Estimation of urinary citrate , calcium and PH levels in diabetic patients and the risk of urinary stone formation in correlation with type of disease

Abstract

Objectives : This study  designed to  evaluate urinary value of  calcium , citrate , and  the PH  then  assess the relation between urinary calcium and citrate with  fasting blood sugar and evaluate the risk of  renal stones in diabetes patients dependent of their type (type 1 and type 2)   .

     Patients and methods :Fifty four  diabetic patients  selected with no history of hypertension,  no heart disease , and no other disease  or smoking. Fasting blood  and 24 hour urine samples were collected  to evaluate fasting blood sugar, urine calcium, urine citrate , and urine PH.

      Results: 30 male (55.6 %) and 24 women (44.4%) in a total of 54 patients with diabetes mellitus, aged between  20-65 years.  The statistic results of  DM type  are 25(46.3 %)  with type 1 and 29 (53.7 %) with type 2. F.B.S increased (11.79 ± 4.66 mmol/l ) significantly (P < 0.01) as compared to healthy individuals (4.5  ± 0.98 mmol/l). Urine calcium significantly elevated  in DM patients (6.184  ± 1.67 mmol/day ) . Urine citrate significantly decreased ( 0.47 ± 0.57 mmol/day )  comparing with healthy individual (2.22 ± 0.55 mmol/day ). Urine PH (4.46  ±  0.50) significantly (P < 0.05) lower than control (6.16 ± 0.38 ). There are  a positive correlation between F.B.S  and urine calcium for all patients but there are adverse correlation with  urinary citrate .  There are no significant differences (P > 0.05 )  in FBS and urine calcium  between DM types except in  urine citrate  (P  < 0.01 ),  and urine PH (P  < 0.05 ) significantly decreased in type 2.

    Conclusion: Findings from this study suggest that poor control of  diabetes result in increased  the risk of urinary stone by causing  hypercalciuria, hypocitruturia, and urine acidity  . Urine citrate concentration  and PH level are more sensitive to the metabolic changes in diabetic patients  and correlated with type of disease,  their  levels in  type 2 diabetic patients  are significantly lower than type 1, so both types of diabetes have relative risk of prevalent stone disease but  type 2 diabetic patients  predisposes  to calcium Urolithiasis more than type 1.