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      The relationship between insulin, insulin resistance, parathyroid hormone, cortisol, testosterone, and thyroid function tests in the presence of nephrolithiasis: a comprehensive analysis

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      Author(s): ,
      Publication date (Electronic):
      Journal: Central European Journal of Urology
      Publisher: Polish Urological Association
      Keywords: cortisol, insulin, nephrolithiasis, parathyroid, thyroid

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          Abstract

          Introduction

          Previous studies have shown that hormonal factors such as levels of insulin, cortisol, testosterone, and insulin resistance are related with increased nephrolithiasis (NL). However, no previous study has evaluated the relationship between insulin, insulin resistance, thyroid hormones, cortisol, intact parathyroid hormone and testosterone levels with the presence of NL in a comprehensive manner.

          Materials and methods

          All patients underwent the following procedures: history taking, physical examination, biochemical analysis [including measurement of levels of insulin, thyroid hormones, cortisol, and total testosterone (for male patients only)], urine analysis, 24–hour urine collection to measure urinary protein, sodium excretion, and creatinine clearance. Insulin resistance was evaluated by the homeostasis model assessment index (HOMA–INDEX). The presence of NL was determined by ultrasonography.

          Results

          The study was composed of 136 patients. In total, 30 patients had NL. Patients with NL were more likely to be older, male, obese, and smokers. Uric acid and HOMA–INDEX were also higher in patients with NL. In the whole group, only insulin (Odds ratio:1.128, CI:1.029–1.236, P:0.01) but not other hormones, and HOMA–INDEX were related with the presence of NL. In males, none of the hormones including total testosterone were associated with NL.

          Conclusions

          Only levels of insulin, but not other hormones were associated with the presence of NL in a group of patients with suspicion of NL. More studies are needed to highlight the mechanisms regarding NL and hormone levels.

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          Diabetes mellitus and the risk of nephrolithiasis.

          Gary Curhan, Meir J. Stampfer, Naomi Taylor (2005)
          Insulin resistance is a central feature of type 2 diabetes mellitus (DM) and may increase the risk of kidney stone formation. Existing cross-sectional data on the association between DM and nephrolithiasis are limited, and no prospective study to date has evaluated the relation between DM and the risk of kidney stones. To evaluate the relation between DM and prevalent kidney stones, we conducted a cross-sectional study of 3 large cohorts including over 200,000 participants: the Nurses' Health Study I (older women), the Nurses' Health Study II (younger women), and the Health Professionals Follow-up Study (men). We then prospectively studied the association between DM and incident nephrolithiasis over a combined 44 years of follow-up. Because insulin resistance can precede the diagnosis of DM by decades, we also prospectively examined the relation between kidney stones and the diagnosis of incident DM. Multivariate regression models adjusted for age, body mass index, thiazide diuretic use, fluid intake, and dietary factors. At baseline, the multivariate relative risk of prevalent stone disease in individuals with DM compared to individuals without was 1.38 (95% CI 1.06-1.79) in older women, 1.67 (95% CI 1.28-2.20) in younger women, and 1.31 (95% CI 1.11-1.54) in men. Prospectively, the multivariate relative risk of incident kidney stone formation in participants with DM compared to participants without was 1.29 (95% CI 1.05-1.58) in older women, 1.60 (95% CI 1.16-2.21) in younger women, and 0.81 (95% CI 0.59-1.09) in men. The multivariate relative risk of incident DM in participants with a history of kidney stones compared to participants without was 1.33 (95% CI 1.18-1.50) in older women, 1.48 (95% CI 1.14-1.91) in younger women, and 1.49 (95% CI 1.29-1.72) in men. DM is a risk factor for the development of kidney stones. Additional studies are needed to determine if the increased risk of DM in stone formers is due to subclinical insulin resistance.
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            The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance.

