Abstract
Nephrolithiasis is considered a systemic disease. A link has been established between nephrolithiasis, cardiovascular disease (CVD), the metabolic syndrome and atherosclerosis. A significant correlation has been found between the high levels of oxidized low-density lipoprotein (oxLDL) and CVD and atherosclerosis, including coronary and femoral artery disease. To the best of our knowledge, oxLDL has not been evaluated in patients with nephrolithiasis. This study aimed to evaluate serum levels of oxLDL, anti-oxLDL antibodies (oxLDL-ab) and other markers of atherosclerosis in patients with nephrolithiasis, according to the severity of the disease. The population sample consisted of 94 patients of 30–70 years of age with no symptoms of CVD who presented with renal calculi documented by ultrasonography, abdominal X-ray or computed tomography. The patients were divided into two groups: Group 1 (≥ 3 stones) and Group 2 (1–2 stones). A comparison control group was formed with 21 healthy individuals. Enzyme-linked immunosorbent assays were used to assess oxLDL and oxLDL-ab. Lipid peroxidation indexes were also analyzed. Median serum oxLDL values were higher in Groups 1 and 2 compared to the control group (≥ 3 stones, p = 0.02; 1–2 stones, p = 0.03). Median serum anti-oxLDL antibody levels were lower in the patients in Group 1 compared to the controls (p = 0.03). There was no significant difference in the oxLDL/oxLDL-ab ratio between patients and controls. These findings suggest that this may be the link between nephrolithiasis and the greater incidence of atherosclerosis and cardiovascular disease in patients with kidney stones.
Similar content being viewed by others
References
Khan SR (2012) Is oxidative stress, a link between nephrolithiasis and obesity, hypertension, diabetes, chronic kidney disease, metabolic syndrome? Urol Res 40:95–112. https://doi.org/10.1007/s00240-011-0448-9
Khan SR, Canales BK (2015) Unified theory on the pathogenesis of Randall’s plaques and plugs. Urolithiasis 43(Suppl 1):109–123. https://doi.org/10.1007/s00240-014-0705-9
Shoag J, Tasian GE, Goldfarb DS, Eisner BH (2015) The new epidemiology of nephrolithiasis. Adv Chronic Kidney Dis 22:273–278. https://doi.org/10.1053/j.ackd.2015.04.004
Pfau A, Knauf F (2016) Update on nephrolithiasis: core curriculum 2016. Am J Kidney Dis 68:973–985. https://doi.org/10.1053/j.ajkd.2016.05.016
Wong YV, Cook P, Somani BK (2015) The association of metabolic syndrome and urolithiasis. Int J Endocrinol 2015:570674. https://doi.org/10.1155/2015/570674
Worcester EM, Coe FL (2010) Clinical practice. Calcium kidney stones. N Engl J Med 363:954–963. https://doi.org/10.1056/NEJMcp1001011
Sakhaee K, Maalouf NM, Sinnott B (2012) Clinical review. Kidney stones 2012: pathogenesis, diagnosis, and management. J Clin Endocrinol Metab 97:1847–1860. https://doi.org/10.1210/jc.2011-3492
Gambaro G, Trinchieri A (2016) Recent advances in managing and understanding nephrolithiasis/nephrocalcinosis. F1000Res. https://doi.org/10.12688/f1000research.7126.1
Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R (2010) An update and practical guide to renal stone management. Nephron Clin Pract 116:c159–c171. https://doi.org/10.1159/000317196
Jeong IG, Kang T, Bang JK, Park J, Kim W, Hwang SS, Kim HK, Park HK (2011) Association between metabolic syndrome and the presence of kidney stones in a screened population. Am J Kidney Dis 58:383–388. https://doi.org/10.1053/j.ajkd.2011.03.021
Hamano S, Nakatsu H, Suzuki N, Tomioka S, Tanaka M, Murakami S (2005) Kidney stone disease and risk factors for coronary heart disease. Int J Urol 12:859–863. https://doi.org/10.1111/j.1442-2042.2005.01160.x
Gambaro G, Ferraro PM, Capasso G (2012) Calcium nephrolithiasis, metabolic syndrome and the cardiovascular risk. Nephrol Dial Transpl 27:3008–3010. https://doi.org/10.1093/ndt/gfs139
Ramaswamy K, Shah O (2014) Metabolic syndrome and nephrolithiasis. Transl Androl Urol 3:285–295. https://doi.org/10.3978/j.issn.2223-4683.2014.06.03
Joshi S, Peck AB, Khan SR (2013) NADPH oxidase as a therapeutic target for oxalate induced injury in kidneys. Oxid Med Cell Longev 2013:462361. https://doi.org/10.1155/2013/462361
