Nephrolithiasis Risk Factors

Aka: Nephrolithiasis Risk Factors, Ureterolithiasis Risk Factors, Recurrent Kidney Stone Risk Factors

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II. 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
    4. Northern Australia

III. Risk Factors: Anatomic Abnormalities

  1. Horseshoe Kidney
  2. Medullary Sponge Kidney
  3. Ureteral Stricture
  4. Ureterocele
  5. Vesicoureteral reflux
  6. Ureteropelvic junction obstruction

IV. Risk Factors: Inherited Conditions

  1. Polycystic Kidney Disease
  2. Renal Tubular Acidosis Type I
  3. Cystinuria
  4. Hypocitraturia
  5. Hypercalciuria
  6. Prmary hyperoxaluria
  7. Lesch-Nyhan Syndrome
  8. 2,8-dihydroxyadenine
  9. Cystic Fibrosis
  10. Xanthinuria

V. Risk Factors: Gastrointestinal Disorders

  1. Inflammatory Bowel Disease (Crohns Disease, Ulcerative Colitis)
    1. Higher risk of Calcium Oxalate Stones
  2. Urinary diversion (enteric hyperoxaluria)
  3. Intestinal resection
  4. Jejunoileal Bypass (Bariatric Surgery)
  5. Intestinal malabsorption

VI. Risk Factors: Miscellaneous

  1. Hypertension
  2. Non-Alcoholic Fatty Liver Disease
  3. Gouty Arthritis
  4. Nephrocalcinosis
  5. Hyperparathyroidism
    1. Higher risk of Calcium Oxalate Stones
  6. Sarcoidosis

VII. Risk Factors: Medications

  1. See Medication Causes of Nephrolithiasis

VIII. 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)
    4. Excessive Carbohydrate intake
  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 (see above)

IX. Risk Factor: Other risks for recurrent stone

  1. Early onset Urolithiasis (child or teen onset)
  2. Family History of stone formation
  3. Calcium Phosphate Stones
  4. Infection associated stones (Struvite Stones, carbonate apatite stones)
  5. Uric Acid stones

X. References

  1. Mobley (Feb 1999) Hospital Medicine, p. 21-38
  2. Fontenelle (2019) Am Fam Physician 99(8): 490-6 [PubMed]
  3. Frassetto (2011) Am Fam Physician 84(11): 1234-42 [PubMed]
  4. Goldfarb (1999) Am Fam Physician 60(8): 2269-76 [PubMed]
  5. Houshiar (1996) Postgrad Med 100(4): 131-8 [PubMed]
  6. Pietrow (2006) Am fam Physician 74(1): 86-94 [PubMed]
  7. Preminger (2007) J Urol 178(6): 2418-34 [PubMed]
  8. Skolarikos (2015) Eur Urol 67(4): 750-63 [PubMed]
  9. Trivedi (1996) Postgrad Med, 100(6): 63-78 [PubMed]

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