Urology Book

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Nephrolithiasis Risk Factors

Aka: Nephrolithiasis Risk Factors
  1. See Also
    1. Nephrolithiasis
    2. Medication Causes of Nephrolithiasis
  2. Risk Factors: General
    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
  3. Risk Factors: Inherited Conditions
    1. Polycystic Kidney Disease
    2. Renal Tubular Acidosis Type I
    3. Hyperparathyroidism
    4. Cystinuria
    5. Hypocitraturia
    6. Hypercalciuria
    7. Prmary hyperoxaluria
  4. Risk Factors: Medications
    1. See Medication Causes of Nephrolithiasis
  5. Risk Factors: 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
  6. References
    1. Mobley (Feb 1999) Hospital Medicine, p. 21-38
    2. Frassetto (2011) Am Fam Physician 84(11): 1234-42 [PubMed]
    3. Goldfarb (1999) Am Fam Physician 60(8): 2269-76 [PubMed]
    4. Houshiar (1996) Postgrad Med 100(4): 131-8 [PubMed]
    5. Pietrow (2006) Am fam Physician 74(1): 86-94 [PubMed]
    6. Preminger (2007) J Urol 178(6): 2418-34 [PubMed]
    7. Trivedi (1996) Postgrad Med, 100(6): 63-78 [PubMed]

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