurgia Specialistica, Ospedale Ca' Foncello, Treviso.
| | - Gian D Cova
- Unità Complessa di Urologia, Dipartimento di Chirurgia Specialistica, Ospedale Ca' Foncello, Treviso.
| | - Mario S Mangano
- Unità Complessa di Urologia, Dipartimento di Chirurgia Specialistica, Ospedale Ca' Foncello, Treviso.
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Arafa A, Eshak ES, Iso H, Shirai K, Muraki I, Sawada N, Tsugane S. Urinary Stones and Risk of Coronary Heart Disease and Stroke: the Japan Public Health Center-Based Prospective Study. J Atheroscler Thromb 2020; 27:1208-1215. [PMID: 32507830 PMCID: PMC7803838 DOI: 10.5551/jat.54775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Evidence is lacking about whether urinary stones are associated with the subsequent risk of cardiovascular diseases. Herein, we investigated the association between history of urinary stones and the risk of coronary heart disease (CHD) and stroke among middle-aged Japanese. Methods: This cohort study included 89,037 Japanese men and women (45–74 years) registered in the Japan Public Health Center-based prospective study. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident CHD and stroke among Japanese adults with a self-reported history of urinary stones compared with those without it. The following covariates were included in the regression models: age, sex, area, body mass index, and histories of hypertension, diabetes, hyperlipidemia, smoking habit, alcohol intake, and physical activity. Results: In total, 1.31% of Japanese adults reported a positive history of urinary stones. Throughout a median follow-up period of 12 years, 1.16% of Japanese adults developed CHD, and 4.96% developed stroke. No associations were detected between history of urinary stones and the risk of CHD (HR 1.04; 95% CI: 0.64–1.67), stroke (HR 0.92; 95% CI: 0.71–1.20), or total CVD (HR 0.95; 95% CI: 0.75–1.19). Younger urinary stone formers (45–59 years) tended to have a higher, though statistically insignificant, risk of CHD than older urinary stone formers (60–74 years): [(HR 1.15; 95% CI: 0.61–2.15) versus (HR 0.83; 95% CI: 0.40–1.76)], respectively. Conclusion: The history of urinary stones was shown to be not associated with the risk of CVD among Japanese adults.
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Affiliation(s)
- Ahmed Arafa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Department of Public Health, Faculty of Medicine, Minia University
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Norie Sawada
- Epidemiology and Prevention Division, Research Center for Cancer Prevention Group, Center for Public Health Sciences, National Cancer Center
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, Research Center for Cancer Prevention Group, Center for Public Health Sciences, National Cancer Center
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Urinary Calculi: A Microbiological and Biochemical Analysis at a Tertiary Care Hospital in Eastern Nepal. Int J Microbiol 2020; 2020:8880403. [PMID: 33005194 PMCID: PMC7503111 DOI: 10.1155/2020/8880403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background The occurrence of urinary tract infection in presence of urolithiasis is frequently noted; however, microbial agents of urolithiasis and their antimicrobial susceptibility patterns remain underinvestigated. This study aimed to identify the microorganisms isolated from urine and stone matrices to determine their antimicrobial susceptibility, to find the association between the pathogens of urine and stone matrices, and to perform the biochemical analysis of stones. Methods A total of 88 cases of urolithiasis admitted for elective stone removal at Department of surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), were enrolled. Preoperative urine culture and postoperative stone culture were performed. Isolation, identification, and AST were done by the standard microbiological technique. Further qualitative biochemical analysis of stones was also attempted. Result Among 88 stone formers recruited, culture of urine, whole stone, and nidus yielded the growth of bacteria 44, 32, and 30, respectively. Bacteria isolated from urine culture correlated with those from stone matrices with a sensitivity of 90%, specificity of 79.69%, PPV of 63.64%, and NPV of 95.45%. Escherichia coli (46.7%) was the most common bacteria followed by Klebsiella pneumoniae (16.7%) and Proteus mirabilis (13.3%) from urine and stone cultures. Almost all the uropathogens isolated were susceptible to commonly used antibiotics. Calcium oxalate (84.1%) was common biochemical constituent found in stone formers followed by calcium oxalate + phosphate (8%). Conclusions The association of microorganism isolated from urine and nidus culture was significant that can predict the source of infective stone; however, in some cases, microorganisms and the antimicrobial susceptibility pattern from urine and nidus were different. This study emphasizes the use of appropriate antimicrobial agents to prevent the regrowth of residual stones and minimize the risk of infectious complications after surgical removal of stones.
