Department of Urology, Irvine (UCI) School of Medicine, University of California, 333 City Blvd. West, Suite 2100, Orange, Irvine, CA, 92868, USA.
Department of Radiology, School of Medicine, University of California, Irvine, USA.
Urolithiasis. 2018 Nov;46(6):535-541. doi: 10.1007/s00240-018-1047-9. Epub 2018 Mar 2.
The concept of adipose tissue as an organ unto itself represents a new medical construct; already differences in the volume of perirenal fat around a tumor-bearing kidney have been described. We hypothesized that renal calculi may have similar impact on perirenal fat or alternatively abnormalities in urinary metabolites may be the result of perirenal fat affecting renal metabolism and subsequent stone formation. Accordingly, we conducted a study utilizing three-dimensional imaging software to evaluate perirenal fat volume (PFV) in patients with nephrolithiasis. Among 40 patients with a history of unilateral nephrolithiasis who underwent percutaneous nephrolithotomy between 2010 and 2016, the following data were acquired: body mass index, past medical history, stone characteristics and composition (i.e., calcium oxalate, calcium phosphate, uric acid, and struvite calculi). In addition, patients were stratified by dominant stone composition (≥ 50% fraction). Bilateral PFV measurements were obtained using the preoperative computed tomography scan and specialized three-dimensional imaging software. The PFV of stone-bearing kidneys was significantly greater than non-stone-bearing kidneys (397.3 and 323 cc, respectively; p = 0.004), with the PFV difference in patients with CO-dominant stone-bearing kidneys reaching statistical significance (p = 0.003). Subgroup analysis showed greater PFV surrounding the stone-bearing kidney irrespective of gender (p = 0.03), with male patients possessing significantly greater stone-bearing (p = 0.01) and bilateral PFV (p = 0.01) compared to females. No significant correlations were found between PFV and stone volume or stone density. The PFV of calcium oxalate stone-bearing kidneys is significantly greater than non-stone-bearing kidneys for both male and female patients with nephrolithiasis.
脂肪组织作为一个独立的器官的概念代表了一个新的医学概念；已经描述了肿瘤肾周围脂肪体积的差异。我们假设肾结石可能对肾周脂肪有类似的影响，或者尿液代谢物的异常可能是肾周脂肪影响肾脏代谢和随后结石形成的结果。因此，我们进行了一项研究，利用三维成像软件评估肾结石患者的肾周脂肪体积（PFV）。在 2010 年至 2016 年间接受经皮肾镜碎石术的 40 例单侧肾结石患者中，获取了以下数据：体重指数、既往病史、结石特征和成分（即草酸钙、磷酸钙、尿酸和鸟粪石结石）。此外，根据主要结石成分（≥50%）对患者进行分层。使用术前 CT 扫描和专用三维成像软件获取双侧 PFV 测量值。肾结石患者的 PFV 明显大于非肾结石患者（分别为 397.3 和 323cc；p=0.004），CO 为主的肾结石患者的 PFV 差异具有统计学意义（p=0.003）。亚组分析显示，无论性别如何，肾结石患者的肾周脂肪体积都较大（p=0.03），与女性相比，男性肾结石患者的肾结石（p=0.01）和双侧 PFV（p=0.01）明显更大。PFV 与结石体积或结石密度之间无显著相关性。肾结石患者的草酸钙结石肾周脂肪体积明显大于非结石肾周脂肪体积，无论男性还是女性。
