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.
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.
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.
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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Metabolic Syndrome Severity Score
International diabetes federation
American Heart Association/National Heart, Lung, and Blood Institute
Body mass index
Supersaturation calcium phosphate
24-Hour urinary calcium
24-Hour urinary oxalate
24-Hour urinary citrate
Supersaturation calcium oxalate
Supersaturation uric acid
24-Hour urinary uric acid
24-Hour urinary sodium
24-Hour urinary ammonium
American Urologic Association
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All authors report no funding, financial or non-financial interests to disclose.
Conflict of interest
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
- Metabolic syndrome
- 24-Hour urinalysis
- Diabetes mellitus