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Type 2 Diabetes Increases the Risk for Uric Acid Stones

Michel Daudon^*, Olivier Traxer, Pierre Conort, Bernard Lacour^* and Paul Jungers

Assistance Publique–Hôpitaux de Paris, ^* Laboratoire de Biochimie A and Service de Néphrologie, Hôpital Necker-Enfants Malades, Service d’Urologie, Hôpital Tenon, and Service d’Urologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

Address correspondence to: Dr. Michel Daudon, AP-HP, Service de Biochimie A, Hôpital Necker-Enfants Malades, 149, Rue de Sèvres, 75743 Paris Cedex 15, France. Phone: +33-01-44-49-51-18; Fax: +33-01-44-49-51-20; E-mail: michel.daudon{at}nck.aphp.fr

Received for publication March 23, 2006. Accepted for publication April 27, 2006.

An increased prevalence of nephrolithiasis has been reported in patients with diabetes. Because insulin resistance, characteristic of the metabolic syndrome and type 2 diabetes, results in lower urine pH through impaired kidney ammoniagenesis and because a low urine pH is the main factor of uric acid (UA) stone formation, it was hypothesized that type 2 diabetes should favor the formation of UA stones. Therefore, the distribution of the main stone components was analyzed in a series of 2464 calculi from 272 (11%) patients with type 2 diabetes and 2192 without type 2 diabetes. The proportion of UA stones was 35.7% in patients with type 2 diabetes and 11.3% in patients without type 2 diabetes (P < 0.0001). Reciprocally, the proportion of patients with type 2 diabetes was significantly higher among UA than among calcium stone formers (27.8 versus 6.9%; P < 0.0001). Stepwise regression analysis identified type 2 diabetes as the strongest factor that was independently associated with the risk for UA stones (odds ratio 6.9; 95% confidence interval 5.5 to 8.8). The proper influence of type 2 diabetes was the most apparent in women and in patients in the lowest age and body mass index classes. In conclusion, in view of the strong association between type 2 diabetes and UA stone formation, it is proposed that UA nephrolithiasis may be added to the conditions that potentially are associated with insulin resistance. Accordingly, it is suggested that patients with UA stones, especially if overweight, should be screened for the presence of type 2 diabetes or components of the metabolic syndrome.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673