Presentation Authors: Daniel C. Rosen*, Blair Gallante, Jake Bamberger, Elie Kaplan-Marans, Ryan Chandhoke, William M. Atallah, Mantu Gupta, New York, NY
Introduction: The association between metabolic syndrome and consequent changes in urinary parameters have been well established. We aimed to further investigate whether these changes can be seen in pre-diabetic or pre-metabolic syndrome stone forming patients.
Methods: We retrospectively reviewed medical records of kidney stone patients who underwent metabolic workup at a comprehensive stone clinic, including their initial 24-hour urine prior to the implementation of metabolic therapy. Patients were divided into cohorts by diabetic-status (as either non-diabetic, pre-diabetic, or diabetic) and separately divided into cohorts by Metabolic Syndrome Risk Score (MSRS). We investigated the relationships between these clinical characteristics and the patientsâ€™ urine parameters and stone compositions. We performed statistical analysis between groups using one-way ANOVA and Games-Howell Post-hoc test.
Results: 383 stone forming patients who were treated between November, 2007 and October, 2018 were included in the study. Diabetic patients as well as patients with increasing MSRS were significantly more likely to have lower pH and increased supersaturation of uric acid but were found to have slightly higher citrate and decreased supersaturation of calcium phosphate (p < 0.05). In post hoc analysis, patients with increasing individual components of the MSRS, demonstrated commensurate deviations of 24-hour urine parameters (p < 0.05). Notably, these findings were seen with only a single MSRS risk factor. Patients with uric acid stones were more likely to have higher MSRS and diabetes (p < 0.05).
Conclusions: Changes in urine parameters can be seen in stone formers even early in the pathogenesis of metabolic syndrome. These patients appear to have demonstrable, correctable, metabolic derangements that may place them at higher risk for recurrent stone formation. This suggests a role for early screening and intervention in first time stone formers with any signs of metabolic syndrome.