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Arafa A, Eshak ES, Iso H. Oxalates, urinary stones and risk of cardiovascular diseases. Med Hypotheses 2020; 137:109570. [PMID: 31972450 DOI: 10.1016/j.mehy.2020.109570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/31/2019] [Accepted: 01/12/2020] [Indexed: 12/20/2022]
Abstract
Increased level of oxalates in urine and plasma can be attributed to endogenous overproduction, increased ingestion or excessive intestinal absorption. When a supersaturation status is reached, oxalates combine with calcium and crystallize to form 80% of the urinary stones. Several cardiovascular diseases such as coronary heart disease and stroke are thought to be associated with the formation of urinary stones via sharing the same pathogenesis and/or risk factors. This review investigated the evidence linking oxalates/urinary stones to cardiovascular diseases. Eventually, two theories can explain the possible association between urinary stones and cardiovascular diseases: the theory of common origin and the theory of common risk factors. While the first theory is based on the common vascular pathophysiology of urinary stones and cardiac events, the later suggests that metabolic syndrome traits increase the risk of urinary stones and cardiovascular diseases independently. A few cohort studies showed a higher risk of coronary heart disease and stroke among people with history of urinary stones than people without it while other cohort studies did not. These studies had different definitions for cardiovascular diseases, used various methods to assess urinary stones, and some of them did not control for potential confounders. When they were pooled together in meta-analyses, a significant heterogeneity across studies was observed. In conclusion, although there is some evidence indicating that urinary stones could increase the risk of cardiovascular diseases, a substantial causal relationship cannot be settled.
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Affiliation(s)
- Ahmed Arafa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Public Health, Faculty of Medicine, Minia University, El-Minia, Egypt
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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Ping H, Lu N, Wang M, Lu J, Liu Y, Qiao L, Wang Y, Jiang L, Zhang X. New-onset metabolic risk factors and the incidence of kidney stones: a prospective cohort study. BJU Int 2019; 124:1028-1033. [PMID: 31077518 DOI: 10.1111/bju.14805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association of kidney stones with new-onset hypertension, diabetes and obesity. PARTICIPANTS AND METHODS This prospective cohort study included participants in the Qingdao Port Cardiovascular Health Study who were aged ≥18 years and had abdominal ultrasonography results in 2013 that were negative for kidney stones. Multivariable Cox regression models with time-dependent covariates were used to estimate the effects of new-onset hypertension, diabetes and obesity on the incidence of kidney stones. RESULTS There were 9667 participants without kidney stones in 2013 (mean age 46.2 years; 75.6% men). During a mean (range) follow-up of 33.5 (6-42) months, 676 (7.0%) incident cases of kidney stones were identified. Kidney stones were more frequent among those who had new-onset of a metabolic factor vs those who did not (hypertension: 7.7 vs 6.0%; diabetes: 8.4 vs 6.6%; obesity: 7.4 vs 6.8%). Adjusted Cox models identified that increased risk of kidney stones was associated with new-onset hypertension (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.25-2.27), new-onset diabetes (HR 1.78, 95% CI 1.07-2.96), and new-onset obesity (HR 1.78, 95% CI 1.15-2.74). CONCLUSIONS New-onset of hypertension, diabetes and obesity were all strongly associated with an increased risk of kidney stones in this prospective cohort study. Results suggest that a substantial proportion of kidney stones are potentially preventable by appropriate control of these metabolic risk factors.
