oxalates and Diabetes-Mellitus--Type-2

Oxalate is a metabolic end-product whose systemic concentrations are highly variable among individuals. Genetic (primary hyperoxaluria) and non-genetic (e.g., diet, microbiota, renal and metabolic disease) reasons underlie elevated plasma concentrations and tissue accumulation of oxalate, which is toxic to the body. A classic example is the triad of primary hyperoxaluria, nephrolithiasis, and kidney injury. Lessons learned from this example suggest further investigation of other putative factors associated with oxalate dysmetabolism, namely the identification of precursors (glyoxylate, aromatic amino acids, glyoxal and vitamin C), the regulation of the endogenous pathways that produce oxalate, or the microbiota's contribution to oxalate systemic availability. The association between secondary nephrolithiasis and cardiovascular and metabolic diseases (hypertension, type 2 diabetes, and obesity) inspired the authors to perform this comprehensive review about oxalate dysmetabolism and its relation to cardiometabolic toxicity. This perspective may offer something substantial that helps advance understanding of effective management and draws attention to the novel class of treatments available in clinical practice.

Topics: Diabetes Mellitus, Type 2; Humans; Hyperoxaluria, Primary; Hypertension; Kidney; Nephrolithiasis; Oxalates

Urolithiasis is common and is becoming more prevalent worldwide. This study assessed the chronological trends in clinical and urinary metabolic features over 20 years in Korean urolithiasis patients. We performed a retrospective analysis of 4,076 patients treated at our clinic from 1996 to 2015. Urinary metabolic data and stone analysis data were available for 1,421 and 723 patients (34.9% and 17.7%), respectively. Patients were categorized into 4 groups according to the date of initial diagnosis: group 1 (1996-2000, n = 897), group 2 (2001-2005, n = 1,018), group 3 (2006-2010, n = 1,043), and group 4 (2011-2015, n = 1,118). Incidental detection of uric acid renal stones has become more prevalent in the past 10 years, accompanied by an increase in body mass index and age at diagnosis. Similarly, the prevalence of diabetes mellitus and of hypertension increased from one group to the next throughout the study period. Levels of 24-hour urinary excretion of sodium, calcium, uric acid, and oxalate have decreased significantly over the study period. The incidence of urinary metabolic abnormalities also showed an identical tendency. The proportion of stones composed of uric acid increased over the study period. In conclusion, incidental detection of uric acid renal stones has become more prevalent in Korea in the past 20 years. Urinary excretion of lithogenic constituents and the incidence of urinary metabolic abnormalities have decreased significantly over this period.

Topics: Age Factors; Body Mass Index; Calcium; Diabetes Mellitus, Type 2; Female; Humans; Hypertension; Incidence; Male; Middle Aged; Oxalates; Republic of Korea; Retrospective Studies; Risk Factors; Sodium; Uric Acid; Urolithiasis

The epidemiological relationship between nephrolithiasis and type 2 diabetes mellitus is well-known. Patients with diabetes mellitus are at increased risk for nephrolithiasis and those with nephrolithiasis are at risk for diabetes mellitus. We examined 24-hour urine composition in stone formers with and without diabetes mellitus.. We retrospectively reviewed a database of 462 stone forming patients to examine the relationship between hypertension and 24-hour urine composition. Multivariate linear regression models were adjusted for age, race, gender, body mass index, hypertension, relevant medications and 24-hour urine constituents.. On univariate analysis diabetic patients had significantly greater urine volume than nondiabetic patients (2.5 vs 2.1 l daily, p = 0.004). Those with diabetes mellitus also excreted less daily potassium (61.1 vs 68.8 mEq, p = 0.04), phosphate (0.84 vs 1.0 gm, p = 0.002) and creatinine (1405.5 vs 1562.8 mg, p = 0.03), and had significantly lower daily urine pH (5.78 vs 6.09, p <0.001) and CaP supersaturation (0.49 vs 1.20, p <0.001) than nondiabetic patients. On multivariate analysis compared to patients without diabetes mellitus those with type II diabetes mellitus had significantly lower urine pH (-0.34, 95% CI -0.48 to -0.21) and significantly greater urine oxalate (6.43 mg daily, 95% CI 1.26 to 11.60) and volume (0.38 l daily, 95% CI 0.13 to 0.64).. Results show that of stone formers patients with type II diabetes mellitus excrete significantly greater urinary oxalate and significantly lower urine pH than those without diabetes mellitus. These findings are important for treating nephrolithiasis since they may influence dietary counseling, medical management and stone prevention.

Topics: Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Humans; Hydrogen-Ion Concentration; Kidney Calculi; Male; Middle Aged; Oxalates; Retrospective Studies

Topics: Adult; Citrates; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Oxalates

Among 42 diabetics, there were 32 with the disease remaining uncontrolled after treatment. Their fasting blood glucose was 15.24 +/- 5.37 mmol/L (mean +/- S), urinary glucose 42.6 +/- 47.83 g/24 hr, urinary oxalate 0.43 +/- 0.16 mmol/24 hr and urinary citrate 3.60 +/- 2.28 mmol/24 hr All of these levels were higher than those in a control group (P less than 0.001). Urinary citrate level was significantly positively correlated with fasting blood glucose level (gamma = 0.3954, P less than 0.001). In the remaining 10 diabetics with the disease controlled after treatment the fasting blood glucose was 7.04 +/- 0.92 mmol/L, urinary citrate 1.92 +/- 0.96 mmol/24 hr and urinary oxalate 0.37 +/- 0.11 mmol/24 hr. All of these levels were significantly lower than those before treatment (P less than 0.01) and were not different from those in the control group (P greater than 0.05). This explains that urinary citrate and oxalate increased when diabetes is uncontrolled as a result of accelerated decomposition due to increased metabolism. Urinary oxalate level is correlated positively with that of urinary citrate (gamma = 0.3773, P less than 0.05). Urinary oxalate and citrate are good index reflecting diabetic metabolic changes. Analysis of urinary oxalate with ion-chromatography is accurate and rapid method worthy to be used clinically.

Topics: Adult; Chromatography, Ion Exchange; Citrates; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Oxalates

The changes in blood serum concentrations of calcium, magnesium, inorganic phosphate, total activity of alkaline phosphatase and the activity of its bone fraction, as well as urinary excretion of calcium, phosphate, hydroxyproline and oxalate have been measured in 31 patients with insulin-dependent (type I) diabetes, in 31 patients with non-insulin-dependent (type II) diabetes and in 29 healthy subjects in the condition of low-calcium diet. The elevated urinary excretion of calcium, phosphate, hydroxyproline and oxalate, lowered blood serum level of magnesium, and increased total and bone fraction activities of alkaline phosphatase were found in diabetic patients. The urinary excretion of calcium and hydroxyproline, and the activity of bone fraction alkaline phosphatase were significantly higher in patients with type II diabetes than in those with type I diabetes. It was concluded that there is a significant relation between the state of metabolic normalization of diabetes and the degree of biochemical aberrations concerning calcium-phosphate metabolism.

Topics: Adult; Calcium; Circadian Rhythm; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Hydroxyproline; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Phosphates

Topics: Cell Nucleus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; In Vitro Techniques; Lymphocytes; Oxalates