            Khashayar Sakhaee, Orson W. Moe, Nicola Abate … (2004)
            Uric acid nephrolithiasis primarily results from low urinary pH, which increases the concentration of the insoluble undissociated uric acid, causing formation of both uric acid and mixed uric acid/calcium oxalate stones. These patients have recently been described as exhibiting features of insulin resistance. This study was designed to evaluate if insulin resistance is associated with excessively low urinary pH in overtly healthy volunteers (non-stone formers) and if insulin resistance may explain the excessively low urinary pH in patients with uric acid nephrolithiasis. Fifty-five healthy volunteers (non stone-formers) with a large range of body mass index and 13 patients with recurrent uric acid nephrolithiasis underwent hyperinsulinemic euglycemic clamp, 24-hour urinary studies, and anthropometric measurements of adiposity. A subgroup of 35 non-stone formers had 2-hour timed urinary collection before and during the hyperinsulinemic phase of the clamp studies. For the non-stone former population, low insulin sensitivity measured as glucose disposal rate significantly correlated with low 24-hour urinary pH (r= 0. 35; P= 0.01). In addition to the previously described acidic urine pH and hypouricosuria, patients with recurrent uric acid nephrolithiasis were found to be severely insulin resistant (glucose disposal rate: uric acid stone-formers vs. normals; 4.1 +/- 1.3 vs. 6.9 +/- 2.1 mg/min/kg of lean body mass, P= 0.008). Acute hyperinsulinemia was associated with higher urinary pH (6.1 +/- 0.7 at baseline to 6.8 +/- 0.7 during hyperinsulinemia; P < 0.0001), urinary ammonia excretion (2.7 +/- 1.6 mEq/2 hr at baseline and 4.0 +/- 2.6 mEq/2 hr P= 0.002) and urinary citrate excretion (48 +/- 33 mg/2 hr at baseline and 113 +/- 68 mg/2 hr P < 0.0001). We conclude that one renal manifestation of insulin resistance may be low urinary ammonium and pH. This defect can result in increased risk of uric acid precipitation despite normouricosuria.
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              Metabolic syndrome and self-reported history of kidney stones: the National Health and Nutrition Examination Survey (NHANES III) 1988-1994.

              David A Shoham, Guichan Cao, Holly Kramer … (2008)
              Metabolic syndrome affects approximately 25% of the American population. Components of metabolic syndrome, such as obesity, hypertension, and diabetes, were associated with kidney stone disease, but no published large-scale study examined the association between metabolic syndrome and history of kidney stones. Cross-sectional analysis. The American Heart Association and National Heart, Lung, and Blood Institute statement on metabolic syndrome was used to define metabolic syndrome. A national probability sample of the US population National Health and Nutrition Examination Survey aged 20 years and older. Metabolic syndrome as defined by the American Heart Association and National Heart, Lung, and Blood Institute. Self-reported history of kidney stones. Of all adults older than 20 years, 4.7% reported a history of kidney stones. The prevalence of self-reported history of kidney stones increased with the number of metabolic syndrome traits from 3% with 0 traits to 7.5% with 3 traits to 9.8% with 5 traits. After adjustment for age and other covariates, the presence of 2 or more traits significantly increased the odds of self-reported kidney stone disease. The presence of 4 or more traits was associated with an approximate 2-fold increase in odds of self-reported kidney stone disease. Cross-sectional design, absence of dietary data. Metabolic syndrome traits are associated with a self-reported history of kidney stones. This association should be verified in prospective studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cent European J Urol
                Journal ID (iso-abbrev): Cent European J Urol
                Journal ID (publisher-id): CEJU
                Title: Central European Journal of Urology
                Publisher: Polish Urological Association
                ISSN (Print): 2080-4806
                ISSN (Electronic): 2080-4873
                Publication date (Electronic): 17 April 2014
                Publication date (Print): 2014
                Volume: 67
                Issue: 1
                Pages: 58-64
                Affiliations
                Konya Numune State Hospital, Konya, Turkey
                Author notes
                Correspondence Baris Afsar, Konya Numune State Hospital, Ferhuniye Mah., Hastane Caddesi, 42690 Konya, Turkey. phone: +90 332 235 45 00. afsarbrs@ 123456yahoo.com
                Article
                Publisher ID: 00327
                DOI: 10.5173/ceju.2014.01.art13
                PMC ID: 4074717
                SO-VID: 2b8c04ff-9c90-478c-bde9-ddbc5503a5de
                Copyright © Copyright by Polish Urological Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 October 2013
                Date revision received : 23 October 2013
                Date accepted : 25 November 2013
                Categories
                Subject: Original Paper

                Keywords: cortisol,insulin,nephrolithiasis,parathyroid,thyroid
                Data availability:
                Keywords: cortisol, insulin, nephrolithiasis, parathyroid, thyroid

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