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Affiliation(s)
- Hao Ping
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Na Lu
- Office of Health Care, Qingdao Fuwai Hospital, Qingdao, China
| | - Mingshuai Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiapeng Lu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuexin Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ludong Qiao
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Krupp D, Westhoff TH, Esche J, Remer T. Prospective relation of adolescent citrate excretion and net acid excretion capacity with blood pressure in young adulthood. Am J Physiol Renal Physiol 2018; 315:F1228-F1235. [PMID: 30019929 DOI: 10.1152/ajprenal.00144.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Experimental data and observational studies in adults suggest that even subtle changes in acid-base balance, indicative of a higher systemic proton load, are related to higher blood pressure (BP) levels and an increased hypertension risk. However, these associations have not been investigated during growth. The kidney is the central organ in regulating excretion of nonvolatile acids, and renal citrate excretion has been shown to be a sensitive, noninvasive marker of changes in systemic acid balance. We thus analyzed the prospective relation of 24-h citrate excretion, as well as net acid excretion capacity (NAEC; a noninvasive indicator of the renal ability to excrete protons), during adolescence (boys: 10-15 yr; girls: 9-14 yr) with BP levels in young adulthood (18-30 yr) in 374 healthy participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. In linear-regression analyses adjusted for age, sex, 24-h urinary excretions of sodium and potassium, as well as further relevant confounders, a 1-mmol/1.73 m2/day higher adolescent citrate excretion was related to 1.2 mmHg lower systolic BP ( P = 0.02) but not to diastolic BP ( P = 0.6). A 10-mEq higher NAEC during adolescence was related to 1.7 mmHg lower systolic BP in young men, but this association was statistically nonsignificant ( P = 0.07) after multivariable adjustment. Additional adjustment for adult body mass index did not alter these findings. To conclude, subtle changes in systemic acid-base balance during adolescence are already indicative for later BP. Potential sex differences in these associations should be investigated in further studies.
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Affiliation(s)
- Danika Krupp
- DONALD Study Center, Department of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn , Dortmund , Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Bochum , Germany
| | - Jonas Esche
- DONALD Study Center, Department of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn , Dortmund , Germany
| | - Thomas Remer
- DONALD Study Center, Department of Nutrition and Food Sciences-Nutritional Epidemiology, University of Bonn , Dortmund , Germany
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Liu YT, Yang PY, Yang YW, Sun HY, Lin IC. The association of nephrolithiasis with metabolic syndrome and its components: a cross-sectional analysis. Ther Clin Risk Manag 2017; 13:41-48. [PMID: 28123300 PMCID: PMC5228628 DOI: 10.2147/tcrm.s125480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Metabolic syndrome is a worldwide disorder and also the major risk factor of several systemic diseases. Evidence identifying the association between metabolic syndrome and nephrolithiasis is lacking, especially in Taiwan. Aim The aim of this study was to investigate the association between nephrolithiasis and metabolic syndrome and its components. Design and setting This was a cross-sectional study conducted in the Health Examination Department of a medical center in Changhua, Taiwan, from January 2010 to December 2010. Methods We reviewed the medical records of patients who had visited the Health Examination Center of Changhua Christian Hospital in 2010. A total of 3,886 individuals were enrolled. According to the exclusion criteria, those with an age <20 years and an abnormal renal function were excluded. A total of 3,793 subjects were included. All P-values are two tailed, and P<0.05 was defined as statistically significant. Results The results showed a correlation between nephrolithiasis and metabolic syndrome and its components. The multivariate-adjusted odds ratio (OR) (95% confidence interval [CI]) of metabolic syndrome for nephrolithiasis was 1.318 (1.083–1.604), with a P-value of 0.006. Larger waist circumference (multivariable-adjusted OR 1.338; 95% CI 1.098–1.631; P=0.004), higher blood pressure (multivariable-adjusted OR 1.333; 95% CI 1.106–1.607; P=0.003), and increased fasting glucose (multivariable-adjusted OR 1.276; 95% CI 1.054–1.546; P=0.01) were associated with nephrolithiasis. Conclusion This is the first study in Taiwan to investigate the relationship between metabolic syndrome and nephrolithiasis. The mechanism is controversial, and several hypotheses are offered. Adequate lifestyle modification and proper treatment in metabolic syndrome management may both contribute to nephrolithiasis prevention.
