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World J Nephrol. Nov 6, 2014; 3(4): 237-242
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.237
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.237
Table 3 Pathophysiologic relationship between insulin resistance and uric acid stone formation
Ref. | Study Type | Year | n | Study population | Outcomes | Conclusion |
Facchini et al[13] | Cross-sectional, single institution | 1991 | 36 | Healthy volunteers with varying degrees of IR | 24H urine (pH, UA), UA clearance, steady-state plasma glucose, metabolic evaluation | As IR increases serum UA increases and urinary UA clearance decreases. Thus, increased serum UA concentration may be considered an additional trait of MetS |
Cappuccio et al[14] | Cross-sectional, single institution | 1993 | 568 | Factory volunteers | Fasting spot urine (UA), fractional excretion of Na+, fasting blood analysis | The higher the serum UA level, the greater the amount of renal Na+ reabsorption. This phenomenon is consistent with hyperinsulinemia, and possibly IR, as insulin is known to increase renal sodium reabsorption |
Pak et al[15] | Retrospective, single institution | 2001 | 56 | UA stone formers vs matched control with diet control | 24H urine | UA stone formers have increased serum UA, decreased fractional excretion of urinary UA, and decreased urinary pH |
Sakhaee et al[16] | Prospective, single institution | 2002 | 70 | Healthy vs stone formers (UA vs Calcium vs Mixed) with diet control | 24H urine (pH, NH4+), fasting glucose | UA stone formers are more likely to have IR/DM. UA stone formation occurs due to impaired NH4+ excretion and urine acidification. Acid loading further decreases urinary pH in these patients as compared to non-UA stone formers/Controls |
Abate et al[17] | Prospective, single institution | 2004 | 68 | Stone free patients vs UA stone formers with diet control | 24H urine (pH, NH4+), glucose disposal rate | Acute hyperinsulinemia leads to elevated urinary pH and NH4+ excretion in normal insulin-sensitive subjects. Alternatively, IR is associated with low urinary pH and impaired NH4+ excretion and could be renal manifestations of IR causing UA stone formation |
Maalouf et al[23] | Cross-sectional, single institution | 2007 | 148 | MetS vs No MetS (all stone free) | 24H urine (pH, NH4+), Homeostasis model for IR, metabolic evaluation | Acidic urine is a feature of MetS and is associated with the degree of IR. As MetS traits increase, urine pH decreases |
Bobulescu et al[24] | Prospective, single institution | 2013 | 35 | Matched patients with and without UA stones, matched non-stone forming diabetic controls | 24H urine, urinary ammonium excretion | Both uric acid non-diabetic patients as well as DM non-stone forming patients had lower urinary pH as compared to matched non-stone forming non-diabetic controls |
Cameron et al[25] | Prospective, single institution | 2011 | 19 | UA stone formers vs normal controls with diet control | 24H urine, diurnal urinary pH | UA stone formers had decreased urinary pH with increased undissociated UA secretion compared to normal controls |
- Citation: Li H, Klett DE, Littleton R, Elder JS, Sammon JD. Role of insulin resistance in uric acid nephrolithiasis. World J Nephrol 2014; 3(4): 237-242
- URL: https://www.wjgnet.com/2220-6124/full/v3/i4/237.htm
- DOI: https://dx.doi.org/10.5527/wjn.v3.i4.237