Hi,, can someone exaplin to me why that someone is diabetes mellitus have a more acidic urine then say... normal pepople? thank yuou...
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* Printer-FriendlyPrinter-Friendly * Email ThisEmail This Publication Logo Diabetes Acidic urine explains high incidence of uric-acid kidney stones in type 2 diabetes Caroline Cassels Information from Industry Direct Renin Inhibition For Treating HypertensionLearn more about the future importance of direct renin inhibition in the management of hypertension. Review: * Expert Panel Discussion on Direct Renin Inhibition. April 6, 2006 Dallas, TX - Low urine pH may be responsible for the high incidence of uric-acid nephrolithiasis in patients with type 2 diabetes?which can be up to four times greater than in the general population?a new study suggests [1]. The study compared urinary biochemical characteristics of patients with type 2 diabetes with those of normal volunteers and subjects without type 2 diabetes but who had developed uric-acid kidney stones. "According to our study, there appears to be a specific physiologic environment?one with highly acidic urine that is linked to type 2 diabetes and insulin resistance. This acidic urine predisposes people to developing this particular type of kidney stone," principal investigator Dr Mary Ann Cameron (University of Texas Southwestern Medical Center, Dallas) told renalwire. According to Cameron, of the total kidney-stone burden, uric-acid stones make up only about 10% of all kidney stones, but in individuals with type 2 diabetes, the proportion can be as high as 30% to 40%. Published online April 5, 2006, the study will appear in the May 2006 issue of the Journal of the American Society of Nephrology. Three groups of individuals were recruited for the study. They included 24 patients with type 2 diabetes who were non-stone formers, eight patients who did not have type 2 diabetes but were uric-acid stone formers (UASF), and 59 normal volunteers. Exclusion criteria included subjects under 35 years of age and those who were pregnant or who had chronic diarrheal illness, creatinine clearance of <70 mL/min, or liver disease. Patients were also excluded if they were using insulin, thiazolidinediones, or nonsteroidal anti-inflammatory drugs. Type 2 diabetes patients included in the study were being treated with either dietary therapy or oral hypoglycemic agents. "We excluded subjects who received insulin or insulin sensitizers because if acidic urine is in fact due to insulin resistance, medication that affects insulin resistance could also affect urine pH," Cameron said. Participants completed a 24-hour urine collection, and fasting blood samples were obtained. Urinary measurements included total urine volume, pH, creatinine, uric acid, citrate, sulfate, ammonium, titratable acidity, and bicarbonates. Blood measurements included serum electrolytes, creatinine, uric acid, glucose, and insulin. In addition, body weight and height was recorded for all participants. Overweight and obesity not the whole story While the three patient groups were similar with respect to age and sex, weight was significantly greater in patients with type 2 diabetes and UASF than in normal volunteers. In addition, the researchers observed an inverse relationship between weight and urine acidity. "We found that body weight correlated with urine pH such that heavier people had more acidic urine, and this finding was seen across all three patient groups. However, when we compared urine acidity in subjects of similar weights in all three groups, normal volunteers had higher urine pH than the other two groups, no matter what their weight. This suggests that factors other than body weight account for the lower urine pH in patients with type 2 diabetes and uric-acid stone formers." Similarly, said Cameron, when her team measured urine sulfate?an indicator of dietary acid load?normal volunteers had higher urine pH levels regardless of the amount of protein they consumed compared with patients with type 2 diabetes. "So again," said Cameron, "there appears to be something intrinsic to diabetic patients such that their urine is more acidic regardless of their weight or the amount of protein they consume." Possible mechanisms Ultimately, said Cameron, she and her colleagues would like to better understand what causes urine to become so acidic in these particular patient populations. Potential mechanisms, she said, include the possibility that insulin resistance causes increased acid production, which is then excreted in the urine. The other possibility, she said, is that there may be a disruption in the way the kidney processes or buffers acid that causes lower urine pH. In the meantime, said Cameron, it is important for physicians to be aware that their patients with type 2 diabetes are at increased risk for uric-acid stones, particularly in the presence of a low urine pH. Source 1. Cameron M, Maalouf NM, Adams-Huet B, et al. Urine composition in type 2 diabetes: Predisposition to uric acid nephrolithiasis. J Am Soc Nephrol 2006; DOI:10.10.1681/ASN.2005121246. Available at: http://www.jasn.org.
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