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Affiliation(s)
- Yen-Tze Liu
- Department of Family Medicine, Changhua Christian Hospital
| | - Pei-Yu Yang
- Department of Laboratory, Show Chwan Memorial Hospital, Changhua City
| | - Yu-Wen Yang
- Department of Family Medicine, Changhua Christian Hospital
| | - Hung-Yu Sun
- Department of Family Medicine, Changhua Christian Hospital
| | - I-Ching Lin
- Department of Family Medicine, Changhua Christian Hospital; School of Medicine, Chung Shan Medical University, Taichung City; School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Lee YC, Huang SP, Juan YS, Huang TY, Liu CC. Impact of metabolic syndrome and its components on kidney stone in aging Taiwanese males. Aging Male 2016; 19:197-201. [PMID: 27138115 DOI: 10.1080/13685538.2016.1174987] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Metabolic syndrome (MtS) and kidney stone are two common aging diseases with male dominant. This is the first study regarding the potential impact of MtS and its components on kidney stone in aging Chinese population. METHODS A total of 694 males with a mean age of 55.6 years were enrolled. The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Subjects were classified as having a disease of kidney stones according to diagnosis by a physician with available medical records or evidence from ultrasonography judged by an investigator of urologist. RESULTS Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with kidney stone had significantly higher prevalence of MtS (p = 0.04, OR = 1.74, 95% CI: 1.0 1-3.00). The presence of MtS had significant correlation with kidney stone (p = 0.01, OR = 1.83, 95% CI: 1.1 4-2.93), which were associated with the increment of MtS components (p < 0.01). After adjusting for age and testosterone level, abnormal blood pressure (BP) was the most significantly independent component of MtS for kidney stone among the MtS components (p < 0.01, OR = 2.81, 95% CI: 1.46-5.39). CONCLUSIONS In aging Taiwanese males, the presence of MtS and its components are strongly associated with kidney stone. Abnormal BP is the most significant risk component of MtS for kidney stone.
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Affiliation(s)
- Yung-Chin Lee
- a Department of Urology , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
- b Faculty of Medicine , College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Shu-Pin Huang
- a Department of Urology , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
- b Faculty of Medicine , College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
- c Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan , and
| | - Yung-Shun Juan
- a Department of Urology , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
- b Faculty of Medicine , College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
- d Department of Urology , Kaohsiung Municipal Hsiao-Kang Hospital , Kaohsiung , Taiwan
| | - Tsung-Yi Huang
- a Department of Urology , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
| | - Chia-Chu Liu
- a Department of Urology , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan
- b Faculty of Medicine , College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
- e Pingtung Hospital, Department of Health, Executive Yuan , Pingtung , Taiwan
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Urinary Tract Physiological Conditions Promote Ciprofloxacin Resistance in Low-Level-Quinolone-Resistant Escherichia coli. Antimicrob Agents Chemother 2016; 60:4252-8. [PMID: 27139482 DOI: 10.1128/aac.00602-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/27/2016] [Indexed: 11/20/2022] Open
Abstract
Escherichia coli isolates carrying chromosomally encoded low-level-quinolone-resistant (LLQR) determinants are frequently found in urinary tract infections (UTIs). LLQR mutations are considered the first step in the evolutionary pathway producing high-level fluoroquinolone resistance. Therefore, their evolution and dissemination might influence the outcome of fluoroquinolone treatments of UTI. Previous studies support the notion that low urine pH decreases susceptibility to ciprofloxacin (CIP) in E. coli However, the effect of the urinary tract physiological parameters on the activity of ciprofloxacin against LLQR E. coli strains has received little attention. We have studied the activity of ciprofloxacin under physiological urinary tract conditions against a set of well-characterized isogenic E. coli derivatives carrying the most prevalent chromosomal mutations (ΔmarR, gyrA-S83L, gyrA-D87N, and parC-S80R and some combinations). The results presented here demonstrate that all the LLQR strains studied became resistant to ciprofloxacin (according to CLSI guidelines) under physiological conditions whereas the control strain lacking LLQR mutations did not. Moreover, the survival of some LLQR E. coli variants increased up to 100-fold after challenge with a high concentration of ciprofloxacin under UTI conditions compared to the results seen with Mueller-Hinton broth. These selective conditions could explain the high prevalence of LLQR mutations in E. coli Furthermore, our data strongly suggest that recommended methods for MIC determination produce poor estimations of CIP activity against LLQR E. coli in UTIs.
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Does hypertension impact 24-hour urine parameters in patients with nephrolithiasis? Urology 2015; 85:539-43. [PMID: 25733263 DOI: 10.1016/j.urology.2014.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/20/2014] [Accepted: 12/05/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the differences in 24-hour urine parameters and stone composition between patients with and without systemic hypertension (HTN) in a large cohort of stone formers. MATERIALS AND METHODS We performed a retrospective review over a 10-year period of patients with stone, who had completed a 24-hour urinalysis (Litholink) and for whom demographic information was available, including the presence of HTN. Univariate and multivariate analyses were performed, comparing the 24-hour urinalysis profiles of patients with HTN with that of normotensive patients. RESULTS Of the 1115 patients eligible for inclusion, 442 patients (40%) had HTN and 673 (60%) did not. Patients with HTN were significantly older, had a higher body mass index, and had a greater number of comorbid conditions than normotensive patients. Univariate analysis revealed significantly lower urine pH, calcium, supersaturation (SS) of calcium oxalate (CaOx) and SS calcium phosphate (all P <.05) in patients with HTN. Multivariate analysis showed significantly lower calcium, citrate, and SS CaOx in patients with HTN (all P <.05). CONCLUSION Our results demonstrate lower levels of calcium and SS CaOx on univariate and multivariate analysis, as well as lower levels of citrate on multivariate analysis in patients with HTN. These results suggest that lower levels of citrate may contribute to stone formation to a greater degree in patients with HTN than abnormalities in calcium metabolism.
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Besiroglu H, Otunctemur A, Ozbek E. The metabolic syndrome and urolithiasis: a systematic review and meta-analysis. Ren Fail 2014; 37:1-6. [PMID: 25353628 DOI: 10.3109/0886022x.2014.976133] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to assess the association between metabolic syndrome (MetS) and urolithiasis. BACKGROUND Observational studies and reviews suggest an association between the incidence of urolithiasis and the prevalence of MetS. However, individual studies are needed to be gathered to come to a more reliable and precise conclusion. METHODS We searched the Pubmed-Medline and Embase databases up to February 2014 to identify studies related to urolithiasis and metabolic syndrome. Three authors independently extracted information on the study design, the characteristics of the study participants, exposure and outcome assessments, and the method used to control for potential confounding factors. A random-effects model was used for the risk estimates. RESULTS Five studies were included in the final analysis. Our meta-analysis of five cross-sectional controlled studies identified a significant association between urolithiasis and MetS, with an overall OR of 1.39 (1.14-1.70). CONCLUSIONS Patients with metabolic syndrome have an increased risk of having urolithiasis indicating that it should be assessed as a systemic disorder. However, these observations need to be evaluated using prospective, randomized studies.
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Affiliation(s)
- Huseyin Besiroglu
- Department of Urology, Okmeydani Training and Research Hospital , Istanbul , Turkey and
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Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T. Salt and nephrolithiasis. Nephrol Dial Transplant 2014; 31:39-45. [PMID: 25031016 DOI: 10.1093/ndt/gfu243] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/18/2014] [Indexed: 12/17/2022] Open
Abstract
Dietary sodium chloride intake is nowadays globally known as one of the major threats for cardiovascular health. However, there is also important evidence that it may influence idiopathic calcium nephrolithiasis onset and recurrence. Higher salt intake has been associated with hypercalciuria and hypocitraturia, which are major risk factors for calcium stone formation. Dietary salt restriction can be an effective means for secondary prevention of nephrolithiasis as well. Thus in this paper, we review the complex relationship between salt and nephrolithiasis, pointing out the difference between dietary sodium and salt intake and the best methods to assess them, highlighting the main findings of epidemiologic, laboratory and intervention studies and focusing on open issues such as the role of dietary salt in secondary causes of nephrolithiasis.
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Affiliation(s)
- Andrea Ticinesi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Loris Borghi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Tiziana Meschi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
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Kang HW, Lee SK, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim WJ. Hypertriglyceridemia and low high-density lipoprotein cholesterolemia are associated with increased hazard for urolithiasis. J Endourol 2014; 28:1001-5. [PMID: 24684546 DOI: 10.1089/end.2014.0135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To assess the association between dyslipidemia and urolithiasis, a propensity score-matching study was performed. PATIENTS AND METHODS Fasting blood samples were taken, and serum lipid profiles were measured in 655 stone formers (SF) and 1965 propensity score-matched controls between 2005 and 2011. The controls, from a health-screening program, did not have a history of dyslipidemia or statin use and have any evidence of stone disease, as determined by abdominal radiography, ultrasonography examination. Propensity score-matching with respect to age, sex, and body mass index was used to minimize selection bias, and the logistic regression analysis was adjusted for other components of metabolic syndrome. RESULTS Compared with controls, the SF group had significantly higher mean triglyceride and lower total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol levels (each P<0.001). The SF group was also more likely to have hypertriglyceridemia and low HDL-cholesterolemia, and less likely to have hypercholesterolemia and high LDL cholesterolemia compared with controls (each P<0.05). When adjusted for other components of metabolic syndrome including obesity, presence of diabetes mellitus or hypertension, the odds ratio (OR) for urinary stones appeared with hypercholesterolemia (OR=0.747, P=0.003), hypertriglyceridemia (OR=1.901, P<0.001), low HDL cholesterolemia (OR=1.886, P<0.001) and high LDL cholesterolemia (OR=0.610, P<0.001). CONCLUSIONS Our study implies that dyslipidemia may play a crucial part in urinary stone risk.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University , College of Medicine and Institute for Tumor Research, Cheongju, South Korea
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Abstract
The pathophysiology of the various forms of urinary stone disease remains a complex topic. Epidemiologic research and the study of urine and serum chemistries have created an abundance of data to help drive the formulation of pathophysiologic theories. This article addresses the associations of urinary stone disease with hypertension, cardiovascular disease, atherosclerosis, obesity, dyslipidemia, diabetes, and other disease states. Findings regarding the impact of dietary calcium and the formation of Randall's plaques are also explored and their implications discussed. Finally, further avenues of research are explored, including genetic analyses and the use of animal models of urinary stone disease.
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Affiliation(s)
- Herman Singh Bagga
- Department of Urology, University of California San Francisco, San Francisco, CA 94143-0738, USA.
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Kokorowski PJ, Routh JC, Hubert KC, Graham DA, Nelson CP. Association of urolithiasis with systemic conditions among pediatric patients at children's hospitals. J Urol 2012; 188:1618-22. [PMID: 22906655 PMCID: PMC4005878 DOI: 10.1016/j.juro.2012.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE Urolithiasis is associated with systemic medical conditions in adults but associations have not been well studied in children. We investigated the association of urolithiasis with diabetes mellitus, hypertension and obesity among children with and without urolithiasis. MATERIALS AND METHODS We performed a matched case-control study using the PHIS (Pediatric Health Information System) database. ICD-9 codes identified urolithiasis cases from 2004 to 2009. Four randomly selected controls were matched by age, hospital, patient care setting and year of treatment. Diagnoses from all hospital encounters were ascertained for comorbid conditions. Univariate and multivariable conditional logistic regression was used to assess the associations of urolithiasis with diabetes mellitus, hypertension and obesity. RESULTS We identified 9,843 urolithiasis cases and 39,047 controls. On univariate analysis stone formers had significantly higher odds of obesity (OR 1.44, 95% CI 1.27-1.64) and hypertension (OR 2.12, 95% CI 1.88-2.40) compared to controls. The odds of type I diabetes mellitus was lower among cases compared to controls (OR 0.38, 95% CI 0.30-0.48). After adjusting for gender, race, insurance type and number of visits using logistic regression, children with urolithiasis still had higher odds of obesity (AOR 1.30, 95% CI 1.12-1.51) and hypertension (AOR 1.61, 95% CI 1.40-1.86) as well as lower odds of type I diabetes mellitus (AOR 0.32, 95% CI 0.25-0.41) compared to controls. CONCLUSIONS Among pediatric patients at freestanding children's hospitals, urolithiasis is associated with higher odds of obesity and hypertension and lower odds of type I diabetes mellitus. These findings may be helpful in further elucidating the etiology of pediatric urolithiasis.
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Affiliation(s)
- Paul J Kokorowski
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Dai M, Zhao A, Liu A, You L, Wang P. Dietary factors and risk of kidney stone: a case-control study in southern China. J Ren Nutr 2012; 23:e21-8. [PMID: 22658934 DOI: 10.1053/j.jrn.2012.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 03/01/2012] [Accepted: 04/04/2012] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Formation of kidney stones is a multifactorial disease, and diet and lifestyle are suggested to contribute remarkably to increased prevalence. The population of Guangzhou, China has a high prevalence rate of kidney stones; however, its risk factors are still unknown. The aim of this study was to investigate the dietary risk factors for kidney stones in southern China. DESIGN A case-control study was carried out. SETTING This study was carried out at the Department of Health Management Center, Guangzhou Nanfang Hospital, China. SUBJECTS This study involved 1,019 newly diagnosed kidney stone patients and 987 healthy control subjects. INTERVENTION A questionnaire regarding dietary patterns and supplements was used to investigate the risk factors for kidney stone formation. MAIN OUTCOME MEASURE Food intake frequency, beverage and alcohol consumption, food supplements, and anthropometry were assessed. RESULTS In the analysis, we found positive associations of kidney stones with consumption of grains (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.08, 4.02) and bean products (OR = 3.50; 95% CI = 1.61, 7.59) in women. The variable "fluid drinking" showed a significant protective effect against kidney stones in men (OR = 0.57; 95% CI = 0.36, 0.88). Consuming leafy vegetables more than 3 times per day was positively associated with stones in both men and women (OR = 2.02; 95% CI = 1.04, 3.91 and OR = 3.86; 95% CI = 1.48, 10.04, respectively). Other dietary factors, dietary supplements, and specific food were not related to kidney stone formation in Guangzhou, China. CONCLUSION The results confirmed that specific diet can affect stone formation in the Chinese population, and varied risk factors were found for different genders.
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Affiliation(s)
- Meng Dai
- Department of Health Management, Nanfang Hospital, Guangzhou, Guangdong, People's Republic of China
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Abstract
PURPOSE OF REVIEW This review describes the relationship between nephrolithiasis, vascular disease and metabolic syndrome. RECENT FINDINGS There is increasing evidence that kidney stone formation is associated with a number of systemic problems including cardiovascular disease, metabolic syndrome and its components. Some of these associations are bidirectional. The reasons for these associations are not totally clear, but potential factors include metabolic responses associated with these disorders that promote a stone forming milieu in urine, environmental factors such as diet, oxidative stress and inflammation and molecular changes impacting the transport of certain analytes in urine. SUMMARY Urologists need to be cognizant of these associations as they may be able to contribute to an early diagnosis of a significant medical problem, or provide counseling to patients to prevent their occurrence.
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Zhao A, Dai M, Chen YJ, Chang HE, Liu AP, Wang PY. Risk factors associated with nephrolithiasis: a case-control study in China. Asia Pac J Public Health 2012; 27:NP414-24. [PMID: 22593218 DOI: 10.1177/1010539512445189] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nephrolithiasis is a multifactorial disease. The authors conducted a case-control study in China to explore its associated risk factors. A total of 725 nephrolithiasis patients and 553 controls were asked to complete a questionnaire that asked for information about psychological, behavioral, and dietary factors along with a physical and blood biochemical examination. For men, higher education was negatively associated with nephrolithiasis (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4-1.0), whereas hypso-waist-to-hip ratio (hypso-WHR), defined as WHRs >0.9 for men and >0.8 for women (OR = 2.2; 95% CI = 1.4-3.4); overexercise (OR = 2.1; 95% CI = 1.3-3.5); and having experienced negative life events (OR = 2.2; 95% CI = 1.2-4.1) were positively associated with nephrolithiasis. For women, higher fluid intake was negatively associated with nephrolithiasis (OR = 0.6; 95% CI = 0.3-0.9), and abnormal status of blood pressure (BP) and blood lipids was positively associated with nephrolithiasis. Varied factors were related to differences in nephrolithiasis occurrence between genders. Besides taking enough fluids, maintaining a normal metabolic status, avoiding overexercise, and reducing BP might be beneficial in preventing nephrolithiasis.
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Affiliation(s)
- Ai Zhao
- Peking University Health Science Center, Beijing, China
| | - Meng Dai
- Nanfang Hospital, Guangzhou, Guangdong, China
| | | | | | - Ai Ping Liu
- Peking University Health Science Center, Beijing, China
| | - Pei Yu Wang
- Peking University Health Science Center, Beijing, China
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A metabonomic study of biochemical changes characteristic of genetically hypertensive rats based on (1)H NMR spectroscopic urinalysis. Hypertens Res 2011; 35:404-12. [PMID: 22089538 DOI: 10.1038/hr.2011.182] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Spontaneously hypertensive rats (SHR) provide a simple model for studying essential hypertension. Their genetic and metabolic features are of great interest because they may provide insights into the pathophysiological processes underlying essential hypertension. We have thus investigated the metabolic characteristics of SHR at various ages, covering the prehypertensive stage and the developmental phase of hypertension, using a (1)H nuclear magnetic resonance (NMR)-based metabonomic approach. Twenty-four-hour urine samples from the SHR and their age-matched normotensive control, Wistar-Kyoto rats, were analyzed using (1)H NMR spectroscopy, and the spectral data were subjected to principal components analysis (PCA) to find metabolic differences between the two strains. Consequently, it was possible to separate the urine samples between the two strains at any age ranging from 4 to 20 weeks in the principal component scores plots. The major spectral regions and signals (metabolites) contributing to the separation were picked up based on the loadings. Subsequently, the urinary excreted levels of metabolites highlighted by the PCA were compared based on the signal intensities corrected by urine volume and body weight. These investigations revealed the major metabolic changes characteristic of the SHR, which included differences in citrate, α-ketoglutarate, succinate, hippurate, phenylacetylglycine, p-cresol glucuronide, creatine, taurine, medium-chain dicarboxylates (tentative), unknown (δ 3.11), and the regions at 3.60, 3.64, 3.68 and 3.88 p.p.m. The results supported the occurrence of metabolic acidosis in the SHR in the period of prehypertension as well as rapidly rising blood pressure. In addition, the intestinal microfloral populations in the SHR were suggested to be altered in the developmental phase of hypertension.
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Overweight, insulin resistance and blood pressure (parameters of the metabolic syndrome) in uric acid urolithiasis. ACTA ACUST UNITED AC 2011; 40:171-5. [PMID: 21866382 DOI: 10.1007/s00240-011-0403-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 07/08/2011] [Indexed: 01/28/2023]
Abstract
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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Kim YJ, Park MS, Kim WT, Yun SJ, Kim WJ, Lee SC. Hypertension Influences Recurrent Stone Formation in Nonobese Stone Formers. Urology 2011; 77:1059-63. [DOI: 10.1016/j.urology.2010.07.492] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/03/2010] [Accepted: 07/23/2010] [Indexed: 01/08/2023]
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Wiessner JH, Garrett MR, Roman RJ, Mandel NS. Dissecting the genetic basis of kidney tubule response to hyperoxaluria using chromosome substitution strains. Am J Physiol Renal Physiol 2009; 297:F301-6. [PMID: 19493966 DOI: 10.1152/ajprenal.00009.2009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Whether genetics may play a role in the pathophysiologic response of kidney tubules to oxalate exposure remains unexplored despite that as many as 15% of the U.S. population annually will experience a kidney stone composed of calcium oxalate. To explore this issue, we utilized a panel of chromosome substitution strains in which one chromosome at a time was transferred from the Brown Norway (BN) rat onto the Dahl salt-sensitive (SS) genetic background. Hyperoxaluria was induced by adding hydroxyproline (HP) to the drinking water. A dose-response (0-2% HP) study found that both SS and BN exhibited the same level of oxalate excretion as HP concentration increased, but only the BN exhibited changes in urothelial pathology and demonstrated crystal deposition at sites of urothelial injury as a function of dose (at 1.5-2.0%). The consomic panel was treated with 2.0% HP and evaluated for hyperoxaluria, renal injury, and crystal deposition. Tubular injury (% Area) and crystal deposition (% Area) were similar between the resistant SS and SS-4, -6, -7, -8, -9, -11, -16, and -20(BN) consomic rats. However, tubular injury was significantly increased in SS-2(BN) compared with the SS parental (9.8 +/- 1.56 and 4.2 +/- 1.09%, respectively). Crystal deposition was observed in SS-2(BN) and SS-18(BN) (4.7 +/- 0.70 and 3.5 +/- 1.3%, respectively) to the same extent as seen in the susceptible BN (3.2 +/- 0.44%). The fact that crystal deposition was observed in SS-18(BN) without extensive overall tubule injury, compared with the more severe widespread tubular injury seen in SS-2(BN), suggests that the underlying mechanism of each locus is different. In conclusion, these studies establish that BN rats demonstrate oxalate-associated pathology and they retain calcium oxalate crystals coincident with urothelial injury but SS rats do not. These observations establish that BN rat chromosome 2 and 18 harbor genes that contribute to these processes.
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Affiliation(s)
- John H Wiessner
- Kidney Disease Center, Medical College of Wisconsin and Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin 53295, USA
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Losito A. Reply. Nephrol Dial Transplant 2009. [DOI: 10.1093/ndt/gfp089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Afsar B, Yilmaz M, Eyileten T. Do patients with uric acid stones exhibit abnormal circadian blood pressure--a hypothesis. Nephrol Dial Transplant 2009; 24:2004; author reply 2004-5. [PMID: 19286692 DOI: 10.1093/ndt/gfp082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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