Kidney Stones In Men Research Articles

Association Between Kidney Stone History and Cardiovascular Event Risk in US Adults

ObjectivesTo determine the association between kidney stone history and predicted 10-year risk of atherosclerotic cardiovascular disease events in a nationally representative US adult sample without existing cardiovascular disease. MethodsThis was a cross-sectional study of the 2017-2020 National Health and Nutrition Examination Survey that included a nationally representative sample of 3,842 adults aged 40-79 free from cardiovascular disease. Kidney stone history was assessed through self-reporting. The 10-year risk of an atherosclerotic cardiovascular disease event was predicted using the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations. ResultsThe weighted prevalence of kidney stones was 12.2% (95% CI: 10.5% to 14.1%). In unadjusted analysis, the odds of borderline or higher (≥5%) atherosclerotic cardiovascular disease risk were higher in stone formers (odds ratio=1.56; 95% CI 1.01-2.40; P=0.046). This association persisted after adjustment for demographics and clinical covariates (adjusted odds ratio=1.57; 95% CI=1.02 to 2.43; P=0.04). A significant interaction by biological sex was identified (p=0.002), with excess risk conferred by kidney stones in men but not women. ConclusionsKidney stone history was independently associated with increased 10-year predicted atherosclerotic cardiovascular disease event risk, with excess risk observed among men but not women. Intensified cardiovascular disease screening may be warranted among stone formers given their increased cardiovascular risk.

Renal caliculi: Types, mechanism, therapeutic approaches encompassing role of GAGS, MGP, Hormones, UPTF1, CAI, Osteopontin

Kidney stones are deposits in the renal pelvis, calyces, and ureters and reside in urine. Kidney stones undergo biomineralization pathogenesis via nucleation, aggregation, and growth of caliculi. The greater prevalence of kidney stones in men than in women may be due to the link between sex hormones. Kidney equilibrium is maintained with glycosaminoglycans inhibiting growth and aggregation. Sialylated glycoforms of urinary prothrombin fragment 1 prevent calcium stone development. Crystal adherence to tubules is inhibited by CAI, and osteopontin inhibits calculi formation. Medical treatments involve the use of alpha blocker, potassium citrate, thiazide, NSAIDS, opioids, antiemetics and other drugs used in treatment of kidney stone, Alpha adrenoceptor blockers, calcium channel blockers and corticosteroids help to expel renal stones, chemolytic treatment and it could be necessary to remove stones surgically if they are affecting kidney function with the use of techniques. Use of catheter, ultrasound, using a flexible scope equipped with a laser, HDAC inhibitors and many are recent advances in treatment lithiasis.

(084) Low Serum Testosterone is Associated with an Increased Risk of First-time Nephrolithiasis in Men Without Testosterone Replacement Therapy

Abstract Introduction Serum testosterone levels in men have declined on a population level since 1999. Although the role of testosterone in nephrolithiasis is unclear, men are twice as likely as women to develop kidney stones. Some studies posit high testosterone levels as a lithogenic factor, but a recent study showed an inverse relationship between testosterone levels and kidney stones, suggesting that low testosterone may increase the risk of kidney stones in men over 40. The relationship between low testosterone in men and kidney stone risk remains unclear. Objective To determine the association of low serum testosterone levels with the development of incident kidney stones in men without a history of testosterone therapy (TTh). Methods Using TriNetX, a tool that de-identifies and aggregates electronic health record data from tens of millions of patients, we used the TriNetX Research Network to examine men aged ≥18 with a known testosterone level. Men with a history of nephrolithiasis before testosterone measurement and a history of TTh at any point in their life were excluded as both are known to increase the risk of subsequent kidney stones. Men were divided into a low testosterone group (<300 ng/dL) and a normal testosterone group (300-1000 ng/dL). Demographic and clinical characteristics, including comorbidities and medications, were compared using descriptive statistics for all patients. To address potential confounders, we used propensity score matching based on demographic and clinical characteristics (Table 1). We used 1:1 greedy nearest-neighbor matching with a caliper of 0.1 pooled standard deviations of the propensity score. A standardized mean difference of less than 0.1 indicated successful matching. Our outcome of interest was all-time risk of developing an initial kidney stone in men aged ≥18 following a laboratory-confirmed low testosterone. Subgroup analyses was performed on age cohorts. Survival analysis was performed using a log-rank test and Cox proportional hazards regression. All analyses were performed on the TriNetX platform without natural language processing. Results 445,682 men ≥18 with low testosterone were included. The number of men before matching (Table 1) and in each age subgroup after matching is seen in table 2. The percentage of men that developed a diagnosis of nephrolithiasis increased with age regardless of testosterone level (Table 2). In men ≥18, low testosterone was associated with higher risk of incident nephrolithiasis (HR 1.14, 1.11-1.17). Men with low testosterone aged 34-44 (HR 1.28, 1.18-1.40) had the highest risk of nephrolithiasis. Low testosterone was not associated with an increased risk of nephrolithiasis in men aged 18-24 (Figure 1). Conclusions In investigating the association of low testosterone with kidney stones in men without a history of kidney stones or TTh, we found that low serum testosterone is associated with a higher risk of a first-time encounter diagnosis of nephrolithiasis in men greater than 25 years of age compared to men with normal testosterone levels. Men aged 33-44 with low serum testosterone had the highest risk of nephrolithiasis. Future work will investigate the risk of kidney stone recurrence in men with low serum testosterone levels. Disclosure No.

