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Asian Journal of Urology, 2018, 5(4): 215-222    doi: 10.1016/j.ajur.2018.06.002
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The influence of metabolic syndrome and its components on the development of nephrolithiasis
Carter Boydb*(),Kyle Wooda,Dustin Whitakerb,Dean G. Assimosa
a. Department of Urology, University of Alabama-Birmingham, Birmingham, AL, USA
b. University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA
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Abstract: 

The prevalence of kidney stone disease is increasing, afflicting 7%-11% of the United States population. Multiple systemic conditions, including obesity and diabetes, are also on the rise. Further, the literature has demonstrated a strong association between metabolic syndrome, its components, and kidney stone disease. In this article, we aim to review the associations of metabolic syndrome and nephrolithiasis, discussing the pathophysiology, urinary parameters, and clinical presentations. With this knowledge, urologists will have a more comprehensive understanding of this complex population of metabolic stone formers enabling improved patient management and treatment of stone disease.
Key words:  Diabetes    Kidney stone    Metabolic syndrome    Obesity    Oxalate    Uric acid    Urolithiasis
收稿日期:  2017-11-16      修回日期:  2018-01-28           出版日期:  2018-10-20      发布日期:  2018-11-19      整期出版日期:  2018-10-20
引用本文:    
. [J]. Asian Journal of Urology, 2018, 5(4): 215-222.
Carter Boyd,Kyle Wood,Dustin Whitaker,Dean G. Assimos. The influence of metabolic syndrome and its components on the development of nephrolithiasis. Asian Journal of Urology, 2018, 5(4): 215-222.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2018.06.002  或          http://www.ajurology.com/CN/Y2018/V5/I4/215
Factors Values
Waist circumference (cm) >102 (males), >88 (females)
Fasting glucose (mg/dL) ≥100 or Rx
Triglycerides (mg/dL) ≥150 or Rx
High-density lipoprotein (ng/mL) <40 (males), <50 (females), or Rx
Blood pressure (mmHg) >130 (systolic), >85 (diastolic), or Rx
Table 1  NCEP ATP III classification.
Classification Required elements Criteria Obesity Hyperglycemia Dyslipidemia (mg/dL) Hypertension (mmHg) Other criteria
WHO IR Required element and ≥2/5 BMI > 30 kg/m2
M: WHR > 0.9
F: WHR > 0.85		 Present TG ≥ 150 or M: HDL-C < 35
F: HDL-C < 39		 >140/90 Microalbuminuria
EGIR Hyperinsulinemia in non-T2DM patients Required element and ≥2/4 M: WC ≥ 94 cm
F: WC ≥ 80 cm		 Present TG ≥ 150 or HDL-C < 39 >140/90 or Rx
AACE IR Required element + any other element + clinical judgment BMI ≥ 25 kg/m2 Present TG ≥ 150 and M: HDL-C < 40
F: HDL-C < 50		 >130/85 Other features of IR
IDF CO (WC or BMI > 30 kg/m2) Required element and ≥2/4 Not part of criteria Fasting glucose ≥ 100 mg/mL TG ≥ 150 or Rx S ≥ 130
D ≥ 85 or Rx
M: HDL < 40 or Rx
F: HDL < 50 or Rx
Table 2  Metabolic syndrome classifications.
Reference Country Study population Mean age (years) Female (%) MetS criteria MetS population NL definition NL population Prevalence Adjusted OR
West et al. (2008) [27] USA 14 870 50.1 52.4 AHA/NHLBI 4949 Self-reported history 699 History of NL in 8.8% of MetS patients vs. 4.3% in non-MetS patients
Component number
0: 3%
3: 7.5%
5: 9.8%		 E: 1.52
Component number
0: 1.0
1: 1.40
2: 2.09
3: 2.56
4: 3.85
5: 3.42
Rendina et al. (2009) [28] Italy 2 132 63.8 51.3 AHA/NHLBI 725 US and self-reported history 298 50.9% of patients with evidence of NL met criteria for MetS E: 2.0
M: 1.89
F: 2.19
Jeong et al. (2011) [30] Korea 34 895 50.0 40.4 NCEP ATP III 4 779 CT and/or US 839 In MetS, 71% increased OR of kidney stone prevalence vs. non-MetS
Component number
0: 1.75%
1: 2.45%
2: 2.76%
3: 3.87%
4: 3.12%
5: 4.37%		 E: 1.25
Kohjimoto et al. (2013) [52] Japan 11 555 52.5 26.1 Obesity, BMI ≥ 25 kg/m2; hypertension,BP ≥ 140/90 mmHg; dyslipidemia, LDL ≥ 140 mg/dL, HDL < 40 mg/dL, or TG ≥ 150 mg/dL; diabetes, fasting ≥ 126 mg/dL, 2-h 75-g glucose test ≥ 200 mg/dL or HbA1c ≥ 6.5% 6 306 Previous radiologic diagnosis 11 555 Component number
0: 57.7%
1: 61.7%
2: 65.2%
3: 69.3%
4: 73.3%		 E: 1.78
Table 3  Association between MetS and nephrolithiasis.
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