The relationship between uric acid and dyslipidemia in type 2 diabetic patients with urolithiasis
Keywords:insulin resistance, lipid profile, triglyceride glucose index, type 2 diabetes mellitus, uric acid, urolithiasis
Background and objectives: Type 2 diabetes mellitus (DM) is characterized by insulin resistance, which can increase the risk of kidney stone formation. This study aimed to find out the association between serum levels of uric acid and lipid profile in type 2 DM patients with urolithiasis in comparison to those without.
Methods: This cross-sectional study was conducted with the approval of the institutional ethical review committee for human studies. A total of 60 type 2 DM patients were included in the study and grouped as patients with urolithiasis and patients without urolithiasis. Biochemical parameters studied were glucose, urea, creatinine, uric acid, serum uric acid to creatinine ratio, lipid profile, HbA1c, and triglyceride glucose index as a measure of insulin resistance.
Results: A significant increase was found in uric acid, urea, serum uric acid to creatinine ratio, and triglyceride glucose index level in type 2 DM urolithiasis cases as compared to DM cases without urolithiasis. It was also found that total cholesterol, triglycerides, LDL-cholesterol, and VLDL-cholesterol levels were significantly elevated and HDL-cholesterol was significantly decreased in urolithiasis cases. Serum uric acid level was positively correlated with total cholesterol, triglycerides, LDL-cholesterol, and VLDL- cholesterol and negatively correlated with HDL-cholesterol in diabetics with urolithiasis.
Conclusions: From this study, it is demonstrated that urolithiasis patients with type 2 DM have higher insulin resistance, altered lipoprotein metabolism, and an increased level of serum uric acid compared to type 2 diabetics without urolithiasis and their lipid components are strongly associated with increased serum uric acid.
Brian H Eisner et al. “Diabetic kidney stone formers excrete more oxalate and have lower urine pH than nondiabetic stone formers”. J Urol 183(6) (2010), pp. 2244–2248. DOI: 10.1016/j.juro.2010.02.007.
C Türk et al. EAU Guidelines on Urolithiasis. 2019.
Daniel G. Fuster et al. “Characterization of the regulation of renal Na+/H+ exchanger NHE3 by insulin”. Am J Physiol Renal Physiol 292(2) (2007), F577–F585. DOI: 10.1152/ajprenal.00240.2006.
E S Hyams and B R Matlaga. “Economic impact of urinary stones”. Transl Androl Urol 3(3) (2014), pp. 278–283. DOI: 10.3978/j.issn.2223-4683.2014.07.02.
Fabio Cesar Miranda Torricelli et al. “Dyslipidemia and kidney stone risk”. J Urol 191(3) (2014), pp. 667–672. DOI: 10.1016/j.juro.2013.09.022.
Fernando Guerrero-Romero et al. “The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp”. J Clin Endocrinol Metab 95(7) (2010), pp. 3347–3351. DOI: 10.1210/jc.2010-0288.
Gisela Unger et al. “Triglycerides and glucose index: a useful indicator of insulin resistance”. Endocrinol Nutr 61(10) (2014), pp. 533–540.
H Beck-Nielsen and L C Groop. “Metabolic and genetic characterization of prediabetic states. Sequence of events leading to non-insulin-dependent diabetes mellitus”. J Clin Invest 94(5) (1994), pp. 1714–1721. DOI: 10.1172/JCI117518.
Hanhan Li et al. “Role of insulin resistance in uric acid nephrolithiasis”. World J Nephrol 3(4) (2014), pp. 237–242. DOI: 10.5527/wjn.v3.i4.237.
Ho Won Kang et al. “Hypertriglyceridemia and low high-density lipoprotein cholesterolemia are associated with increased hazard for urolithiasis”. J Endourol 28(8) (2014), pp. 1001–1005. DOI: 10.1089/end.2014.0135.
I. Alexandru Bobulescu, Orson W. Moe, and Orson W. Moe. “Luminal Na+/H+ exchange in the proximal tubule”. Pflugers Arch 458(1) (2009), pp. 5–21. DOI: 10.1007/s00424-008-0595-1.
International Diabetes Federation. IDF Diabetes Atlas. Brussels. 2017. URL: https://diabetesatlas.org/.
J Kerstetter et al. “Mineral homeostasis in obesity: effects of euglycemic hyperinsulinemia”. Metabolism 40(7) (1991), pp. 707–713. DOI: 10.1016/0026-0495(91)90088-e.
James H Masterson et al. “Dyslipidemia is associated with an increased risk of nephrolithiasis”. Urolithiasis 43(1) (2015), pp. 49–53. DOI: 10.1007/s00240-014-0719-3.
Marshall L Stoller et al. “The primary stone event: a new hypothesis involving a vascular etiology”. J Urol 171(5) (2004), pp. 1920–1924. DOI: 10.1097/01.ju.0000120291.90839.49.
Mehmet Inci et al. “Association between body mass index, lipid profiles, and types of urinary stones”. Ren Fail 34(9) (2012), pp. 1140–1143. DOI: 10.3109/0886022X.2012.713298.
Minkook Son, Jeongkuk Seo, and Sung Yang. “Association between dyslipidemia and serum uric acid levels in Korean adults: Korea National Health and Nutrition Examination Survey 2016-2017”. PLoS One 15(2) (2020), e0228684–e0228684. DOI: 10.1371/journal.pone.0228684.
Moira A Petit et al. “Bone mass and strength in older men with type 2 diabetes: the Osteoporotic Fractures in Men Study”. J Bone Miner Res 25(2) (2010), pp. 285–291. DOI: 10.1359/jbmr.090725.
Naim M Maalouf et al. “Association of urinary pH with body weight in nephrolithiasis”. Kidney Int 65(4) (2004), pp. 1422–1425. DOI: 10.1111/j.1523-1755.2004.00522.x.
Nicola Abate et al. “The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance”. Kidney Int 65(2) (2004), pp. 386–392. DOI: 10.1111/j.1523-1755.2004.00386.x.
Ryosuke Ando et al. “Impact of insulin resistance, insulin and adiponectin on kidney stones in the Japanese population”. Int J Urol 18(2) (2011), pp. 131–138. DOI: 10.1111/j.1442-2042.2010.02690.x.
S M Bagnasco et al. “The regulation of renal ammoniagenesis in the rat by extracellular factors. III. Effects of various fuels on in vitro ammoniagenesis”. Metabolism 32(9) (1983), pp. 900–905. DOI: 10.1016/0026-0495(83)90204-4.
Sarawut Lapmanee et al. “High dietary cholesterol masks type 2 diabetes-induced osteopenia and changes in bone microstructure in rats”. Lipids 49(10) (2014), pp. 975–986. DOI: 10.1007/s11745-014-3950-3.
William Gustavo Lima, Maria Emília Soares Martins-Santos, and Valéria Ernestânia Chaves. “Uric acid as a modulator of glucose and lipid metabolism”. Biochimie 116 (), pp. 17–23. DOI: 10.1016/j.biochi.2015.06.025.
Y V Wong, P Cook, and B K Somani. “The association of metabolic syndrome and urolithiasis”. Int J Endocrinol 2015 (2015), pp. 570674–570674. DOI: 10.1155/2015/570674.
How to Cite
Copyright (c) 2022 Dona Devasia, V Nimisha
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The authors retain all proprietary rights, including copyright, such as patent and trade mark rights and rights to any process or procedure described in the article.