title: Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients.
abstract: OBJECTIVE
  Previous studies have demonstrated that obesity can increase the risk of stone formation as well as recurrence rates of stone disease. Yet appropriate medical management can significantly decrease the risk of recurrent stone disease. Therefore, we analyzed our obese patient population, assessing the risk factors for stone formation and the impact of selective medical therapy on recurrent stone formation.
  
  
  METHODS
  A retrospective chart review was performed to identify obese patients with stone disease from our Stone Center. Metabolic risk factors for stones were identified as well as patient response to medical therapy. A similar analysis was performed on a group of age and sex matched nonobese stone formers.
  
  
  RESULTS
  Of 1,021 patients 140 (14%) were identified as obese (body mass index greater than 30). Of these patients complete metabolic evaluations were available in 83 with an average followup of 2.3 years. The most common presenting metabolic abnormalities among these obese patients included gouty diathesis (54%), hypocitraturia (54%) and hyperuricosuria (43%), which presented at levels that were significantly higher than those of the nonobese stone formers (p <0.05). Stone analysis was available in 32 obese patients with 63% having uric acid calculi. After initiating treatment with selective medical therapy obese and nonobese patients demonstrated normalization of metabolic abnormalities, resulting in an average decrease in new stone formation from 1.75 to 0.15 new stones formed per patient per year in both groups.
  
  
  CONCLUSIONS
  Obesity, as a result of dietary indiscretion, probable purine gluttony and possible type II diabetes, appears to have a significant role in recurrent stone formation. Appropriate metabolic evaluation, institution of medical therapy and dietary recommendations to decrease animal protein intake can significantly improve the risk of recurrent stone formation in these often difficult to treat patients.
authors.affiliation: Comprehensive Kidney Stone Center, The Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Wesley O
authors.initials: WO
authors.lastname: Ekeruo
authors.forename: Yeh Hong
authors.initials: YH
authors.lastname: Tan
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Young
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Michaella E
authors.initials: ME
authors.lastname: Maloney
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Mathias
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000652:urine; D015897:Comorbidity; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014527:Uric Acid / Q000652:urine
chemical_list: D014527:Uric Acid; D002118:Calcium