Stress-stones-stress-recurrent stones: a self-propagating cycle? Difficulties in solving this dichotomy
Autor: | Allen L. Rodgers, Montserrat Arzoz-Fabregas, Josep Roca-Antonio, Luis Ibarz-Servio, Dalielah Jappie-Mahomed |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Urology Urinary system 030232 urology & nephrology Physiology Holistic Health Logistic regression Risk Assessment 03 medical and health sciences chemistry.chemical_compound symbols.namesake 0302 clinical medicine Urolithiasis Recurrence Risk Factors Stress (linguistics) medicine Humans Chronic stress Magnesium Citrates Life Style Aged Retrospective Studies business.industry Middle Aged medicine.disease Surgery Uric Acid Bonferroni correction chemistry 030220 oncology & carcinogenesis Case-Control Studies Creatinine symbols Uric acid Causal link Kidney stones Female business Stress Psychological |
Zdroj: | Urolithiasis. 45(6) |
ISSN: | 2194-7236 |
Popis: | Numerous studies have reported an association between stress and urolithiasis. Although urinary risk factors have been measured in several of these, compelling evidence of a causal relationship has not been established. A shortcoming is that alterations in single urinary parameters rather than ratios and quotients, which provide a more synergistic risk evaluation, have been measured. Recently, we speculated about a possible association between chronic stress and stone recurrence. This presents an intriguing dichotomy of whether stress causes stones or vice versa, or whether they are linked in a self-propagating stress–stones–stress-recurrence cycle. We investigated the latter hypothesis in a retrospective case–control designed study in which we calculated urinary ratios and quotients which are regarded as diagnostic indicators of stone risk. These included Ca/Cr, Ox/Cr, Mg/Cr, Cit/Cr, urate/Cr and citrate–magnesium–calcium ratios, activity product quotient for calcium oxalate (CaOx) and relative supersaturation of CaOx, brushite and uric acid. Overnight urinary data from 128 participants comprising 31 first time (FS), 33 recurrent (RS) CaOx stone formers and 64 controls were used. All subjects had been previously assessed for chronic stress dimensions, as well as for stress caused by their stone episodes per se. Conditional and unconditional logistic regression (with a Bonferroni correction for multiple tests) and simple linear regression were used to analyse various components of the data. Although RS had more stressful life events, with greater intensity of perception than FS, there were no significant differences between the groups regarding any of the urinary risk factors. No significant association between stressful life events and any of the urinary ratios or quotients was observed. A direct causal link between stress and stone recurrence was not indicated. We believe that future studies should shift their focus from traditional urinary risk factors to other stone-forming mechanisms. However, we recognize that there is an inherent problem in attempting to solve the stress–stones dichotomy as it would be impossible to disentangle alterations in risk factors which arise from lifestyle stress and those arising from stone episodes themselves. |
Databáze: | OpenAIRE |
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