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The impact of metabolic syndrome components on urinary parameters and risk of stone formation

Abstract

Purpose

To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components.

Methods

Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study. Patients were given a six point (0–5) Metabolic Syndrome Severity Score (MSSS) based on the number of co-occurring MS components and split into six respective groups. Baseline clinical characteristics and metabolic profiles were compared between groups.

Results

Four-hundred-ninety-five patients were included in the study. Median age and median BMI was 58 years and 27.26 kg/m2, respectively. Several significant metabolic differences were noted, most notably a downward trend in median urinary pH (p < 0.001) and an upward trend in median urinary supersaturation uric acid (p < 0.001) across groups as MSSS increased. Multivariate analysis demonstrated an independent association between higher MSSS and increasing number of urinary abnormalities. A second multivariate analysis revealed that all MS components except hyperlipidemia were independently associated with low urinary pH. Additionally, obesity was independently associated with the greatest number of urinary abnormalities and had the strongest association with hyperuricosuria.

Conclusions

Prior research has attributed the strong association of nephrolithiasis and MS to high prevalence of UA nephrolithiasis and low urinary pH. Our findings indicate that all MS components with the exception of hyperlipidemia were independently associated with low urinary pH suggesting a mechanism independent from insulin resistance.

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Fig. 1

Abbreviations

MSSS:

Metabolic Syndrome Severity Score

MS:

Metabolic syndrome

DM:

Diabetes mellitus

HLD:

Hyperlipidemia

HTN:

Hypertension

HTG:

Hypertriglyceridemia

IDF:

International diabetes federation

AHA/NHLBI:

American Heart Association/National Heart, Lung, and Blood Institute

BMI:

Body mass index

HbA1c:

Glycated hemoglobin

SSCaP:

Supersaturation calcium phosphate

Ca24:

24-Hour urinary calcium

Ox24:

24-Hour urinary oxalate

Cit24:

24-Hour urinary citrate

SSCaOx:

Supersaturation calcium oxalate

SSUA:

Supersaturation uric acid

UA24:

24-Hour urinary uric acid

Na24:

24-Hour urinary sodium

NH424:

24-Hour urinary ammonium

CaOx:

Calcium oxalate

UA:

Uric acid

OR:

Odds ratio

AUA:

American Urologic Association

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Funding

All authors report no funding, financial or non-financial interests to disclose.

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Affiliations

Authors

Contributions

BJN protocol/project development; data collection or management; data analysis; manuscript writing/editing, RDC protocol/project development; data collection or management; manuscript writing/editing, KJA protocol/project development; manuscript writing/editing, K-ME protocol/project development; data collection or management; data analysis; manuscript writing/editing, GB protocol/project development; data collection or management; manuscript writing/editing, KA protocol/project development; data collection or management; manuscript writing/editing, PI protocol/project development; data collection or management; data analysis; manuscript writing/editing, ADJ data collection or management; manuscript writing/editing, AWM manuscript writing/editing, GM manuscript writing/editing.

Corresponding author

Correspondence to Jacob N. Bamberger.

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Conflict of interest

None.

Ethical approval

The study was approved by the Institutional Review Board and necessary informed consent was collected from all participants.

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Bamberger, J.N., Rosen, D.C., Khusid, J.A. et al. The impact of metabolic syndrome components on urinary parameters and risk of stone formation. World J Urol (2021). https://doi.org/10.1007/s00345-021-03790-7

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Keywords

  • Nephrolithiasis
  • Metabolic syndrome
  • 24-Hour urinalysis
  • Diabetes mellitus