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



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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Fig. 1



Metabolic Syndrome Severity Score


Metabolic syndrome


Diabetes mellitus








International diabetes federation


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


Body mass index


Glycated hemoglobin


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


Calcium oxalate


Uric acid


Odds ratio


American Urologic Association


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

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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.

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Correspondence to Jacob N. Bamberger.

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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).

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