Main Article Content
Urolithiasis, metabolic syndrome, diabetes, stone recurrence, stone formation, complications
Urolithiasis is a common urological problem in the United Kingdom. 6% of the adult population were diag-nosed with diabetes in England in 2013. Researchers suggest the association of diabetes with stone forma-tion, recurrence, and morbidity. This study aimed to compare the prevalence of risk factors like metabolic syndrome, urinary tract infections, age, gender and ethnicity among diabetics versus non-diabetics and to determine how diabetes affects the biochemical and surgical outcomes of urolithiasis.
There were182 patients treated surgically for urolithiasis between January 2010 and December 2012 were retrospectively analyzed. Information was cross-referenced with electronic notes to produce biochemical and surgical data.
A total of 31 (17%) patients had type 2 diabetes. The mean age of diabetics was significantly higher than non-diabetics by nearly 12 years (p-value < 0.001). Hypertension, hyperlipidaemia, obesity and UTIs were more prevalent among diabetics (p-value < 0.001, < 0.001, 0.01, 0.009 respectively). Diabetics had signifi-cantly bigger mean stones size (p-value=0.008) and are at higher risk of stone recurrence at 1 year (p-value =0.04) than non-diabetics. Stone recurrence was not significant at 3 and 5 years between the two groups. Diabetics significantly had higher urinary oxalate, and nearly statistically significant lower phosphate levels (p-value=0.007, 0.076 respectively).
Diabetics were significantly older and associated with metabolic syndrome. UTIs were more prevalent among diabetics which put them at risk of postoperative complications. Diabetics are at higher risk of stone recurrence at 1 year compare to non-diabetics. Biochemical urinary findings are important as they can guide the management of recurrent stone formers.
2. Prezioso D, Illiano E, Piccinocchi G, Cricelli C, Pic-cinocchi R, Saita A, et al. Urolithiasis in Italy: An epidemiological study. Arch Ital di Urol e Androl 2014;86(2):99–102.
3. Scales CD, Smith AC, Hanley JM, Saigal CS. Preva-lence of kidney stones in the United States. Eur Urol 2012;62(1):160–5.
4. Seklehner S, Laudano M a, Chughtai B, Jamzadeh A, Del Pizzo JJ, Engelhardt PF, et al. Trends in the utilization of percutaneous and open nephrolithotomy in the treatment of renal calculi. J Endourol [Internet] 2013;27(8):984–8. Available from: http://www.ncbi .nlm.nih.gov/pubmed/23590666
5. Heers H, Turney BW. Trends in urological stone disease: a 5-year update of hospital episode statistics. BJU Int 2016;118(5):785–9.
6. Meydan N, Barutca S, Caliskan S, Camsari T, Mey-dan N, Barutca S, et al. Urin Stone Dis Diabet Mel 2016;5599(August).
7. Li H, Klett DE, Littleton R, Elder JS, Sammon JD. Role of insulin resistance in uric acid nephrolithiasis. World J Nephrol 2014;3(4):237–42.
8. Cupisti A, Meola M, D’Alessandro C, Bernabini G, Pasquali E, Carpi A, et al. Insulin resistance and low urinary citrate excretion in calcium stone formers. Biomed Pharmacother 2007;61(1):86–90.
9. Coe FL, Strauss AL, Tembe V, Le Dun S. Uric acid saturation in calcium nephrolithiasis. Kidney Int [Internet] 1980;17(5):662–8. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/7401461
10. Diabetes UK. Diabetes-key-stats-guidelines-April2014-1. Diabetes UK [Internet] 2014;(3):1–21. Available from: http://scholar.google.com/scholar?hl=en&btnG=Searc h&q=intitle:DIABETES+:+FACTS+AND+STATS#5
11. Health and Social Care Information Centre. Quality and Outcomes Framework – Prevalence, Achieve-ments and Exceptions Report QOF Data Quality Statement and Frequently Asked Questions. 2014-15. 2015;(October).
12. Mary E. Adult Obesity and Type 2 Diabetes About Public Health England. Public Heal Engl 2014;1–39.
13. Holman N, Forouhi NG, Goyder E, Wild SH. The Association of Public Health Observatories (APHO) Diabetes Prevalence Model: Estimates of total diabe-
tes prevalence for England, 2010-2030. Diabet Med
14. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS,
Flegal KM, Engelgau MM, et al. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999-2002. Diabetes Care 2006; 29(6):1263–8.
