J Rheum Dis.  2018 Apr;25(2):116-121. 10.4078/jrd.2018.25.2.116.

Is the Serum Uric Acid Level Independently Associated with Incidental Urolithiasis?

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 2Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.
  • 3Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. mdjsoh@amc.seoul.kr

Abstract


OBJECTIVE
Urolithiasis is one of the manifestations of gout and the risk is higher in gouty patients. On the other hand, an independent association between the urinary stone and serum uric acid (UA) level has not been established. This study examined whether the risk of urolithiasis increases with increasing serum UA level.
METHODS
Among the people who visited a tertiary hospital from 2010 to 2013, 13,964 individuals who underwent both ultrasonography and a laboratory test were recruited in the study. The risk of urolithiasis on ultrasonography was analyzed in association with the serum UA level by multiple logistic regression analysis with an adjustment for age, sex, body mass index, estimated glomerular filtration rate, and known underlying diseases, including diabetes mellitus and hypertension.
RESULTS
Among the 6,743 men (48.3%) and 7,221 women (51.7%), the age was 51.3±13.5 and the serum UA level was 4.5±2.1 mg/dL. Hyperuricemia (>7 mg/dL) was observed in 1,381 cases (9.9%). Urolithiasis was detected by ultrasonography in 608 cases (4.4%). The detection rates of urolithiasis in individuals with hyperuricemia and normouricemia were 5.9% and 4.1%, respectively (p=0.001). Multiple logistic regression analysis showed that individuals with hyperuricemia had a significantly higher risk of urolithiasis (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI], 1.20~1.96; p=0.001). A comparison of the highest with the lowest quartile of serum UA revealed a multivariable-adjusted OR of 3.17 (95% CI, 1.98~5.11) for men and 1.79 (1.08~2.93) for women.
CONCLUSION
These results suggest that individuals with a higher serum UA level have a higher risk of subclinical and clinical urolithiasis.

Keyword

Uric acid; Hyperuricemia; Urolithiasis; Urinary calculi; Gout

MeSH Terms

Body Mass Index
Diabetes Mellitus
Female
Glomerular Filtration Rate
Gout
Hand
Humans
Hypertension
Hyperuricemia
Logistic Models
Male
Odds Ratio
Tertiary Care Centers
Ultrasonography
Uric Acid*
Urinary Calculi
Urolithiasis*
Uric Acid

Figure

  • Figure 1. Proportion of urolithiasis according to serum uric acid levels.

  • Figure 2. Plots of odds ratios (ORs) for urolithiasis according to serum uric acid level, age, glomerular filtration rate (GFR), presence of diabetes mellitus, presence of hypertension, body mass index, and serum uric acid quartile. Squares and horizontal bars represent ORs and 95% confidence intervals (CIs), respectively. *p<0.05, **p<0.01, ***p<0.001.

  • Figure 3. Effect plots showing the predicted probabilities and 95% confidence intervals (represented by shaded areas or error bars) for urolithiasis based on the multivariable logistic regression model.


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