Kidney Stones and Metabolic Syndrome

Posted on by Jesse Santiano, M.D.

The pain of renal colic is one of the most severe pains in the emergency department. Kidney stone pains are agonizing and relentless. Usually, the patients are writhing in pain and vomiting and sweating profusely.

Kidney stones are formed in the kidney. As the stone travels down the ureter to get to the urinary bladder, the stones have to pass thru 3 narrow areas. A stone as small as 1 mm can get stuck in any or all of the narrowing and cause severe pain in the lower back then travels down the groin.

Obstructive kidney stones are potentially life-threatening if combined with a urinary tract infection. That is because the infected urine can not drain, and the bacterial toxin spreads throughout the body, creating a septic condition. This is a surgical emergency as the blockage needs to be resolved immediately or else septic shock and death can ensue.

Blausen_0595_KidneyStones

How Do Kidney Stones Form?

Kidney stones vary in size and shape and are made from calcium phosphate, calcium oxalate, and uric acid. The causes could be from a parathyroid problem and infections. There has been a rise in the number of kidney stones that paralleled the increase in obesity and metabolic syndrome.

Metabolic syndrome is composed of obesity, Type 2 diabetes, high triglyceride levels, and low HDL in the blood, and hypertension. Each of the five conditions of metabolic syndrome has been associated with the formation of kidney stones.

Pos-renal
Typical areas of Kidney stone pain

Obesity

Abdominal obesity is defined as waist circumference in men of ≥ 40 inches (102 cm) and  ≥ 35 in (88 cm) in women. The rise in abdominal obesity has paralleled the increase in kidney stones in a study of 181,092,957 inpatients. [1] A sizeable abdominal girth can be from the fat in the abdominal wall (subcutaneous fat) and the intraabdominal fat within the abdominal cavity (visceral fat) or both.

Having a large amount of visceral fat is associated with the formation of inflammatory cytokines that contributes to other disease conditions all over the body. Fujimura and associates used the CT scan to measure the amount of the fat inside the abdomen (visceral fat) within. What they found is that the amount of the visceral fat is parallel to the frequency of kidney stone formation in males of all ages [2]

The Body Mass Index (BMI) can be an indicator of the amount of fat in the body. Studies have shown that people with a higher BMIs excreted more urinary oxalic acid, uric acid, ium, and phosphate than those with lower BMIs. They also found that people with a higher BMI have more acidic urine.[9]

Type 2 Diabetes

The human body excretes the by-products of its metabolism thru the urine. Uric acid is a by-product of protein metabolism and is typically excreted in the urine.  As long as the urine has the right acid-base balance (ph), the uric acid remains dissolved in the urine.

 In Type 2 Diabetes (T2D), the urine becomes more acidic, which leads to the molecules of the uric acid to stick together, forming a stone. [4] In a study by Duadon, they found out that T2D increases the risk of kidney stones independent of age and the presence or absence of obesity. [3]

800px-Nefrolit
8.5 mm Kidney stone (Ouch!)

Hypertension

Based on many studies, hypertension is associated with kidney stones no matter the age, weight, and kidney function. The relationship is bidirectional. People with kidney stones have also been found to have higher blood pressure compared to the rest of the population.

Dyslipidemia

A triglyceride level of ≥ 150 mg/dl or HDL < 50 mg /dl is a component of the metabolic syndrome. In a study of 30,448 patients enrolled in the 6th Nationwide Survey on Urolithiasis in Japan conducted in 2005, the presence of metabolic syndrome traits was associated with a significant amount of calcium, uric acid, and oxalic acid in the urine. All of which can form a kidney stone in the environment of acidic urine. They also found that citric acid, which is protective against kidney stone formation, is decreased in dyslipidemia [10].

High Fructose Diet

A diet high in fructose, which is present in beverages and food has been implicated in increasing the urinary excretion of calcium, oxalate, and uric acid. Other non-fructose sugars were not associated with increased risk in this study by Taylor. [12]

Take Away Message

Avoid high fructose/sucrose food.

The Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits and vegetables, moderate in low-fat dairy products and low in animal protein. It has also been found to decrease the risk of kidney stones. [11]

Anyone who has a kidney stone should consult with their physician to be screened for cardiovascular dangers like hypertension, dyslipidemia, diabetes, and obesity.  All of the components of the metabolic syndrome are interconnected. The presence of one like obesity will most likely lead to the formation of the others.

Having a kidney stone attack is one of the worst pains anybody will encounter. Diet and exercise can help prevent not just kidney stone development but the other diseases associated with metabolic syndrome.

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Thanks for reading.

Related Readings:

  1. The Metabolic Syndrome
  2. Diseases Associated with the Metabolic Syndrome
  3. The 80/20 Rule Applied to Diseases
  4. Cancers Associated with Metabolic Syndrome
  5. Lung Diseases Associated with Metabolic Syndrome
  6. The Deadliest Diseases Associated with Metabolic Syndrome
  7. Abnormal Blood Clots and Metabolic Syndrome
  8. Eye Problems and Metabolic Syndrome
  9. Ear Problems and Metabolic Syndrome
  10. Periodontal Disease and Metabolic Syndrome

References:

[1] Nowfar S et al. The relationship of obesity and gender prevalence changes in United States inpatient nephrolithiasis. Urology. 2011 Nov;78(5):1029-33. doi: 10.1016/j.urology.2011.04.011. Epub 2011 Jun 15.

[2] Fujimura M et al. VISCERAL FAT ACCUMULATION AS A RISK FACTOR FOR URINARY STONE FORMATION. Journal of Urology 1 Apr 2009

[3] Daudon M et al. Type 2 diabetes increases the risk for uric acid stones. J Am Soc Nephrol. 2006 Jul;17(7):2026-33. Epub 2006 Jun 14.

[4] Abate N et al. The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int. 2004 Feb;65(2):386-92.

[5] Kohjimoto Y et al. Association of metabolic syndrome traits and severity of kidney stones: results from a nationwide survey on urolithiasis in Japan. Am J Kidney Dis. 2013 Jun;61(6):923-9. doi: 10.1053/j.ajkd.2012.12.028. Epub 2013 Feb 20.
[6] Sakhaee K  et al. Metabolic syndrome and uric acid nephrolithiasis. Semin Nephrol. 2008 Mar;28(2):174-80. doi: 10.1016/j.semnephrol.2008.01.010.
Rev Urol. 2015; 17(3): 117–128. PMCID: PMC4633655 PMID: 26543426

 

[8] Taylor EN et al. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005 Jan 26;293(4):455-62.

[9] Taylor EN et al.  Body size and 24-hour urine composition. Am J Kidney Dis. 2006 Dec;48(6):905-15.
[10] Sakhaee K et al. Stone forming risk of calcium citrate supplementation in healthy postmenopausal women.  2004 Sep;172(3):958-61.

[11] Taylor EN et al. DASH-Style Diet Associated with Reduced Risk for Kidney Stones

J Am Soc Nephrol. 2009 Oct; 20(10): 2253–2259.
[12] Taylor EN et al. Fructose consumption and the risk of kidney stones. Kidney Int. 2008 Jan;73(2):207-12. Epub 2007 Oct 10.

Image Credits:

  • Kidney and stone  “Medical gallery of Blausen Medical 2014“.
  • Kidney stone pain By NIH – Taken from http://kidney.niddk.nih.gov/spanish/pubs/stones_ez/index.htm, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1148434.

Kidney Stone measurement By Robert R. Wal – http://en.wikipedia.org/wiki/Kidney_stone, Public Domain, https://commons.wikimedia.org/w/index.php?curid=3101185