Role of insulin resistance in uric acid nephrolithiasis

Abstract

Metabolic syndrome has been implicated in the pathogenesis of uric acid stones. Although not completely understood, its role is supported by many studies demonstrating increased prevalence of uric acid stones in patients with metabolic syndrome and in particular insulin resistance, a major component of metabolic syndrome. This review presents epidemiologic studies demonstrating the association between metabolic syndrome and nephrolithiasis in general as well as the relationship between insulin resistance and uric acid stone formation, in particular. We also review studies that explore the pathophysiologic relationship between insulin resistance and uric acid nephrolithiasis.

Keywords: Nephrolithiasis, Kidney calculi, Uric acid, Insulin resistance, Metabolic syndrome

Core tip: Increasing awareness of the association between prevalence of metabolic syndrome and uric acid nephrolithiasis has caused a closer examination into modifiable risk factors for stone recurrence. The mechanism behind this association is thought to be due to decreased ammoniagenesis as caused by insulin resistance in the proximal tubule of the kidney. The presence or recurrence of uric acid stones should prompt the physician to look for traits of metabolic syndrome. Further studies into this causal relationship may provide additional medical interventions to decrease incident stones.