Khan SR (2014) Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis. Transl Androl Urol 3:256–276. https://doi.org/10.3978/j.issn.2223-4683.2014.06.04
Chung HJ (2014) The role of Randall plaques on kidney stone formation. Transl Androl Urol 3:251–254. https://doi.org/10.3978/j.issn.2223-4683
Coe FL, Evan AP, Worcester EM, Lingeman JE (2010) Three pathways for human kidney stone formation. Urol Res 38:147–160. https://doi.org/10.1007/s00240-010-0271-8
Bagga HS, Chi T, Miller J, Stoller ML (2013) New insights into the pathogenesis of renal calculi. Urol Clin N Am 40:1–12. https://doi.org/10.1016/j.ucl.2012.09.006
Shavit L, Girfoglio D, Vijav V, Goldsmith D, Ferraro PM, Moochhala SH, Unwin R (2015) Vascular calcification and bone mineral density in recurrent kidney stone formers. Clin J Am Soc Nephrol 10:278–285. https://doi.org/10.2215/CJN.06030614
Alexander RT, Hemmelgarn BR, Wiebe N, Bello A, Samuel S, Klarenbach SW, Curhan GC, Tonelli M, Alberta Kidney Disease Network (2014) Kidney stones and cardiovascular events: a cohort study. Clin J Am Soc Nephrol 9:506–512. https://doi.org/10.2215/CJN.04960513
Ferraro PM, Tylor EN, Eisner BH, Gambaro G, Rimm EB, Mukamal KJ, Curhan GC (2013) History of kidney stones and the risk of coronary heart disease. JAMA 310:408–415. https://doi.org/10.1001/jama.2013.8780
Rule AD, Roger VL, Melton LJ 3rd, Bergstralh EJ, Li X, Peyser PA, Krambeck AE, Lieske JC (2010) Kidney stones associate with increased risk for myocardial infarction. J Am Soc Nephrol 10:1641–1644. https://doi.org/10.1681/ASN.2010030253
Eisner BH, Cooperberg MR, Curhan GC et al (2007) Nephrolithiasis and the risk of cardiovascular disease. J Urol 177:449
Reiner AP, Khan A, Eisner BH, Pletcher MJ, Sadetsky N, Dale Williams O, Polak JF, Jacobs DR, Stoller ML (2011) Kidney stones and subclinical atherosclerosis in young adults: Coronary Artery Risk Development in Young Adults (CARDIA) study. J Urol. https://doi.org/10.1016/j.juro.2010.10.086
Khan SR (2013) Reactive oxygen species as the molecular modulators of calcium oxalate kidney stone formation: evidence from clinical and experimental investigations. J Urol 189:803–811. https://doi.org/10.1016/j.juro.2012.05.078
Rafleian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H (2014) Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med 5:927–946
Libby P, Ridker PM, Hansson GK (2011) Progress and challenges in translating the biology of atherosclerosis. Nature 473:317–325. https://doi.org/10.1038/nature10146
Wang T, Palucci D, Law K, Yanagawa B, Yam J, Butany J (2012) Atherosclerosis: pathogenesis and pathology. Diagn Histopathol 18:461–467. https://doi.org/10.1016/j.mpdhp.2012.09.004
Hansson GK (2001) Immune mechanisms in atherosclerosis. Arterioscler Thromb Vasc Biol 21:1876–1890. https://doi.org/10.1161/hq1201.100220
Huang Y, Song L, Wu S, Fan F, Lopes-Virella MF (2001) Oxidized LDL differentially regulates MMP-1 and TIMP-1 expression in vascular endothelial cells. Atherosclerosis 156:119–125. https://doi.org/10.1016/S0021-9150(00)00638-9
Shah PK, Falk E, Badimon JJ, Fernandez-Ortiz A, Mailhac A, Villareal-Levy G, Fallon JT, Regnstrom J, Fuster V (1995) Human monocyte-derived macrophages induce collagen breakdown in fibrous caps of atherosclerotic plaques. Potential role of matrix-degrading metalloproteinases and implications for plaque rupture. Circulation 92:1565–1569
Duarte M, Moresco RN, Bem AF (2008) [Assays for measurement of oxidized low-density lipoprotein and its application as a marker of cardiovascular risk]. Rev Bras Anal Clin 40:101–106
Tsimikas S, Bergmark C, Beyer RW, Patel R, Pattison J, Miller E, Juliano J, Witztum JL (2003) Temporal increases in plasma markers of oxidized low-density lipoprotein strongly reflect the presence of acute coronary syndrome. J Am Coll Cardiol 41:360–370. https://doi.org/10.1016/S0735-1097(02)02769-9
Goyal T, Mitra S, Khaidakov M, Wang X, Singla S, Ding Z, Liu S, Mehta JL (2012) Current concepts of the role of oxidized LDL receptors in atherosclerosis. Curr Atheros Rep 14:150–159. https://doi.org/10.1007/s11883-012-0228-1
