Pcos / Kidney Stones

¶ … PCOS, Kidney Stones)

DuRant and Leslie provide a basic overview of all known facts concerning the condition known as polycystic ovary syndrome. While this is the most widespread endocrine condition to affect young women (estimates place its incidence at between 5 and 10% of the young female population) it is frequently not diagnosed. The basic diagnostic criteria are indeed somewhat contentious, and presently a diagnosis hinges upon the presence of two of the following three symptoms: irregularities in ovulation (either failure to ovulate or irregular or lengthened menstrual cycle, i.e., oligoovulation), a raised level of male hormones with no other cause, and polycystic ovaries with no other cause. Each of these individual symptoms can, of course, be caused by other conditions, but the presence of two of them with any other conditions (i.e., adrenal tumor) ruled out indicates polycystic ovary syndrome. As the descriptor "syndrome" should indicate, the cause of polycystic ovary syndrome is presently not understood. The consensus is that it involves some defect in the endocrine processes that govern ovulation, in which the hypothalamus and pituitary in the brain communicate chemically with the ovaries to trigger ovulation. The syndrome generally accompanies onset of menarche at age 12 or 13: young women who have polycystic ovary syndrome generally never develop a consistent schedule of menstruation. Other symptoms include those generally associated with heightened androgen levels, including male facial hair, male pattern baldness, and acne. Half of women with polycystic ovary syndrome are obese. However the chief clinical sign is endocrine, indicated by a heightened level of luteinizing hormone and follicle stimulating hormone in the ratio of 2:1 or higher. This heightened hormonal ratio is present in 60 to 70% of patients with the syndrome, and more likely to occur in those who are not obese. Weight control and oral contraceptives (to counteract increased androgens) can alleviate some of the symptoms, but polycystic ovary syndrome correlates to other illnesses later in life like diabetes mellitus, hyperlipidemia, endometrial cancer, and infertility, and thus should be treated as a potential risk factor for these later conditions. In particular, polycystic ovary syndrome is more common in patients who have a prevalence of type 2 diabetes on both sides of the family.

Alexander, Hemmelgarn et al. (2012) conducted a cohort study in which a large (over three million) group of patients had their renal activity monitored. The study ultimately came to focus on the subgroup who had undergone kidney stones: these were followed up with and examined, at a median follow-up period of eleven years, in Alberta, Canada. The goal was to examine patients who had experienced at least one episode of kidney stones and to see if that correlated with any other forms of kidney disease (up to and including end stage renal disease) later in life. The basic measure used for examining the patients on the follow-up visit was the level of serum creatinine, the most basic measure of kidney health that is available to physicians. Those patients who had double the expected serum creatinine level were judged to have chronic kidney disease.