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Kidney stones - Risk Factors

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of kidney stones.

Alternative Names

Calcium stones; Nephrolithiasis

Risk Factors:

Kidney stones are one of the most common disorders of the urinary tract. They are an ancient health problem. Evidence of kidney stones has been found in an Egyptian mummy estimated to be more than 7,000 years old.

At this time, studies suggest kidney stones affect more than 5% of Americans and that the rate has increased since the 1970s.

Gender and Age

Men. Kidney stones are more common in men than women. The risk of kidney stones increases in men in their 40s and continues to rise until age 70. Caucasian men have a higher risk than other groups.

Women. The risk of kidney stones peaks in a woman's 50s. In younger women, stones are more likely to develop during the late stages of pregnancy. Pregnant women tend to have a higher calcium intake, but their kidneys do not handle the calcium as well as they did prior to pregnancy. Kidney stones are still rare during pregnancy, however, affecting only 1 in 1,500 pregnancies.

Risk Factors in Children. Stones in the urinary tract in children are usually due to genetic factors. Most of the time, the cause is too much calcium in the urine (hypercalciuria). Deformities in the urinary tract pose a significant risk for kidney stones in children. Children with low birth weight who need to be fed intravenously are also at risk for stones.

Obesity and Weight Gain

Obesity and weight gain are both associated with an increased risk of kidney stones.

Higher BMIs and larger waist circumferences are both risk factors for kidney stones. Researchers think that there may be a link between fat tissue, insulin resistance, and urine composition. People with larger body sizes may excrete more calcium and uric acid, which increase the risk of kidney stone formation.

Family History

A family history of kidney stones increases one's risk for the condition. Researchers are looking into markers or other factors that might predict kidney stones in relatives, although none has yet been clearly identified. A family history of gout may also make a person vulnerable to stones.

Ethnicity

Caucasians seem to have the highest incidence of kidney stones, followed by Mexican Americans. African-Americans have the lowest risk.

Geographical Differences

Dietary factors, minerals in local water, or both may contribute to geographic differences that have been observed in the occurrence of kidney stones. Studies have reported the highest occurrence of kidney stones in the southern region of the United States and the lowest occurrence in the west.

Lifestyle Factors

Specific Foods. In general, certain foods increase the risk for stones only in people who have a genetic or medical vulnerability. People whose diets are high in animal protein and low in fiber and fluids may be at higher risk for stones. A number of foods contain oxalic acid, but there is no proof that such foods make any major contribution to calcium oxalate stones in people who do not have other risk factors. However, several studies have shown that increasing dietary calcium and restricting salt, animal protein, and foods rich in oxalate can help prevent calcium oxalate stones from returning.

Stress. One study reported that people who had a major, stressful life experience were more likely to develop stones than those who had not had a stressful experience. Some experts speculate that this increased risk may be due to a hormone called vasopressin, which is released in response to stress. Vasopressin also increases the concentration of urine.

Being Bedridden. Any medical or physical condition that keeps a person in bed or immobile increases blood levels of calcium from bone breakdown, thereby posing a risk for stone formation.

Medical Conditions

Gout. Patients with gout are at a high risk of uric acid stones.

High Blood Pressure. People with high blood pressure are up to three times more likely to develop kidney stones. It is not entirely clear whether having high blood pressure increases the risk for a stone, or if stones lead to high blood pressure, or there is an action linking both.

Inflammatory Bowel Disease. Crohn's disease and ulcerative colitis cause problems in the absorption of substances in the intestines. These problems significantly increase the risk for kidney stones, particularly in men.

Urinary Tract Infections. Urinary tract infections (UTI) are almost always the cause of struvite stones.

Hyperparathyroidism. The parathyroid glands regulate calcium levels in the body through parathyroid hormone. In hyperparathyroidism, one or more of these glands makes too much parathyroid hormone. Some people with hyperparathyroidism develop kidney stones. Surgery to remove the hyperactive parathyroid gland in such patients reduces the risk for stone formation, but the risk still remains high for some time after surgery.

Other Medical Conditions. Kidney disease, chronic diarrhea, certain cancers (such as leukemia and lymphoma), and sarcoidosis (swelling around the organs) put people at higher risk for stones.

Medications

AIDS medications. More than 10% of AIDS patients who take the medicine indinavir develop stones. The risk is even higher in people with AIDS who also have hepatitis B, hepatitis C, or hemophilia, as well as those who are very thin or who take the antibiotic combination TMP-SMX.

Other Drugs. Kidney stones are a rare side effect of thyroid hormones and loop diuretics (drugs that increase urination). In fact, diuretics are also used to prevent calcium stones. Certain cancer chemotherapies can also cause kidney stones. Long-term use of medications such as antacids, which change the acidic content of urine, may increase the risk for kidney stones.

Resources

References

Cameron MA, Maalouf NM, Adams-Huet B, Moe OW, Sakhaee K. Urine composition in type 2 diabetes: predisposition to uric Acid nephrolithiasis. J Am Soc Nephrol. 2006 May;17(5):1422-1428. Epub 2006 Apr 5.

Cameron MA, Sakhaee K. Uric acid nephrolithiasis. Urol Clin North Am. 2007;34(3):335-346.

Chandhoke PS. Evaluation of the recurrent stone former. Urol Clin North Am. 2007; 34(3):315-322.

Finkielstein VA. Strategies for preventing calcium oxalate stones. CMAJ. 2006;174(10):1407-1409.

Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol. 2006;175(5):1742-1747.

Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. In: Wein AJ, ed. Wein: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders; 2007:chap 44.

Miller NL, Evan AP, Lingeman JE. Pathogenesis of renal calculi. Urol Clin North Am. 2007; 34(3):295-313.

Monk RD, Bushinsky DA. Kidney Stones. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008.

Pietrow PK, Preminger GM. "Evaluation and Medical Management of Urinary Lithiasis." In: Wein AJ, Kavoussi LR, Novick AC, et al. (eds.) Wein: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders; 2007.

Sinha MK, Collazo-Clavell ML, Rule A, et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney International. 2007;72:100-107.

Straub M, Hautmann RE. Developments in stone prevention. Curr Opin Urol. 2005;15(2):119-126.

Taylor EN, Stampfer MJ, Curhan GC. Fatty acid intake and incident nephrolithiasis. Am J Kidney Dis. 2005;45(2):267-274.

Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455-462.

Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int. 2005;68(3):1230-1235.

Wasserstein AG. Nephrolithiasis. American Journal of Kidney Diseases. 45(2);2005:422-428.

Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am. 2007;34(3):409-419.

  • Reviewed last on: 7/27/2009
  • Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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