Trpkovic A, Resanovic I, Stanimirovic J, Radak D, Mousa SA, Cenic-Milosevic D, Jevremovic D, Isenovic ER (2015) Oxidized low-density lipoprotein as a biomarker of cardiovascular diseases. Crit Rev Clin Lab Sci 52:70–85. https://doi.org/10.3109/10408363.2014.992063
Linna M, Ahotupa M, Löppönen MK, Irjala K, Vasnkari T (2013) Circulating oxidized LDL lipids, when proportioned to HDL-c, emerged as a risk factor of all-cause mortality in a population-based survival study. Age Ageing 42:110–113. https://doi.org/10.1093/ageing/afs074
Santos AO, Fonseca FA, Fisher SM, Monteiro CM, Brandão SA, Póvoa RM, Bombig MT, Carvalho AC, Monteiro AM, Ramos E, Gidlund M, Figueiredo Neto AM, Izar MC (2009) High circulating autoantibodies against human oxidized low-density lipoprotein are related to stable and lower titers to unstable clinical situation. Clin Chim Acta 406:113–118. https://doi.org/10.1016/j.cca.2009.06.005
Medeiros AM, Von Mühlen CA, Gidlund MA, Bodanese R, Gottlieb MG, Bodanese LC (2010) Antibodies against oxLDL and acute coronary syndrome. Arq Bras Cardiol 95:47–54. https://doi.org/10.1590/S0066-782X2010005000063
Nowak B, Szmyrka-Kaczmarek M, Durazińska A, Plaksej R, Borysewicz K, Korman L, Wiland P (2012) Anti-ox-LDL antibodies and anti-ox-LDL-B2GPI antibodies in patients with systemic lupus erythematosus. Adv Clin Exp Med 21:331–335
Hasna A, Meiyappan K, Periyasam SG, Kalyaperumal M, Bobby Z, Subramaniam AV (2015) Is urolithiasis associated with increased levels of high sensitivity C-reactive protein and interleukin-6 in diabetic patients? J Clin Diagn Res 9:BC01–BC03. https://doi.org/10.7860/JCDR/2015/12489.5681
Yencilek E, Sari H, Yencilek F, Yeşil E, Aydın H (2017) Systemic endothelial function measured by flow-mediated dilation is impaired in patients with urolithiasis. Urolithiasis 45:545–552. https://doi.org/10.1007/s00240-016-0941-2
Girona J, Manzanares JM, Marimón F, Cabré A, Heras M, Guardiola M, Ribalta J, Masana L (2008) Oxidized to non-oxidized lipoprotein ratios are associated with arteriosclerosis and the metabolic syndrome in diabetic patients. Nutr Metab Cardiovasc Dis 18:380–387. https://doi.org/10.1016/j.numecd.2007.04.002
Kim S, Chang Y, Sung E, Kang JG, Yun KE, Jung HS, Hyun YY, Lee KB, Joo KJ, Shin H, Ryu S (2018) Association between sonographically diagnosed nephrolithiasis and subclinical coronary artery calcification in adults. Am J Kidney Dis 71:35–41. https://doi.org/10.1053/j.ajkd.2017.06.026
Smith-Bindman R, Aubin C, Bailitz J et al (2014) Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med 371:1100–1110. https://doi.org/10.1056/NEJMoa1404446
Acknowledgements
The authors are grateful to the staff of the translational research laboratory, Instituto de Medicina Integral Prof. Fernando Figueira for their support in the analysis.
Funding
This study was funded by the Fundação de Amparo à Ciência e Tecnologia do Estado de Pernambuco (FACEPE; Grant no. APQ-351-4.01/11).
Author information
Authors and Affiliations
Contributions
ACPF conceived the original idea for the study, provided intellectual content and reviewed the manuscript. MCM contributed to the analysis of the ELISA findings. LCT and MCMBD contributed to the development of the study protocol and were involved in the evaluation and interpretation of the results and in the preparation of the manuscript. DEC and NS provided intellectual content of critical importance to the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed were in accordance with the ethical standards of the 1964 Helsinki declaration. The internal review board of the Instituto de Medicina Integral Prof. Fernando Figueira approved the study protocol under reference number CAAE 21614613.0.0000.5201.
Informed consent
Informed consent was obtained from all the individual participants included in the study.
Additional information
In memoriam: Nestor Schor.
Rights and permissions
About this article
Cite this article
de Freitas, A.C.P., Torres, L.C., Duarte, M.d.M.B. et al. Is oxidized low-density lipoprotein the connection between atherosclerosis, cardiovascular risk and nephrolithiasis?. Urolithiasis 47, 347–356 (2019). https://doi.org/10.1007/s00240-018-1082-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-018-1082-6