A comparison of the metabolic profiles of diabetic and non-diabetic uric acid stone formers

Introduction: The aim of this study was to compare the metabolic profiles of diabetic and non-diabetic patients with uric acid stones to understand whether preventive strategies should be tailored to reflect different causative factors.Methods: The results of the metabolic evaluation of patients with uric acid stones identified prospectively from the Metabolic Stone Clinic at St. Joseph’s Hospital, London, Canada were reviewed. Information included patients’ clinical histories, 24 hour urine collections, blood chemistry and stone analysis.Results: Complete data were obtained from 68 patients with uric acid stones. Twenty-two patients had diabetes. There were no statistically significant differences in mean age, body mass index, or history of gout. Among diabetics, pure uric acid stones were identified in 14 patients (63%) and mixed uric acid in 8 (36%). Pure uric acid stones were more common in the diabetic cohort (63% vs. 46%, p = 0.16). Urine pH, serum and urine uric acid levels and 24-hour urine volumes were similar in both groups. The diabetic group had an increased average oxalate excretion (424 μmol/d vs. 324 μmol/d, p = 0.003).Conclusion: The exact etiological basis for the higher oxalate excretion in diabetic uric acid stone formers is unclear. Whether this is a metabolic feature of diabetes, due to dietary indiscretion or the iatrogenic consequence of dietary advice requires further investigation.

A comparison of the metabolic profiles of diabetic and non-diabetic uric acid stone formers

INTRODUCTION

The aim of this study was to compare the metabolic profiles of diabetic and non-diabetic patients with uric acid stones to understand whether preventive strategies should be tailored to reflect different causative factors.

METHODS

The results of the metabolic evaluation of patients with uric acid stones identified prospectively from the Metabolic Stone Clinic at St. Joseph's Hospital, London, Canada were reviewed. Information included patients' clinical histories, 24 hour urine collections, blood chemistry and stone analysis.

RESULTS

Complete data were obtained from 68 patients with uric acid stones. Twenty-two patients had diabetes. There were no statistically significant differences in mean age, body mass index, or history of gout. Among diabetics, pure uric acid stones were identified in 14 patients (63%) and mixed uric acid in 8 (36%). Pure uric acid stones were more common in the diabetic cohort (63% vs. 46%, p = 0.16). Urine pH, serum and urine uric acid levels and 24-hour urine volumes were similar in both groups. The diabetic group had an increased average oxalate excretion (424 μmol/d vs. 324 μmol/d, p = 0.003).

CONCLUSION

The exact etiological basis for the higher oxalate excretion in diabetic uric acid stone formers is unclear. Whether this is a metabolic feature of diabetes, due to dietary indiscretion or the iatrogenic consequence of dietary advice requires further investigation.

Simultaneous renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder

Herein we report a rare combination of two urological tumors simultaneously: renal cell carcinoma of the kidney and transitional cell carcinoma of the bladder. A 67 year old male presented with hematuria. He was diagnosed with left renal cell carcinoma and transitional cell carcinoma of the bladder. Subsequently this patient underwent left nephrectomy (palliative) to control the pain and transurethral resection of bladder tumor. The clinical picture, radiographic and histological finding are presented, as well as the treatment offered.