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As stone risk falls, health status may rise


Brian R. Matlaga, MD, MPH Dr. Matlaga is associate professor at the James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore.

 

Medical maladies such as obesity, diabetes mellitus, and hypertension have all been independently associated with an increased risk for nephrolithiasis. Given the dramatic rises in prevalence that all of these diseases have displayed over recent years, there is great interest in better understanding the inter-relationships of these phenomena, as discussed in two articles in this issue of Urology Times.

In many cases, the association between kidney stones and a systemic disease are bidirectional: those with kidney stones are at increased risk for the disease, and vice versa. Therefore, it may be that improvements in overall health status may ameliorate kidney stone risk.

A recent study by Best and associates broadens our understanding of the association between diabetes mellitus and kidney stones, as they investigated the effect of glycemic control, assessed by hemoglobin A1c, on stone composition. Individuals with particularly poor glycemic control were more likely to form uric acid stones, suggesting that improved control of diabetes may reduce the risk of uric acid stone formation.

A logical extension of our understanding of the interplay between kidney stones and systemic disease is that an increasingly healthy lifestyle will be associated with a reduction in stone risk. Sorensen et al have reported that in the Women’s Health Initiative Observational Study, physical activity, even of a very mild degree, significantly reduced kidney stone risk. As the amount of physical activity increased, the reduction in stone formation increased as well.

Krambeck and associates investigated the effect of a healthy work lifestyle on stone risk, as they evaluated whether certain medical work environments increased the likelihood of a stone event. They found that employees who worked in an operating room had a significantly greater prevalence of stone disease compared to those in the medical field who worked elsewhere. Those physicians at greatest risk reported increased stress and less fluid intake in their daily life.

Taking all of these studies together provides the practicing urologist with straightforward ways to counsel our patients on maneuvers to reduce stone risk. Importantly, and reflected in the aforementioned studies, these maneuvers will also increase our patients’ overall health status and ameliorate associated systemic diseases.UT


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