Relationship Between Serum Testosterone Levels and Kidney Stones Prevalence in Men.

BackgroundThe role of serum testosterone levels in male renal stone formation remains controversial. This study aimed to evaluate the relationship between serum testosterone levels and kidney stone prevalence in males.MethodsWe conducted a cross-sectional study based on the data from the National Health and Nutrition Examination Survey 2011–2016, which included 6,633 male participants, to investigate the association between testosterone levels and the prevalence of kidney stones.ResultsIn this study, using the highest quartile of serum testosterone as a reference, a logistic regression model adjusted for confounders in all participants showed that the first quartile (OR: 1.375, p = 0.016), the second quartile (OR: 1.348, p = 0.021), and the third quartile (OR: 1.472, p = 0.003) of testosterone significantly increased kidney stone risks. In the 41–60 age group, the ORs of kidney stone risk in the first, second, and third of serum testosterone were 1.904 (P = 0.005), 1.599 (P = 0.040), and 1.734 (P = 0.015), respectively. This trend can also be found in the 61–80-year group, except in the first quartile of serum testosterone (OR: 1.169, P = 0.436). Adjusted smoothed curves suggest a non-linear relationship between the 8 quantiles of serum testosterone and the risk of kidney stones in all participants and the 61–80 age group and a significant negative relationship in the 41–60 age group (OR: 0.921, P = 0.0193). But no correlation was seen in the 20–40 group.ConclusionsSerum testosterone levels were significantly inversely associated with the prevalence of kidney stones in men over 40 years of age, but no correlation was seen in the 20–40 group. The role of testosterone in stone formation should be redefined, and its effect should be further verified.

Re: Effect of Water Composition and Timing of Ingestion on Urinary Lithogenic Profile in Healthy Volunteers: A Randomized Crossover Trial.

No AccessJournal of UrologyUrological Survey1 Dec 2020Re: Effect of Water Composition and Timing of Ingestion on Urinary Lithogenic Profile in Healthy Volunteers: A Randomized Crossover Trial Dean G. AssimosMD Dean G. AssimosDean G. Assimos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001280.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Effect of Water Composition and Timing of Ingestion on Urinary Lithogenic Profile in Healthy Volunteers: A Randomized Crossover Trial." The Journal of Urology, 204(6), p. 1374 Suggested Reading : Dietary and lifestyle risk factors associated with incident kidney stones in men and women. J Urol 2017; 198: 858. Link, Google Scholar : Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 1996; 155: 839. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 6December 2020Page: 1374-1374 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean G. Assimos More articles by this author Expand All Advertisement PDF DownloadLoading ...

OR04-1 Dietary Sodium Intake, the Renin-Angiotensin-Aldosterone System, and the Risk for Incident Kidney Stones

