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Insulin resistance and low urinary citrate excretion in calcium stone formers.

Abstract

Epidemiological data suggest an association between kidney stones and some features of metabolic syndrome such as an overweight condition, arterial hypertension or glucose intolerance. However, mechanisms remain to be elucidated. This study aimed to evaluate insulin resistance, as assessed by homeostasis model assessment (HOMA-IR), and urine composition analysis in patients affected by calcium nephrolithiasis. A cohort of 61 (38 male, 29-57 years of age) non-diabetic calcium stone formers was studied. Data about body mass index, arterial blood pressure, serum biochemistry including parathyroid hormone and calcitriol were recorded in all the patients; fasting glucose and insulin were determined to calculate HOMA-IR value and accordingly the patients were grouped into tertiles. Urine pH and urinary excretion of calcium, citrate, phosphate, oxalate, uric acid, urea and creatinine were measured on 24h urine samples. Patients of the highest HOMA-IR tertile showed lower urine citrate levels than patients of the lowest HOMA-IR tertile (475+/-243 vs. 630+/-187 mg/24h, p<0.05), whereas no difference was detected as far as urinary oxalate, calcium, uric acid, phosphate, and urine pH and urine volume output were concerned. HOMA-IR values were positively related to uric acid serum levels (r=0.31, p<0.05) and negatively to urinary citrate excretion (r=-0.26, p<0.05). Hypocitraturic patients showed higher levels of HOMA-IR than normocitraturic ones (3.03+/-0.92 vs. 2.25+/-1.19, p<0.05). This study shows that a higher level of insulin resistance is associated with lower urinary citrate excretion, and that hypocitraturic patients show a greater insulin resistance than normocitraturic calcium stone formers. This may be related to changes in citrate, Na(+)-K(+) and H(+) renal tubule transports, which have been described in insulin resistance. In conclusion, insulin resistance may contribute to an increased risk of calcium stone formation by lowering urinary citrate excretion. This finding suggests the need for a careful metabolic assessment in patients known to form calcium stones in order to ensure stone recurrence prevention and cardiovascular protection.

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  • Authors+Show Affiliations

    ,

    Department of Internal Medicine, Nephrology Unit, University of Pisa, Via Roma 67, 56126 Pisa, Italy. acupisti@med.unipi.it

    , , , , ,

    Source

    MeSH

    Adult
    Calcium
    Calcium Oxalate
    Citrates
    Dietary Proteins
    Female
    Humans
    Insulin Resistance
    Male
    Middle Aged
    Regression Analysis
    Urinary Calculi

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17184967

    Citation

    Cupisti, A, et al. "Insulin Resistance and Low Urinary Citrate Excretion in Calcium Stone Formers." Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, vol. 61, no. 1, 2007, pp. 86-90.
    Cupisti A, Meola M, D'Alessandro C, et al. Insulin resistance and low urinary citrate excretion in calcium stone formers. Biomed Pharmacother. 2007;61(1):86-90.
    Cupisti, A., Meola, M., D'Alessandro, C., Bernabini, G., Pasquali, E., Carpi, A., & Barsotti, G. (2007). Insulin resistance and low urinary citrate excretion in calcium stone formers. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, 61(1), pp. 86-90.
    Cupisti A, et al. Insulin Resistance and Low Urinary Citrate Excretion in Calcium Stone Formers. Biomed Pharmacother. 2007;61(1):86-90. PubMed PMID: 17184967.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Insulin resistance and low urinary citrate excretion in calcium stone formers. AU - Cupisti,A, AU - Meola,M, AU - D'Alessandro,C, AU - Bernabini,G, AU - Pasquali,E, AU - Carpi,A, AU - Barsotti,G, Y1 - 2006/12/04/ PY - 2006/03/16/received PY - 2006/09/27/accepted PY - 2006/12/23/pubmed PY - 2007/4/4/medline PY - 2006/12/23/entrez SP - 86 EP - 90 JF - Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie JO - Biomed. Pharmacother. VL - 61 IS - 1 N2 - Epidemiological data suggest an association between kidney stones and some features of metabolic syndrome such as an overweight condition, arterial hypertension or glucose intolerance. However, mechanisms remain to be elucidated. This study aimed to evaluate insulin resistance, as assessed by homeostasis model assessment (HOMA-IR), and urine composition analysis in patients affected by calcium nephrolithiasis. A cohort of 61 (38 male, 29-57 years of age) non-diabetic calcium stone formers was studied. Data about body mass index, arterial blood pressure, serum biochemistry including parathyroid hormone and calcitriol were recorded in all the patients; fasting glucose and insulin were determined to calculate HOMA-IR value and accordingly the patients were grouped into tertiles. Urine pH and urinary excretion of calcium, citrate, phosphate, oxalate, uric acid, urea and creatinine were measured on 24h urine samples. Patients of the highest HOMA-IR tertile showed lower urine citrate levels than patients of the lowest HOMA-IR tertile (475+/-243 vs. 630+/-187 mg/24h, p<0.05), whereas no difference was detected as far as urinary oxalate, calcium, uric acid, phosphate, and urine pH and urine volume output were concerned. HOMA-IR values were positively related to uric acid serum levels (r=0.31, p<0.05) and negatively to urinary citrate excretion (r=-0.26, p<0.05). Hypocitraturic patients showed higher levels of HOMA-IR than normocitraturic ones (3.03+/-0.92 vs. 2.25+/-1.19, p<0.05). This study shows that a higher level of insulin resistance is associated with lower urinary citrate excretion, and that hypocitraturic patients show a greater insulin resistance than normocitraturic calcium stone formers. This may be related to changes in citrate, Na(+)-K(+) and H(+) renal tubule transports, which have been described in insulin resistance. In conclusion, insulin resistance may contribute to an increased risk of calcium stone formation by lowering urinary citrate excretion. This finding suggests the need for a careful metabolic assessment in patients known to form calcium stones in order to ensure stone recurrence prevention and cardiovascular protection. SN - 0753-3322 UR - https://www.unboundmedicine.com/medline/citation/17184967/Insulin_resistance_and_low_urinary_citrate_excretion_in_calcium_stone_formers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0753-3322(06)00332-5 DB - PRIME DP - Unbound Medicine ER -