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Nephrolithiasis Risk Factors

See Also
1. Nephrolithiasis
General Factors
1. Increases with advancing age up to 65 years
2. Male gender (men account for 66% of cases)
3. Geographic location (hot, arid climates)
  1. Southeastern United States ("stone belt")
  2. Mediterranean countries
  3. Middle Eastern countries
Inherited Conditions
1. Polycystic Kidney Disease
2. Renal Tubular Acidosis
3. Hyperparathyroidism
4. Cystinuria
5. Hypocitraturia
6. Hypercalciuria
Medications
1. Triamterene
2. Sulfonamide
3. Carbonic Anhydrase Inhibitors
4. Indinavir (Crixivan)
5. Acetazolamide (Diamox)
6. Corticosteroids
Dietary and Hydration Factors
1. Low urine volume
  1. Inadequate access to hydration or restrooms
  2. Athlete
  3. Heat exposure
  4. Bowel Disease
    1. Bowel Surgery (e.g. Ileostomy)
    2. Infammatory bowel disease (e.g. Crohn's Disease)
    3. Chronic Diarrhea
    4. Peptic Ulcer Disease
2. Other dietary factors
  1. Animal protein intake (see aciduria below)
    1. Purine Containing Foods and other protein intake
  2. High Oxalate Containing Foods (hyperoxaluria)
  3. Excessive sodium intake (Hypercalciuria risk)
3. Hypercalciuria (70% of stone formers)
  1. Type 1: Increased PTH (resorptive Hypercalciuria)
    1. Hyperparathyroidism
    2. Sarcoidosis
  2. Type 2: Increased Calcium absorption from gut
  3. Type 3: Increased Urinary Phosphorus loss
  4. Type 4: Increased Urinary Calcium loss
4. Hyperoxaluria
  1. Citrate deficiency (not oxalate metabolism problem)
5. Hypocitraturia (Distal Renal Tubular Acidosis)
6. Hyperuricosuria
7. Acidosis and aciduria (results in loss of citrate)
  1. Acetazolamide (Diamox)
  2. Renal Tubular Acidosis
  3. Protein loading (especially with animal protein)
  4. Bowel disease
References
1. Goldfarb (1999) Am Fam Physician 60(8):2269
2. Houshiar (1996) Postgrad Med 100(4):131
3. Mobley (Feb 1999) Hospital Medicine, p. 21-38
4. Trivedi (1996) Postgrad Med 100(6):63

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 3/22/2010. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.