Correlation Of Metabolic Syndrome With Risk Factors, Recurrence And Kidney Injury Of Urolithiasis

Part I Correlation of metabolic syndrome with risk factors and stone composition of urolithiasisObjective:To investigate the relationship between metabolic syndrome and risk factors of urolithiasis, and to compare the difference in stone composition between with and without metabolic syndrome.Methods:An analysis was performed in urinary stone formers from April 2013 to December 2013 in department of urology Zhongshan hospital, as well as non-stone formers with metabolic syndrome from September 2013 to November 2013 in department of endocrinology Zhongshan hospital and recruited normal people. The general conditions, history of present illness, past medical history, serum and urinary characteristics were collected. The differences of serum and urinary characteristics were compared between individuals with and without metabolic syndrome in stone formers and non-stone formers, respectively. Multivariate analysis was performed to investigate the relationship between metabolic syndrome and urine composition. A separate analysis was performed in urinary stone formers whose stone composition was analyzed from September 2012 to December 2013 in department of urology Zhongshan hospital. The general conditions, history of present illness, past medical history, serum characteristics and stone composition were collected. The difference of stone composition was compared according to metabolic syndrome status.Results:I.188 patients with urinary stone disease were included in the analysis for comparison of serum and urinary characteristics.50 patients among them had metabolic syndrome. Compared with stone formers without metabolic syndrome, those with metabolic syndrome had lower urine pH, and higher calcium, phosphorus, uric acid, oxalate, sodium and potassium in 24-hour urine. On adjusted multivariate analysis compared with stone formers without metabolic syndrome, urine pH of those with metabolic syndrome was 0.4 lower (95% CI-0.7～0.1, P=0.014). Stone formers with metabolic syndrome excreted 1.03 mmol more (95% CI 0.08～1.99 mmol, P=0.034) calcium,608 μmol more (95% CI 133～1083 μmol, P=0.012) uric acid and 7.00 mg more (95% CI 2.52～11.47, P=0.002) oxalate in 24-hour urine. Ⅱ.109 individuals without urinary stone disease were included in the analysis for comparison of serum and urinary characteristics.58 individuals among them had metabolic syndrome. Compared with individuals without metabolic syndrome, those with metabolic syndrome had lower urine pH, and lower citrate in 24-hour urine. On adjusted multivariate analysis compared with individuals without metabolic syndrome, urine pH of those with metabolic syndrome was 0.4 lower (95% CI -0.8～-0.1, P=0.011).Ⅲ.348 patients with urinary stone disease were included in the analysis for comparison of stone composition.67 patients among them had metabolic syndrome. The proportion of uric acid stone was markedly higher in stone formers with rather than without metabolic syndrome (13.4% vs.6.9%, P=0.019). However, the proportion of calcium oxalate, calcium phosphate and struvite stone did not differ between two groups. The multivariate adjusted odds ratio for uric acid stone according to metabolic syndrome indicated that metabolic syndrome (OR 2.688,95% CI 1.114～6.482, P=0.028) was independently associated with uric acid stone.Conclusions:Metabolic syndrome was associated with risk factors of urolithiasis such as significantly increased calcium, oxalate, uric acid and acidity of urine. The proportion of uric acid stone was higher in stone formers with rather than without metabolic syndrome, and metabolic syndrome was an independent risk factor of uric acid stone. syndrome. Compared with individuals without metabolic syndrome, those with metabolic syndrome had lower urine pH, and lower citrate in 24-hour urine. On adjusted multivariate analysis compared with individuals without metabolic syndrome, urine pH of those with metabolic syndrome was 0.4 lower (95% CI -0.8～-0.1, P=0.011).