Estimation of urinary citrate , calcium and PH levels in diabetic patients and the risk of urinary stone formation in correlation with type of disease
Keywords:Diabetes mellitus type, Renal stones, Urine calcium, Urine citrate and Urine Ph
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.