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Stones: Epidemiology and Pathogenesis
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==== Acquired ==== # '''<span style="color:#ff0000">Diabetes''' #* '''Diabetic stone formers have a lower urine pH''' compared with non-diabetic stone formers '''due to insulin resistance''' #** In normal individuals, insulin stimulates ammoniagenesis in renal tubule cells by promoting gluconeogenesis from glutamine and by stimulating ammonium excretion by the proximal tubular sodium/hydrogen exchanger. Failure of the renal tubule cells to respond to insulin '''results in defective ammonia production and/or excretion, thereby leading to a reduction in urinary pH and uric acid stone formation'''. #* '''Diabetic stone formers are approximately 6x more likely to develop a uric acid stone'''. #** Uric acid stones are found in 34% of stone-forming patients with diabetes mellitus compared to 6% of non-diabetic stone formers # '''<span style="color:#ff0000">Obesity</span>''' # '''<span style="color:#ff0000">Metabolic syndrome</span>''' # '''<span style="color:#ff0000">Tumour lysis syndrome</span>''' # '''<span style="color:#ff0000">Volume depletion</span>''' # '''<span style="color:#ff0000">High animal protein intake</span>''' # '''<span style="color:#ff0000">Chronic diarrhea</span>''' # '''<span style="color:#ff0000">Uricosuric drugs</span>''' # '''<span style="color:#ff0000">Idiopathic</span>''' * '''<span style="color:#ff0000">All 11 conditions associated with hyperuricosuria listed above</span>'''
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