Context: We previously reported that acute changes in dietary sodium intake and renin-angiotensin-aldosterone system (RAAS) activity could substantially modulate calcium homeostasis. We demonstrated that humans consuming a high sodium diet for one week, compared with a restricted sodium diet for one week, had suppression of the RAAS, a ~100% increase in calciuria (P<0.0001), and a ~10% decrease in serum calcium (P<0.0001). Whether these marked and acute changes induced by high dietary sodium intake are sustained chronically is not known. We hypothesized that a high dietary sodium intake over many years could increase calciuria and the risk for incident kidney stones. Methods: We studied 2496 participants from the Health Professionals Follow-up Study (HPFS) (all men) and the Nurses’ Health Study I (NHSI) (all women). 24-hour urine samples, collected from participants confirmed to have kidney stones and appropriate controls, were assessed for calcium, sodium, creatinine, as well as other factors. Participants were categorized by 24-hour urinary sodium excretion (<120, 120-139, 140-159, 160-179, 180-199, 200-219, >/=220 mEq/day) and the relative risk for developing kidney stones was assessed for each category of sodium excretion via adjusted logistic regression models. Models were adjusted for age, history of hypertension, and numerous urinary parameters (volume, creatinine, oxalate, uric acid, citrate, magnesium, potassium, phosphorus, and pH). Adjustment for urinary calcium was performed to evaluate the role of calciuria in modifying the relation between urinary sodium excretion and kidney stones. Results: Mean adjusted urinary calcium levels for individuals with urinary sodium excretion of <120 mEq/day compared to >/=220 mEq/day were 178 (SD=73) vs. 228 (SD=91) mg/day in men and 161 (SD=60) vs. 208 (SD=80) mg/day in women. When compared with a urinary sodium excretion of <120 mEq/day (relative risk=1.00), having a urinary sodium excretion of >/=220 mEq/day was associated with a higher risk for incident kidney stones in men [RR=1.90 (95% CI 1.18, 3.05)] and women [RR=2.02 (95% CI 1.19, 3.43)]. These associations were attenuated and no longer statistically significant after adjusting for urinary calcium excretion, thereby suggesting that developing kidney stones was mediated, in part, through an increase in urinary calcium excretion when urinary sodium excretion was higher. Conclusion: The combination of our physiology and epidemiology studies suggest that higher dietary sodium intake, and concomitant suppression of the RAAS, result in increased calciuria and an approximately two-fold higher risk for developing kidney stones. Studies to evaluate dietary sodium restriction, and/or RAAS inhibition, as potential methods to decrease calciuria and kidney stones are warranted.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Oct 2017This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.07.012AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 198(4), pp. 715–716 References 1 : Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol2017; 198: 875. Link, Google Scholar 2 : AUA policy statement on use of multiparametric magnetic resonance imaging in the diagnosis, staging and management of prostate cancer. J Urol2017; 198: 832. Abstract, Google Scholar 3 : Predictive nomogram for recurrence following surgery for nonmetastatic renal cell cancer with tumor thrombus. J Urol2017; 198: 810. Abstract, Google Scholar 4 : Predicting complications following robot-assisted partial nephrectomy with the ACS NSQIP® universal surgical risk calculator. J Urol2017; 198: 803. Link, Google Scholar 5 : Effects of withdrawing α1-blocker from combination therapy with α1-blocker and 5α-reductase inhibitor in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective and comparative trial using urodynamics. J Urol2017; 198: 905. Abstract, Google Scholar 6 : Focal laser ablation of prostate cancer: feasibility of magnetic resonance imaging-ultrasound fusion for guidance. J Urol2017; 198: 839. Link, Google Scholar 7 : Dietary and lifestyle risk factors associated with incident kidney stones in men and women. J Urol2017; 198: 858. Link, Google Scholar 8 : Severity of preoperative proteinuria is a risk factor for overall mortality in patients undergoing nephrectomy. J Urol2017; 198: 795. Link, Google Scholar 9 : Characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation for refractory urgency urinary incontinence. J Urol2017; 198: 890. Abstract, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 198Issue 4October 2017Page: 715-716 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Dietary and Lifestyle Risk Factors Associated with Incident Kidney Stones in Men and Women

Several dietary and lifestyle factors are associated with a higher risk of kidney stones. We estimated the population attributable fraction and the number needed to prevent for modifiable risk factors, including body mass index, fluid intake, DASH (Dietary Approaches to Stop Hypertension) style diet, dietary calcium intake and sugar sweetened beverage intake. We used data on the HPFS (Health Professionals Follow-Up Study) cohort and the NHS (Nurses' Health Study) I and II cohorts. Information was obtained from validated questionnaires. Poisson regression models adjusted for potential confounders were used to estimate the association of each risk factor with the development of incident kidney stones and calculate the population attributable fraction and the number needed to prevent. The study included 192,126 participants who contributed a total of 3,259,313 person-years of followup, during which an incident kidney stone developed in 6,449 participants. All modifiable risk factors were independently associated with incident stones in each cohort. The population attributable fraction ranged from 4.4% for a higher intake of sugar sweetened beverages to 26.0% for a lower fluid intake. The population attributable fraction for all 5 risk factors combined was 57.0% in HPFS, 55.2% in NHS I and 55.1% in NHS II. The number needed to prevent during 10 years ranged from 67 for lower fluid intake to 556 for lower dietary calcium intake. Five modifiable risk factors accounted for more than 50% of incident kidney stones in 3 large prospective cohorts. Assuming a causal relation, our estimates suggest that preventive measures aimed at reducing those factors could substantially decrease the burden of kidney stones in the general population.

Total, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney Stones

Previous studies of vitamin C and kidney stones were conducted mostly in men and either reported disparate results for supplemental and dietary vitamin C or did not examine dietary vitamin C. Prospective cohort analysis. 156,735 women in the Nurses' Health Study (NHS) I and II and 40,536 men in the Health Professionals Follow-up Study (HPFS). Total, dietary, and supplemental vitamin C intake, adjusted for age, body mass index, thiazide use, and dietary factors. Incident kidney stones. During a median follow-up of 11.3 to 11.7 years, 6,245 incident kidney stones were identified. After multivariable adjustment, total vitamin C intake (<90 [reference], 90-249, 250-499, 500-999, and ≥1,000mg/d) was not significantly associated with risk for kidney stones among women, but was among men (HRs of 1.00 [reference], 1.19 [95% CI, 0.99-1.46], 1.15 [95% CI, 0.93-1.42], 1.29 [95% CI, 1.04-1.60], and 1.43 [95% CI, 1.15-1.79], respectively; P for trend = 0.005). Median total vitamin C intake for the 500- to 999-mg/d category was ∼700mg/d. Supplemental vitamin C intake (no use [reference], <500, 500-999, and ≥1,000mg/d) was not significantly associated with risk for kidney stones among women, but was among men (HR, 1.19 [95% CI, 1.01-1.40] for ≥1,000mg/d; P for trend = 0.001). Dietary vitamin C intake was not associated with stones among men or women, although few participants had dietary intakes > 700mg/d. Nutrient intakes derived from food-frequency questionnaires, lack of data on stone composition for all cases. Total and supplemental vitamin C intake was significantly associated with higher risk for incident kidney stones in men, but not in women.

Dietary cadmium exposure and kidney stone incidence: A population-based prospective cohort study of men & women

Cadmium exposure is associated with increased urinary calcium excretion. Hypercalciuria is recognised as a major risk factor for kidney stone formation. Increased prevalence of kidney stones among those occupationally exposed to cadmium has previously been suggested. Food is the main source of cadmium exposure in the general population with tobacco representing an important additional source among smokers.We aimed to assess the association between dietary cadmium exposure and kidney stone incidence in two large population-based, prospective cohorts of men (Cohort of Swedish Men; COSM) and women (The Swedish Mammography Cohort; SMC). Those with a history of kidney stones were excluded.At baseline 1997, men (45–79yrs) and women (48 to 83yrs), completed a self-administered questionnaire on diet and lifestyle. During 12years of follow-up, we ascertained 707 cases of kidney stones in men and 290 in women through linkage of the cohorts to the national inpatient and outpatient registers. Individual dietary cadmium exposure was estimated using dietary data and concentrations of cadmium in food. Hazard ratios (HR) were calculated using the Cox proportional hazards regression models with adjustment for other risk factors.Estimated dietary cadmium exposure was not associated with increased kidney stone incidence among men HR 0.97 (95% confidence interval (CI): 0.77–1.23) or women HR 0.99 (95% CI: 0.89–1.43), comparing the highest tertile with the lowest. In conclusion, our results do not support a strong association between dietary cadmium and kidney stone risk at the exposure levels seen in the general population.

Dietary Factors and Risk of Kidney Stone: A Case–Control Study in Southern China

Formation of kidney stones is a multifactorial disease, and diet and lifestyle are suggested to contribute remarkably to increased prevalence. The population of Guangzhou, China has a high prevalence rate of kidney stones; however, its risk factors are still unknown. The aim of this study was to investigate the dietary risk factors for kidney stones in southern China. A case-control study was carried out. This study was carried out at the Department of Health Management Center, Guangzhou Nanfang Hospital, China. This study involved 1,019 newly diagnosed kidney stone patients and 987 healthy control subjects. A questionnaire regarding dietary patterns and supplements was used to investigate the risk factors for kidney stone formation. Food intake frequency, beverage and alcohol consumption, food supplements, and anthropometry were assessed. In the analysis, we found positive associations of kidney stones with consumption of grains (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.08, 4.02) and bean products (OR = 3.50; 95% CI = 1.61, 7.59) in women. The variable "fluid drinking" showed a significant protective effect against kidney stones in men (OR = 0.57; 95% CI = 0.36, 0.88). Consuming leafy vegetables more than 3 times per day was positively associated with stones in both men and women (OR = 2.02; 95% CI = 1.04, 3.91 and OR= 3.86; 95% CI = 1.48, 10.04, respectively). