1
|
Cheng Y, Zheng H, Yin H, Yin D, Wang H, Wang Y, Tang Q, Gu S. Changes in metabolic overweight phenotypes over time and risk of nephrolithiasis: a cohort study. BMC Public Health 2024; 24:1898. [PMID: 39014388 PMCID: PMC11251252 DOI: 10.1186/s12889-024-19229-8] [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: 11/21/2023] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Overweight/obesity is considered an independent risk factor for nephrolithiasis, but little is known about its effect on nephrolithiasis according to metabolic health status. OBJECTIVES We aimed to investigate the association between various metabolic overweight phenotypes and the occurrence of nephrolithiasis. It also explores whether changes in these phenotypes over time influence the risk of nephrolithiasis. MATERIALS AND METHODS A total of 10,315 participants free of nephrolithiasis who underwent an annual health checkup from 2017 to 2022 were included in our prospective cohort study. They were categorized into four groups according to the presence of overweight and metabolic abnormalities (MA). The primary endpoint was the occurrence of renal stones. Multivariable Cox analysis was conducted to elucidate the relationship between metabolic overweight phenotypes and incident nephrolithiasis. RESULTS During a median follow-up duration of 4.02 years, nephrolithiasis occurred in 1,468 (14.23%) participants. In the full cohort, we observed that the 5-year cumulative incidences of nephrolithiasis were highest in the metabolically healthy overweight (MHO) and metabolically abnormal overweight (MAO) groups. The hazard ratios (HRs) for nephrolithiasis, relative to metabolically healthy normal weight (MHNW), ranged from 1.19 (95% CI:1.03-1.37; MHO) to 1.32 (95% CI:1.15-1.51; MAO). Furthermore, individuals with persistent MHO throughout follow-up were at a 1.42-fold increased risk of nephrolithiasis (P < 0.001), and 32.17% of individuals experienced changes in phenotype during follow-up. Among MAO subjects, those who transitioned to MHO and MHNW had a 26% and 45% lower risk of incident nephrolithiasis, respectively, compared to those who persisted in the MAO phenotype. CONCLUSION Individuals in the MHO and MAO groups exhibit an elevated risk of incident nephrolithiasis in this prospective cohort study. A significant proportion of nephrolithiasis cases may be potentially preventable through the appropriate management of metabolic risk factors for MAO subjects.
Collapse
Affiliation(s)
- Yang Cheng
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China
| | - Hui Zheng
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China
| | - Hongli Yin
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China
| | - Donghua Yin
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China
| | - Hui Wang
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China
| | - Ying Wang
- Center for Health Management, Jiangsu Province Geriatric Hospital, 2 Yi-He Road, Nanjing, 210009, China.
| | - Qiang Tang
- School of Sports and Health, Nanjing Sport Institute, 8 Ling-Gu Temple Road, Nanjing, 210014, China.
- Jiangsu Collaborative Innovation Center for Sport and Health Project, Nanjing, China.
| | - Shouyong Gu
- Institute of Geriatric Medicine, Jiangsu Province Geriatric Hospital, 65 Jiang-Su Road, Nanjing, 210009, China.
| |
Collapse
|
2
|
Ye Z, Wu C, Xiong Y, Zhang F, Luo J, Xu L, Wang J, Bai Y. Obesity, metabolic dysfunction, and risk of kidney stone disease: a national cross-sectional study. Aging Male 2023; 26:2195932. [PMID: 37038659 DOI: 10.1080/13685538.2023.2195932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association between different metabolic syndrome-body mass index (MetS-BMI) phenotypes and the risk of kidney stones. MATERIALS AND METHODS Participants aged 20-80 years from six consecutive cycles of the NHANES 2007-2018 were included in this study. According to their MetS status and BMI, the included participants were allocated into six mutually exclusive groups: metabolically healthy normal weight (MHN)/overweight (MHOW)/obesity (MHO) and metabolically unhealthy normal weight (MUN)/overweight (MUOW)/obesity (MUO). To explore the association between MetS-BMI phenotypes and the risk of kidney stones, binary logistic regression was used to determine the odds ratios (ORs). RESULTS A total of 13,589 participants were included. It was revealed that all the phenotypes with obesity displayed higher risks of kidney stones (OR = 1.38, p < 0.01 for MHO & OR = 1.80, p < 0.001 for MUO, in the fully adjusted model). The risk increased significantly when metabolic dysfunction coexisted with overweight and obesity (OR = 1.39, p < 0.05 for MUOW & OR = 1.80, p < 0.001 for MUO, in the fully adjusted model). Of note, the ORs for the MUO and MUOW groups were higher than those for the MHO and MHOW groups, respectively. CONCLUSIONS Obesity and unhealthy metabolic status can jointly increase the risk of kidney stones. Assessing the metabolic status of all individuals may be beneficial for preventing kidney stones.
Collapse
Affiliation(s)
- Zhenyang Ye
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Changjing Wu
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Fuxun Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jinyang Luo
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lijing Xu
- Department of Urology, West China Xiamen Hospital of Sichuan University, Xiamen, P.R. China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jia Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yunjin Bai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China
| |
Collapse
|
3
|
Arnous MG, Vaughan L, Mehta RA, Schulte PJ, Lieske JC, Milliner DS. Characterization of Stone Events in Patients With Type 3 Primary Hyperoxaluria. J Urol 2023; 209:1141-1150. [PMID: 36888927 PMCID: PMC11034812 DOI: 10.1097/ju.0000000000003400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Hallmarks of primary hyperoxaluria type 3 are nephrolithiasis and hyperoxaluria. However, little is known about factors influencing stone formation in this disease. We characterized stone events and examined associations with urine parameters and kidney function in a primary hyperoxaluria type 3 population. MATERIALS AND METHODS We retrospectively analyzed clinical, and laboratory data of 70 primary hyperoxaluria type 3 patients enrolled in the Rare Kidney Stone Consortium Primary Hyperoxaluria Registry. RESULTS Kidney stones occurred in 65/70 primary hyperoxaluria type 3 patients (93%). Among the 49 patients with imaging available, the median (IQR) number of stones was 4 (2, 5), with largest stone 7 mm (4, 10) at first imaging. Clinical stone events occurred in 62/70 (89%) with median number of events per patient 3 (2, 6; range 1-49). Age at first stone event was 3 years (0.99, 8.7). Lifetime stone event rate was 0.19 events/year (0.12, 0.38) during follow-up of 10.7 (4.2, 26.3) years. Among 326 total clinical stone events, 139 (42.6%) required surgical intervention. High stone event rates persisted for most patients through the sixth decade of life. Analysis was available for 55 stones: pure calcium oxalate accounted for 69%, with mixed calcium oxalate and phosphate in 22%. Higher calcium oxalate supersaturation was associated with increased lifetime stone event rate after adjusting for age at first event (IRR [95%CI] 1.23 [1.16, 1.32]; P < .001). By the fourth decade, estimated glomerular filtration rate was lower in primary hyperoxaluria type 3 patients than the general population. CONCLUSIONS Stones impose a lifelong burden on primary hyperoxaluria type 3 patients. Reducing urinary calcium oxalate supersaturation may reduce event frequency and surgical intervention.
Collapse
Affiliation(s)
- Muhammad G. Arnous
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Ramila A. Mehta
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Phillip J. Schulte
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn S. Milliner
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pediatric Nephrology, Mayo Clinic, Rochester, MN USA
| |
Collapse
|
4
|
Atorvastatin Decreases Renal Calcium Oxalate Stone Deposits by Enhancing Renal Osteopontin Expression in Hyperoxaluric Stone-Forming Rats Fed a High-Fat Diet. Int J Mol Sci 2022; 23:ijms23063048. [PMID: 35328466 PMCID: PMC8954580 DOI: 10.3390/ijms23063048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/13/2022] Open
Abstract
Calcium oxalate (CaOx) is the major constituent of kidney stones. Growing evidence shows a close connection between hyperlipidemia, cardiovascular disease (CVD), and the formation of kidney stones. Owing to their antioxidant properties, statins control hyperlipidemia and may ameliorate CaOx stone formation. The present study was designed to investigate the suppressive effects of statins on CaOx urolithiasis and their potential mechanism. We used rats fed a high-fat diet (HFD) to achieve hyperlipidemia (HL) and hydroxyproline (HP) water to establish a hyperoxaluric CaOx nephrolithiasis model; the animals were administered statins (A) for 28 days. The rats were divided into eight groups treated or not with A, i.e., Control, HP, HL, HL + HP. HL aggravated urinary calcium crystallization compared to the control. Due to increased expression of renal osteopontin (OPN), a key anti-lithic protein, and reduced free radical production, the calcium crystals in the urinary bladder increased as renal calcium deposition decreased. The levels of the ion activity product of CaOx (AP(CaOx)) decreased after statins administration, and AP(Calcium phosphate) (CaP) increased, which suggested the dominant calcium crystal composition changed from CaOx to CaP after statin administration. In conclusion, atorvastatin decreases renal CaOx stone deposits by restoring OPN expression in hyperoxaluric rats fed a HFD.
Collapse
|
5
|
Pak YG, Yagudaev DM, Gallyamov EA. THE FUNCTIONAL STATE OF THE RENAL PARENCHYMA AFTER VARIOUS VIDEO ENDOSURGICAL METHODS OF TREATMENT OF PATIENTS WITH LARGE AND COMPLEX KIDNEY STONES. SURGICAL PRACTICE 2021. [DOI: 10.38181/2223-2427-2021-3-5-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The work is based on the analysis of literature data devoted to the problem of preserving the functional state of the kidneys with various video endoscopic methods of surgical treatment of large and complex kidney stones. The purpose of the review is to highlight the likelihood of deterioration in the functional state of the kidneys in the postoperative period. A detailed analysis of postoperative outcomes in various minimally invasive methods of treatment of patients with large and complex kidney stones was carried out, with an overview of the possibility of using dynamic nephroscintigraphy as a method of objectively assessing the functional state of the kidneys.
Collapse
Affiliation(s)
- Yu. G. Pak
- CUC «City multidisciplinary hospital No. 2»
| | | | - E. A. Gallyamov
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian
Federation
| |
Collapse
|
6
|
Faridi MS, Singh KS. Preliminary study of prevalence of urolithiasis in North-Eastern city of India. J Family Med Prim Care 2020; 9:5939-5943. [PMID: 33681023 PMCID: PMC7928100 DOI: 10.4103/jfmpc.jfmpc_1522_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Urinary tract stone is one of the major urological problems globally and has changed significantly in the last few decades. The epidemiology differs according to geography, socioeconomic status, and diet. The primary care physicians are initially consulted rather than urologists because of increase in the prevalence of urolithiasis and saturation of health facilities. Objectives: To study the prevalence of urolithiasis in the urology department of a tertiary care centre, Manipur, India. Methods: A total 621 patients of urolithiasis were studied. After history and physical examination of each patient, urolithiasis was confirmed by X-ray Kidney Ureter Bladder (KUB) or Ultrasound (USG) KUB. Results: The male to female ratio was 1.01:1. 30.8% patients came from Imphal West district. 63.1% of studied population had single stone and commonly seen in the 31–40 years of age, whereas multiple stones (n = 59) were found most commonly in the 41–50 years of age group. The difference of number of stones according to age group was statistically significant (P = 0.000). The most common location of stones was in kidneys (67.4%) and stones in urethra were the least common (P = 0.000). Conclusion: In this preliminary study, we report the prevalence of urolithiasis in Manipur, India. The better understanding of the epidemiology of urolithiasis is important to plan the effective treatment and prevention strategies in general practice. There is a shift in gender distribution of urolithiasis. Aging demographics, number of stones, obesity; all were associated with increased prevalence of urolithiasis.
Collapse
Affiliation(s)
- Mohammad Shazib Faridi
- Department of Urology & Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, Connaught Place, New Delhi, India
| | | |
Collapse
|
7
|
Taguchi K, Chen L, Usawachintachit M, Hamamoto S, Kang M, Sugino T, Unno R, Tzou DT, Sherer BA, Okada A, Yasui T, Ho SP, Stoller ML, Chi T. Fatty acid-binding protein 4 downregulation drives calcification in the development of kidney stone disease. Kidney Int 2020; 97:1042-1056. [PMID: 32247632 DOI: 10.1016/j.kint.2020.01.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Abstract
Nephrolithiasis is a significant source of morbidity, and its incidence has increased significantly over the last decades. This rise has been attributed to concurrent increasing rates of obesity, associated with a 3-time risk of developing NL. To date, the mechanism by which obesity is linked to stone formation has not been elucidated. We aimed to utilize a transcriptomics approach to discover the missing link between these two epidemic diseases. We investigated gene expression profiling of nephrolithiasis patients by two RNA-sequencing approaches: comparison between renal papilla tissue with and without the presence of calcified Randall's plaques (RP), and comparison between the papilla, medulla, and cortex regions from within a single recurrent stone forming kidney. Results were overlaid between differently expressed genes found in the patient cohort and in the severely lithogenic kidney to identify common genes. Overlay of these two RNA-sequencing datasets demonstrated there is impairment of lipid metabolism in renal papilla tissue containing RP linked to downregulation of fatty acid binding protein (FABP) 4. Immunohistochemistry of human kidney specimens and microarray analysis of renal tissue from a nephrolithiasis mouse model confirmed that FABP4 downregulation is associated with renal stone formation. In a FABP4 knockout mouse model, FABP4 deficiency resulted in development of both renal and urinary crystals. Our study revealed that FABP4 plays an important, previously unrecognized role in kidney stone formation, providing a feasible mechanism to explain the link between nephrolithiasis and metabolic syndrome.
Collapse
Affiliation(s)
- Kazumi Taguchi
- Department of Urology, University of California, San Francisco, California, USA; Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ling Chen
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Manint Usawachintachit
- Department of Urology, University of California, San Francisco, California, USA; Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Misun Kang
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - David T Tzou
- Department of Urology, University of California, San Francisco, California, USA
| | - Benjamin A Sherer
- Department of Urology, University of California, San Francisco, California, USA
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sunita P Ho
- Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, California, USA
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, California, USA.
| |
Collapse
|
8
|
Vitamin D and calcium kidney stones: a review and a proposal. Int Urol Nephrol 2018; 51:101-111. [DOI: 10.1007/s11255-018-1965-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022]
|
9
|
Metabolically healthy and unhealthy obesity phenotypes and risk of renal stone: a cohort study. Int J Obes (Lond) 2018; 43:852-861. [PMID: 30006578 DOI: 10.1038/s41366-018-0140-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 02/04/2023]
|
10
|
Acetazolamide-Induced Nephrolithiasis in Idiopathic Intracranial Hypertension Patients. J Neuroophthalmol 2016; 36:126-30. [DOI: 10.1097/wno.0000000000000330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Differential Roles of Peroxisome Proliferator-Activated Receptor-α and Receptor-γ on Renal Crystal Formation in Hyperoxaluric Rodents. PPAR Res 2016; 2016:9605890. [PMID: 27022389 PMCID: PMC4789040 DOI: 10.1155/2016/9605890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
Peroxisome proliferator-activated receptors (PPARs) and related inflammatory and oxidative molecule expression were investigated in a hyperoxaluric rodent model to evaluate the in vivo efficacy of PPAR agonists in preventing renal crystal formation. PPAR expression was examined in a mouse hyperoxaluria kidney stone model induced by daily intra-abdominal glyoxylate injection. Therapeutic effects of the PPARα agonist fenofibrate and PPARγ agonist pioglitazone were also assessed in a 1% ethylene glycol-induced rat model of hyperoxaluria. Crystal formation, inflammation, cell injury, apoptosis, and oxidative stress were compared to those of vehicle-treated controls. Quantitative reverse transcription-polymerase chain reaction revealed that PPARα and PPARγ expression decrease and increase, respectively, during crystal formation in hyperoxaluric kidneys. In addition, PPARα localized to the cytoplasm of both proximal and distal tubular cells, whereas PPARγ accumulated in the nucleus of proximal tubular cells. Furthermore, renal crystal formation was significantly less prevalent in pioglitazone-treated rats but higher in the fenofibrate-treated and fenofibrate/pioglitazone-cotreated groups compared to controls, thus indicating that pioglitazone, but not fenofibrate, markedly decreased cell inflammation, oxidative stress, and apoptosis. Collectively, the results demonstrated that PPARγ suppressed renal crystal formation via its antioxidative and anti-inflammatory effects; however, the renotoxicity of PPARα may elicit the opposite effect.
Collapse
|
12
|
Sigurjonsdottir VK, Runolfsdottir HL, Indridason OS, Palsson R, Edvardsson VO. Impact of nephrolithiasis on kidney function. BMC Nephrol 2015; 16:149. [PMID: 26316205 PMCID: PMC4551564 DOI: 10.1186/s12882-015-0126-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background Kidney stone disease has been associated with reduced kidney function and chronic kidney disease (CKD). The objective of the study was to examine kidney function, body mass index (BMI) and the prevalence of cardiovascular disease, hypertension and diabetes in recurrent kidney stone formers. Methods A cross-sectional, case-control study comparing measures of kidney function, BMI and comorbid conditions was conducted in 195 kidney stone patients aged 18 to 70 years with recurrent clinical stone events and 390 age- and gender-matched controls. Wilcoxon-Mann-Whitney, chi-square tests and analysis of covariance were used to compare serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) between the groups. Results The median age of stone formers was 51 (range, 19–70) years and 108 (55 %) were males. Seventy patients (36 %) had experienced 2–4 clinical stone events, 41 (21 %) 5–10 episodes and 84 (43 %) more than 10. The median SCr was 75 (41–140) μmol/L in the stone formers and 64 (34–168) μmol/L in the control group (p < 0.001). The mean eGFR was 87 ± 20 and 104 ± 22 mL/min/1.73 m2 in the stone formers and controls, respectively (p < 0.001). After adjustment for body size and comorbid conditions, the difference in SCr and eGFR between cases and controls remained highly significant (p < 0.001). The prevalence of CKD was 9.3 % among stone formers compared with 1.3 % in the control group (P < 0.001). Hypertension and diabetes were significantly more prevalent among the cases that also had higher BMI than controls. Conclusions Recurrent kidney stone formers have a significantly lower level of kidney function and a markedly higher prevalence of CKD than age- and gender-matched control subjects. The observed deleterious effect of kidney stones on kidney function appears to be independent of comorbid conditions.
Collapse
Affiliation(s)
- Vaka K Sigurjonsdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Children's Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | | | - Olafur S Indridason
- Division of Nephrology, Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Runolfur Palsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Division of Nephrology, Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Vidar O Edvardsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Children's Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| |
Collapse
|
13
|
Proinflammatory and Metabolic Changes Facilitate Renal Crystal Deposition in an Obese Mouse Model of Metabolic Syndrome. J Urol 2015; 194:1787-96. [PMID: 26192255 DOI: 10.1016/j.juro.2015.07.083] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE To clarify metabolic syndrome induced stone formation mechanisms we investigated the metabolic and immunohistochemical characteristics associated with renal crystal deposition using a model of mice with metabolic syndrome administered a high fat diet and ethylene glycol. MATERIALS AND METHODS Ob/Ob mice with Leptin gene deficiencies and metabolic syndrome related characteristics were compared with wild heterozygous lean mice. Four study groups were fed standard food and water (control group), a high fat diet and normal water (high fat diet group), 1% ethylene glycol and standard food (ethylene glycol group) or a high fat diet and 1% ethylene glycol (high fat diet plus ethylene glycol group). Blood, urine and kidney samples were taken after 14 days. RESULTS Ob/Ob mice in the high fat diet plus ethylene glycol group showed diffuse renal crystal depositions. Lean and Ob/Ob mice in the high fat diet plus ethylene glycol group showed significant excretion of urinary calcium oxalate crystals. Ob/Ob mice had significant hypercalciuria, hyperphosphaturia and hyperlipidemia, massive lipid fragments in tubular lumina and fat droplets in renal tubular cells. Ob/Ob mice in the high fat diet plus ethylene glycol group had markedly increased expression of osteopontin, monocyte chemoattractant protein-1, interleukin-6 and tumor necrosis factor-α. In Ob/Ob mice the number of proinflammatory macrophages was considerably elevated. CONCLUSIONS We induced renal crystal deposition in mice with metabolic syndrome using a high fat diet and ethylene glycol. Increases in luminal mineral and lipid density, and proinflammatory adipocytokines and macrophages facilitated renal crystal formation in mice with metabolic syndrome.
Collapse
|
14
|
Wang K, Zhang P, Xu X, Fan M. Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis. Urol Int 2015; 95:15-25. [DOI: 10.1159/000369216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
Objective: To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. Results: Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. Conclusion: Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.
Collapse
|