Southside Endocrinology, University of Alabama Medical School, 1020 26th Street South, Birmingham, AL 35205, USA.
Diabetes Obes Metab. 2012 Apr;14(4):299-303. doi: 10.1111/j.1463-1326.2011.01519.x. Epub 2011 Nov 13.
There is an increased prevalence of nephrolithiasis and an increase in the incidence of renal colic in patients with diabetes, obesity, hypertension and insulin resistance because of an increased frequency of uric acid crystallization. Uric acid crystallization occurs in the milieu of an acid urine and is not due to hyperuricosuria as with insulin resistance, urinary uric acid levels are generally decreased because of increased renal tubular reabsorption. However, in the presence of insulin resistance, there is decreased renal tubular generation of ammonia and increased sodium absorption leading to acidification of the urine and uric acid crystallization. The presence of a low urine pH should alert the clinician to the increased risk of nephrolithiasis particularly in the obese, diabetic or hypertensive patient. Prevention of nephrolithiasis can be achieved in susceptible individuals either by alkalizing the urine and/or by further decreasing the uric acid content of the urine with a xanthine oxidase inhibitor such as allopurinol.
由于尿酸结晶形成的频率增加，糖尿病、肥胖症、高血压和胰岛素抵抗患者的肾结石患病率增加，肾绞痛发病率也增加。尿酸结晶发生在酸性尿液环境中，并非如胰岛素抵抗时的高尿酸尿症所致。由于肾小管重吸收增加，通常情况下尿液尿酸水平降低。然而，在胰岛素抵抗的情况下，肾小管生成的氨减少，钠吸收增加，导致尿液酸化和尿酸结晶。尿液 pH 值低的情况下，应引起临床医生的注意，特别是在肥胖、糖尿病或高血压患者中，增加了肾结石的风险。易感个体可以通过碱化尿液和/或使用黄嘌呤氧化酶抑制剂（如别嘌醇）进一步降低尿液中的尿酸含量来预防肾结石。
