October 26, 2004
Other
Question from La Habra, California, USA:
Several years ago, I was diagnosed with diabetes. Because I was 48 years old at the time of diagnosis, my diabetes was presumptively considered to be type 2. Consistent with that diagnosis, I’ve found that I can achieve tight glycemic control (A1cs 4.7 to 5.1) through weight loss, diet, and exercise. However, I must severely restrict my consumption of carbohydrates in order to avoid two or three hour postprandial glucose levels in excess of 140 mg/dL [7.8 mmol/L], the control point recommended by the American College of Endocrinology. So, I typically consume only 20 to 60 grams per day.
More recently, I was diagnosed with mild/moderate inflammatory bowel disease. The pathology is nongranulomatous, but my physician has tentatively concluded that I have Crohn’s rather than ulcerative colitis. My physician suspects that I may also have irritable bowel syndrome, but I’m unsure what evidence supports this opinion.
Also, I have a twenty-year history of kidney stones. Based on an analysis of captured stones, I’ve been told they’re calcium oxalate stones, but they often are not visible on x-ray. This has complicated diagnosis and treatment on several occasions, leading to some very frustrating situations.
About two months ago, I had acute flank pain traced to a bilateral pair of 1-2 cm stones visible on CT scan. A planned lithotripsy was aborted, because the target ureteral stone could not be seen on x-ray. This has prompted a change of opinion regarding the nature of the stones, which are now thought to be uric acid stones. That conclusion hasn’t been confirmed by tests of serum or urine levels of uric acid. However, a relatively acidic urine pH, along with radiotransparency, seems to enough to make the case.
Not being a believer in coincidence, I can’t help but wonder if these three diseases–diabetes, Crohn’s, and uric acid stones–might somehow be related. So far, none of my physicians primary care, urology, or gastroenterology, has suggested or explored this possibility. Are there any potential connections that would be worth exploring? I don’t want to waste the caregiver’s time or resources. But, I also don’t want to fail to recognize an underlying condition that might lead to future problems unless diagnosed and treated.
Answer:
Diabetes is not associated with uric acid stones. There are hereditary and acquired forms of elevated uric acid in blood and urine. Oxalate stones can be associated with intrinsic bowel disease, such as inflammatory bowel disease, although this is not the most common cause of oxalate stones. Malabsorption leads to increased oxalate absorption. This can be antagonized with oral calcium, a drug called cholestyramine, and increased fluids. It would be helpful to know the composition of the stone. On the other hand, there are therapies for urate stones, too.
JTL
