Abstract
The aim of this study was to compare the clinical characteristics of “pure” uric acid renal stone formers (UA-RSFs) with that of mixed uric acid/calcium oxalate stone formers (UC-RSFs) and to identify which urinary and dietary risk factors predispose to their formation. A total of 136 UA-RSFs and 115 UC-RSFs were extracted from our database of renal stone formers. A control group of 60 subjects without history of renal stones was considered for comparison. Data from serum chemistries, 24-h urine collections and 24-h dietary recalls were considered. UA-RSFs had a significantly (p = 0.001) higher body mass index (26.3 ± 3.6 kg/m2) than UC-RSFs, whereas body mass index of UA-RSFs was higher but not significantly than in controls (24.6 ± 4.7) (p = 0.108). The mean urinary pH was significantly lower in UA-RSFs (5.57 ± 0.58) and UC-RSFs (5.71 ± 0.56) compared with controls (5.83 ± 0.29) (p = 0.007). No difference of daily urinary uric acid excretion was observed in the three groups (p = 0.902). Daily urinary calcium excretion was significantly (p = 0.018) higher in UC-RSFs (224 ± 149 mg/day) than UA-RSFs (179 ± 115) whereas no significant difference was observed with controls (181 ± 89). UA-RSFs tend to have a lower uric acid fractional excretion (0.083 ± 0.045% vs 0.107+/-0.165; p = 0.120) and had significantly higher serum uric acid (5.33 ± 1.66 vs 4.78 ± 1.44 mg/dl; p = 0.007) than UC-RSFs. The mean energy, carbohydrate and vitamin C intakes were higher in UA-SFs (1987 ± 683 kcal, 272 ± 91 g, 112 ± 72 mg) and UC-SFs (1836 ± 74 kcal, 265 ± 117, 140 ± 118) with respect to controls (1474 ± 601, 188 ± 84, 76 ± 53) (p = 0.000). UA-RSFs should be differentiated from UC-RSFs as they present lower urinary pH, lower uric acid fractional excretion and higher serum uric acid. On the contrary, patients with UC-RSFs show urinary risk factors more similar to those for calcium oxalate stones. The dietary approach in patients forming uric acid stones should be reconsidered with more attention to the quantity and quality of carbohydrate intake.
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References
Sakhaee K (2014) Epidemiology and clinical pathophysiology of uric acid kidney stones. J Nephrol 27:241–245
Ngo TC, Assimos DG (2007) Uric acid nephrolithiasis: recent progress and future directions Rev Urol 9: 17–27.
Trinchieri A, Croppi E, Montanari E (2016) Obesity and nephrolithiasis: evidence of regional influences. Urolithiasis. doi:10.1007/s00240-016-0908-3
Reichard C, Gill BC, Sarkissian C, De S, Monga M (2015) 100% uric acid stone formers: what makes them different? Urology 85:296–298
Kamel KS, Cheema-Dhadli S, Halperin ML (2002) Studies on the pathophysiology of the low urine pH in patients with uric acid stones. Kidney Int 61:988–994
Gutman A, Yue TF (1963) An abnormality of glutamine metabolism in primary gout. Am J Med 35:820–831
Pollak V, Mattenheimer H (1965) Glutaminase activity in the kidney in gout. J Lab Clin Med 66:564–570
Pak CY, Sakhaee K, Peterson RD, Poindxter JR, Frawley WH (2001) Biochemical profile of idiopathic uric acid nephrolithiasis. Kidney Int 60:757–761
Daudon M, Traxer O, Conort P, Lacour B, Jungers P (2006) Type 2 diabetes increases the risk for uric acid stones. J Am Soc Nephrol 17:20–26
Maalouf NM, Cameron MA, Moe OW, Sakhaee K (2004) Novel insights into the pathogenesis of uric acid nephrolithiasis. Curr Opin Nephrol Hypertens 13:181–189
Sakhaee K, Adams-Huet B, Moe OW, Pak CY (2002) Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int 62:971–979
Friedlander JI, Moreira DM, Hartman C, Elsamra SE, Smith AD, Okeke Z (2014) Comparison of the metabolic profile of mixed calcium oxalate/uric acid stone formers to that of pure calcium oxalate and pure uric acid stone formers. Urology 84:289–294
Daudon M, Bader CA, Jungers P (1993) Urinary calculi: review and classification methods and correlations with etiology. Scanning Microsc 7:1081–1104
Grases F, Costa-Bauza A, Ramis M, Montesinos V, Conte A (2002) Simple classification of renal calculi closely related to their micromorphology and etiology. Clin Chem Acta 322:29–36
Negri AL, Spivacow R, Del Valle E, Pinduli I, Marino A, Fradinger E, Zanchetta JR (2007) Clinical and biochemical profile of patients with “pure” uric acid nephrolithiasis compared with “pure” calcium oxalate stone formers. Urol Res 35:247–251
Ter Maaten JC, Voorburg A, Heine RJ, Ter Wee PM, Donker AJ, Gans RO (1997) Renal handling of urate and sodium during acute physiological hyperinsulinaemia in healthy subjects. Clin Sci Lond 92:51–58
Coe FL (1978) Hyperuricosuric calcium oxalate nephrolithiasis. Kidney Int 13:418–426
Favus MJ, Coe FL (1980) The effects of allopurinol treatment on stone formation on hyperuricosuric calcium oxalate stone-formers. Scand J Urol Nephrol Suppl 53:265–271
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 350:1093–1103
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Alcohol intake and risk of incident gout in men: a prospective study. Lancet 363:1277–1281
Choi HK, Curhan G (2008) Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ 336:309–312
Choi HK, Willett W, Curhan G (2007) Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum 56:2049–2055
Tracy CR, Best S, Bagrodia A, Poindexter JR, Adams-Huet B, Sakhaee K, Maalouf N, Pak CY, Pearle MS (2014) Animal protein and the risk of kidney stones: a comparative metabolic study of animal protein sources. J Urol 192:137–141
Siener R, Hesse A (2003) The effect of a vegetarian and different omnivorous diets on urinary risk factors for uric acid stone formation. Eur J Nutr 42:332–337
Cameron M, Maalouf NM, Poindexter J, Adams-Huet B, Sakhaee K, Moe OW (2012) The diurnal variation in urine acidification differs between normal individual and uric acid stone formers. Kidney Int 81:1123–1130
Emmerson BT (1996) The management of gout. N Engl J Med 334:445–451
Yu TF (1974) Milestones in the treatment of gout. Am J Med 56:676–685
Remer T, Manz F (1995) Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 95:791–797
Bessesen DH (2001) The role of carbohydrate in insulin resistance J Nutr 131: 2782S–2786S
Fam AG (2002) Gout, diet and the insulin resistance syndrome. J Rheumatol 29:1350–1355
Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J (2000) Beneficial effect of weight loss associated with moderate calorie/carbohydrate restriction and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 59:539–543
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Alberto Trinchieri and Emanuele Montanari have no conflict of interest in relation to this paper.
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All the procedures performed in controls and patients were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendements.
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In consideration of the retrospective design of the study no specific informed consent was obtained, although an informed consent to use clinical data for research studies is routinely obtained from all the patients who are admitted to our institutions.
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Trinchieri, A., Montanari, E. Biochemical and dietary factors of uric acid stone formation. Urolithiasis 46, 167–172 (2018). https://doi.org/10.1007/s00240-017-0965-2
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DOI: https://doi.org/10.1007/s00240-017-0965-2