Kohjimoto Yasuo, Iba Akinori, Sasaki Yumiko, Hara Isao
The Department of Urology, Wakayama Medical University.
Hinyokika Kiyo. 2011 Jan;57(1):43-7.
Recent epidemiological studies revealed an association of obesity, diabetes mellitus, hypertension and metabolic syndrome (MetS) with kidney stone disease. We examined how these disorders cause kidney stones. A clinical study on 467 patients with nephrolithiasis at our institution revealed that clustering of MetS traits increased the risk of uric acid stone formation by decreasing urinary pH. A subsequent study analyzing detailed data from 30,448 patients enrolled in the 6th Nationwide Survey on Urolithiasis in Japan showed that clustering of MetS traits were associated with an increased severity of the kidney stone disease and elevated urinary excretion of calcium, uric acid and oxalate. Finally, the OLETF rats, an animal model of MetS, showed lower urinary pH, decreased citrate excretion, and increased uric acid and calcium excretion. In addition, the administration of pioglitazone, an agent that improves insulin resistance, significantly increased the urinary pH. These results indicate that MetS causes changes in urinary constituents, leading to an increased risk of both uric acid and calcium oxalate stone formation. We suggest that kidney stone disease should be considered as a component of MetS and that the improvement in insulin resistance by means of diet and lifestyle changes and medical therapy might help to prevent this disorder.
近期的流行病学研究表明，肥胖、糖尿病、高血压和代谢综合征（MetS）与肾结石病之间存在关联。我们研究了这些病症是如何导致肾结石的。在我们机构对467例肾结石患者进行的一项临床研究显示，MetS特征的聚集通过降低尿液pH值增加了尿酸结石形成的风险。随后一项对参与日本第6次全国尿路结石调查的30448例患者的详细数据分析表明，MetS特征的聚集与肾结石病的严重程度增加以及尿钙、尿酸和草酸盐排泄增加有关。最后，作为MetS动物模型的OLETF大鼠表现出较低的尿液pH值、降低的柠檬酸盐排泄以及增加的尿酸和钙排泄。此外，给予改善胰岛素抵抗的药物吡格列酮可显著提高尿液pH值。这些结果表明，MetS会导致尿液成分发生变化，从而增加尿酸结石和草酸钙结石形成的风险。我们建议，肾结石病应被视为MetS的一个组成部分，通过饮食和生活方式改变以及药物治疗改善胰岛素抵抗可能有助于预防这种病症。
