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| The influence of metabolic syndrome and its components on the development of nephrolithiasis |
Carter Boydb*( ),Kyle Wooda,Dustin Whitakerb,Dean G. Assimosa
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a. Department of Urology, University of Alabama-Birmingham, Birmingham, AL, USA
b. University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA |
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Abstract The prevalence of kidney stone disease is increasing, afflicting 7%-11% of the United States population. Multiple systemic conditions, including obesity and diabetes, are also on the rise. Further, the literature has demonstrated a strong association between metabolic syndrome, its components, and kidney stone disease. In this article, we aim to review the associations of metabolic syndrome and nephrolithiasis, discussing the pathophysiology, urinary parameters, and clinical presentations. With this knowledge, urologists will have a more comprehensive understanding of this complex population of metabolic stone formers enabling improved patient management and treatment of stone disease.
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Received: 16 November 2017
Published: 19 November 2018
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Corresponding Authors:
Boyd Carter
E-mail: cjboyd1@uab.edu
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| Factors | Values | | Waist circumference (cm) | >102 (males), >88 (females) | | Fasting glucose (mg/dL) | ≥100 or Rx | | Triglycerides (mg/dL) | ≥150 or Rx | | High-density lipoprotein (ng/mL) | <40 (males), <50 (females), or Rx | | Blood pressure (mmHg) | >130 (systolic), >85 (diastolic), or Rx |
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| Classification | Required elements | Criteria | Obesity | Hyperglycemia | Dyslipidemia (mg/dL) | Hypertension (mmHg) | Other criteria | | WHO | IR | Required element and ≥2/5 | BMI > 30 kg/m2
M: WHR > 0.9
F: WHR > 0.85 | Present | TG ≥ 150 or M: HDL-C < 35
F: HDL-C < 39 | >140/90 | Microalbuminuria | | EGIR | Hyperinsulinemia in non-T2DM patients | Required element and ≥2/4 | M: WC ≥ 94 cm
F: WC ≥ 80 cm | Present | TG ≥ 150 or HDL-C < 39 | >140/90 or Rx | | | AACE | IR | Required element + any other element + clinical judgment | BMI ≥ 25 kg/m2 | Present | TG ≥ 150 and M: HDL-C < 40
F: HDL-C < 50 | >130/85 | Other features of IR | | IDF | CO (WC or BMI > 30 kg/m2) | Required element and ≥2/4 | Not part of criteria | Fasting glucose ≥ 100 mg/mL | TG ≥ 150 or Rx | S ≥ 130
D ≥ 85 or Rx | | M: HDL < 40 or Rx
F: HDL < 50 or Rx |
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| Reference | Country | Study population | Mean age (years) | Female (%) | MetS criteria | MetS population | NL definition | NL population | Prevalence | Adjusted OR | | West et al. (2008) [27] | USA | 14 870 | 50.1 | 52.4 | AHA/NHLBI | 4949 | Self-reported history | 699 | History of NL in 8.8% of MetS patients vs. 4.3% in non-MetS patients
Component number
0: 3%
3: 7.5%
5: 9.8% | E: 1.52
Component number
0: 1.0
1: 1.40
2: 2.09
3: 2.56
4: 3.85
5: 3.42 | | Rendina et al. (2009) [28] | Italy | 2 132 | 63.8 | 51.3 | AHA/NHLBI | 725 | US and self-reported history | 298 | 50.9% of patients with evidence of NL met criteria for MetS | E: 2.0
M: 1.89
F: 2.19 | | Jeong et al. (2011) [30] | Korea | 34 895 | 50.0 | 40.4 | NCEP ATP III | 4 779 | CT and/or US | 839 | In MetS, 71% increased OR of kidney stone prevalence vs. non-MetS
Component number
0: 1.75%
1: 2.45%
2: 2.76%
3: 3.87%
4: 3.12%
5: 4.37% | E: 1.25 | | Kohjimoto et al. (2013) [52] | Japan | 11 555 | 52.5 | 26.1 | Obesity, BMI ≥ 25 kg/m2; hypertension,BP ≥ 140/90 mmHg; dyslipidemia, LDL ≥ 140 mg/dL, HDL < 40 mg/dL, or TG ≥ 150 mg/dL; diabetes, fasting ≥ 126 mg/dL, 2-h 75-g glucose test ≥ 200 mg/dL or HbA1c ≥ 6.5% | 6 306 | Previous radiologic diagnosis | 11 555 | Component number
0: 57.7%
1: 61.7%
2: 65.2%
3: 69.3%
4: 73.3% | E: 1.78 |
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