15. Amato M, Lusini ML, Nelli F. Epidemiology of neph-rolithiasis today. In: Urologia Internationalis 2004; 1–5.
16. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P. Study on the Prevalence and Incidence of Urolithi-asis in Germany Comparing the Years 1979 vs. 2000. Eur Urol 2003;44(6):709–13.
17. Akinci M, Esen T, Tellaloglu S. Urinary stone disease in Turkey: an updated epidemiological study. Eur Urol 1991;20(3):200–3.
18. Stamatiou KN, Karanasiou VI, Lacroix RE, Kavouras NG, Papadimitriou VT, Chlopsios C, et al. Prevalence of urolithiasis in rural Thebes, Greece. Rural Remote Health 2006;6(4):610.
19. Safarinejad MR. Adult urolithiasis in a population-based study in Iran: Prevalence, incidence, and associated risk factors. Urol Res 2007;35(2):73–82.
20. Diabetes UK. Facts and Stats [Internet]. https://www .diabetes.org.uk/About_us/What-we-say/Statistics/ (Accessed: 13/07/2016). 2015. Available from: https://www.diabetes.org.uk/About_us/What-we-say/ Statistics/
21. Riste L, Khan F, Cruickshank K. High prevalence of type 2 diabetes in all ethnic groups, including europeans, in a British inner city: Relative poverty, history, inactivity, or 21st century Europe? Diabetes Care 2001;24(8):1377–83.
22. Prevalence and risk Care processes Structured educa-tion Treatment targets.
23. Stamatelou K, Francis M, Jones C, Nyberg L, Curhan G. Time trends in reported prevalence of kidney ston . . . [Kidney Int. 2003] - PubMed - NCBI. Kidney Int [Internet] 2003;63:1817–23. Available from: http:// www.ncbi.nlm.nih.gov/pubmed?term=time trend in reported prevalence of kidney stones in US
24. Shafiee M. Urinary Composition and Stone Formation. Univ Toronto. 2010;23(85–88):165–9.
25. Siener R, Glatz S, Nicolay C, Hesse A. The role of overweight and obesity in calcium oxalate stone formation. Obes Res [Internet] 2004;12(1):106–13. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/14742848%5Cnhttp://onlinelibrary.wiley .com/store/10.1038/oby.2004.14/asset/oby.2004.14 .pdf?v=1&t=ils0mmfg&s=35747f86e3015a1cbb7a0 c3ff28e5285bf2a76be
26. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA [Internet] 2005;293(4):455–62. Available from: http://www.ncbi .nlm.nih.gov/pubmed/15671430
27. Borghi L, Meschi T, Guerra A, Briganti A, Schianchi T, Allegri F, et al. Essential arterial hypertension and stone disease. Kidney Int 1999;55(6):2397–406.
28. Inci M, Demirtas A, Sarli B, Akinsal E, Baydilli N. Association between body mass index, lipid pro-files, and types of urinary stones. Ren Fail [Internet] 2012;34(July):1140–3. Available from: http://www .ncbi.nlm.nih.gov/pubmed/22889148
29. Tran TY, Flynn M, O’Bell J, Pareek G. Calculated insulin resistance correlates with stone-forming urinary metabolic changes and greater stone burden in high-risk stone patients. Clin Nephrol [Internet] 2016; Available from: http://www.ncbi.nlm.nih.gov/ pubmed/27125629
30. Koye DN, Shaw JE, Reid CM, Atkins RC, Reutens AT, Magliano DJ. Incidence of chronic kidney disease among people with diabetes: a systematic review of observational studies. Diabet Med [Internet] 2017;1–15. Available from: http://doi.wiley.com/10.1111/dme.13324
31. Adler a I, Stevens RJ, Manley SE, Bilous RW, Cull C a, Holman RR, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003;63:225–32.
32. Worcester EM, Parks JH, Evan AP, Coe FL. Renal func-tion in patients with nephrolithiasis. J Urol [Internet] 2006;176(August):600–3; discussion 603. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16813897
33. Vupputuri S, Soucie JM, McClellan W, Sandler DP. History of kidney stones as a possible risk factor for chronic kidney disease. Ann Epidemiol 2004;222–8.
