BERKELEY, CA (UroToday.com) - No disease is local!

As we continue to investigate the origins of illness, we are learning that most surgical disease, which is invariably localized, is the effect of a multifactorial cause. In urolithiasis, we are now beginning to understand that there is an association, between obesity and urolithiasis (i.e. the metabolic syndrome). The metabolic syndrome also includes hyperlipidemia, type 2 diabetes, and hypertension.

In this study from South Korea, among 163 first time stone-formers, followed for more than 3 years (median 4.5 years), obesity (defined here as a BMI of > 25) alone was the strongest factor predicting stone recurrence. Of note, uric acid was higher and pH was lower in the obese patients; this is attributed to impaired ammonium excretion secondary to insulin resistance and hyperinsulinemia that are characteristic of the type II diabetes associated with the metabolic syndrome. Not surprisingly, the obese patients had a much higher incidence of uric acid stones (16%).

Bottom line: "Lose the weight, lose the stone".

Lee SC, Kim YJ, Kim TH, Yun SJ, Lee NK, Kim WJ

J Urol. 2008 Feb;179(2):570-4
doi: 10.1016/j.juro.2007.09.040

PubMed Abstract
PMID: 18078957

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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