Ⅲ.348 patients with urinary stone disease were included in the analysis for comparison of stone composition.67 patients among them had metabolic syndrome. The proportion of uric acid stone was markedly higher in stone formers with rather than without metabolic syndrome (13.4% vs.6.9%, P=0.019). However, the proportion of calcium oxalate, calcium phosphate and struvite stone did not differ between two groups. The multivariate adjusted odds ratio for uric acid stone according to metabolic syndrome indicated that metabolic syndrome (OR 2.688,95% CI 1.114～6.482, P=0.028) was independently associated with uric acid stone.Conclusions:Metabolic syndrome was associated with risk factors of urolithiasis such as significantly increased calcium, oxalate, uric acid and acidity of urine. The proportion of uric acid stone was higher in stone formers with rather than without metabolic syndrome, and metabolic syndrome was an independent risk factor of uric acid stone.Part Ⅱ Correlation of metabolic syndrome with recurrence of urolithiasisObjective:To investigate the relationship between metabolic syndrome and recurrence of urolithiasis.Methods:A retrospective analysis was performed in urinary stone formers from March 2008 to February 2012 in department of urology Zhongshan hospital. The general conditions, history of present illness, past medical history, preoperative serum characteristics and postoperative stone free status were collected. Patients who were followed for 24-72 months (median 47 months) since operation were included in recurrence analysis to compare the difference according to metabolic syndrome status.Results:218 patients with urinary stone disease were included in recurrence analysis. 52 patients among them had metabolic syndrome. Kaplan-Meier estimates demonstrated a significant difference in the recurrence of urinary stone between patients with and without metabolic syndrome (log-rank test, P=0.019). Multivariate Cox regression analysis revealed that metabolic syndrome was significantly associated with stone recurrence (HR 1.817,95% CI 1.105～2.988, P=0.011).Conclusions:Metabolic syndrome is an independent predictive determinant for stone recurrence. Treatment of metabolic syndrome should be paid attention in urinary stone recurrence prevention of stone formers with metabolic syndrome. patients with and without metabolic syndrome (log-rank test, P=0.019). Multivariate Cox regression analysis revealed that metabolic syndrome was significantly associated with stone recurrence (HR 1.817,95% CI 1.105～2.988, P=0.011).Conclusions:Metabolic syndrome is an independent predictive determinant for stone recurrence. Treatment of metabolic syndrome should be paid attention in urinary stone recurrence prevention of stone formers with metabolic syndrome.Part Ⅲ Correlation of metabolic syndrome with kidney injury of calcium oxalate nephrolithiasisObjective:To investigate relationship between metabolic syndrome and kidney injury of calcium oxalate nephrolithiasis.Methods:An analysis was performed in patients with calcium oxalate nephrolithiasis from April 2013 to December 2013 in department of urology Zhongshan hospital. They were divided into metabolic syndrome+calcium oxalate stone group (MS+CaOx group) and calcium oxalate stone group (CaOx group) according to metabolic syndrome status. Non-stone formers with metabolic syndrome (MS group) from September 2013 to November 2013 in department of endocrinology Zhongshan hospital and recruited normal people (N group) were also enrolled. The general conditions, history of present illness, past medical history, serum characteristics were collected.10 mL mid-stream clean catch urine was collected on morrow morning. Kidney injury molecule-1 (KIM-1) and malondialdehyde (MDA) in urine were measured. Differences of KIM-1 and MDA between 4 groups were compared.Results:196 research objects were classified into 4 groups, (MS+CaOx) group (n=38), CaOx group (n=67), MS group (n=51) and N group (n=40).There were statistically significant differences of urine KIM-1 (P=0.000) and MDA (P=0.000) between 4 groups, respectively. Urine KIM-1 of (MS+CaOx) group was higher than that of CaOx group, MS group and N group, respectively (P<0.05). Urine KIM-1 of MS group and CaOx group was both higher than that of N group, respectively (P<0.05). No difference of urine KIM-1 was observed between MS group and CaOx group (P>0.05). Urine MDA of (MS+CaOx) group was higher than that of CaOx group, MS group and N group, respectively (P<0.05). No difference of urine MDA was observed between MS group, CaOx group and N group (P>0.05).Conclusions:Metabolic syndrome aggravated kidney injury of calcium oxalate nephrolithiasis. Treatment of metabolic syndrome should be paid more attention in order to alleviate kidney injury when treating kidney stone formers with metabolic syndrome.