34. Gambaro G, Favaro S, D’Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001;37(1523–6838 (Electronic)):233–43.
35. Gambaro G, Favaro S, D’Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis [Internet] 2001;37(2):233–43. Available from: http://www.ncbi .nlm.nih.gov/pubmed/11157364
36. Hirji I, Guo Z, Andersson SW, Hammar N, Gomez-Caminero A. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). JDiabetes Complicat 2012;26(1873–460X (Electronic)):513–6.
37. Meydan N, Barutca S, Caliskan S, Camsari T. Urinary stone disease in diabetes mellitus. Scand J Urol Nephrol 2003;37(1):64–70.
38. Wei W, Leng J, Shao H, Wang W. Diabetes, a risk factor for both infectious and major complications after percutaneous nephrolithotomy. Int J Clin Exp Med 2015;8(9):16620–6.
39. Lojanapiwat B. Infective complication following percutaneous nephrolithotomy. Urol Sci [Internet] 2016;27(1):8–12. Available from: http://dx.doi .org/10.1016/j.urols.2015.04.007
40. Mitsuzuka K, Nakano O, Takahashi N, Satoh M. Identification of factors associated with postopera-tive febrile urinary tract infection after ureteroscopy for urinary stones. Urolithiasis 2015;44(3):257–62.
41. Ronald A, Ludwig E. Urinary tract infections in adults with diabetes. In: Int J Antimicrob Agents 2001;287–92.
42. Nalbant I, Ozturk U, Sener NC, Dede O, Bayraktar AM, Imamoglu MA. The comparison of standard and tubeless percutaneous nephrolithotomy procedures.
Int Braz J Urol. 2012;38(6):795–800.
43. Gutierrez J, Smith A, Geavlete P, Shah H, Kural AR, de
Sio M, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 2013;31(5):1135–40.
44. Nakamon T, Kitirattrakarn P, Lojanapiwat B. Out-comes of percutaneous nephrolithotomy: Compari-son of elderly and younger patients. Int Braz J Urol 2013;39(5):692–701.
45. Pak CYC, Sakhaee K, Moe O, Preminger GM, Poin-dexter JR, Peterson RD, et al. Biochemical profile of stone-forming patients with diabetes mellitus. Urology 2003;61(3):523–7.
46. Viers BR, Lieske JC, Vrtiska TJ, Herrera Hernandez LP, Vaughan LE, Mehta RA, et al. Endoscopic and His-tologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers. Urology 2015;85(4):771–6.
47. Hartman C, Friedlander JI, Moreira DM, Elsamra SE, Smith AD, Okeke Z. Differences in 24-hour urine composition between stone patients with and without diabetes mellitus. BJU Int [Internet] 2014;1–15. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24823472
48. Kadlec AO, Greco K, Fridirici ZC, Hart ST, Vellos T, Turk TM. Metabolic syndrome and urinary stone composition: What factors matter most? Urology 2012;80(4):805–10.
49. Whalley NA, Martins MC, Van Dyk RC, Meyers AM. Lithogenic risk factors in normal black volunteers, and black and white recurrent stone formers. BJU Int 1999;84(3):243–8.
50. E.B. F, S. M, J.M. S. The Effect of Disease Sever-ity on 24-Hour Urine Parameters in Kidney Stone Patients with Type 2 Diabetes. Urology [Internet] 2016;87:52–9. Available from: http://www.elsevier .com/locate/urology%5Cnhttp://ovidsp.ovid.com/ ovidweb.cgi?T=JS&PAGE=reference&D=emed13 &NEWS=N&AN=20151008277
51. Eisner BH, Porten SP, Bechis SK, Stoller ML. Diabetic Kidney Stone Formers Excrete More Oxalate and Have Lower Urine pH Than Nondiabetic Stone Formers. J Urol 2010;183(6):2244–8.
52. Kin M. No Title. (December 1995).
53. Ferraro PM, Curhan GC, D’Addessi A, Gambaro G.
Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol 2016;
54. Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, et al. Hypertriglyceridemia is associated with increased risk for stone recurrence in patients with urolithiasis. Urology 2014;84(4):766–71.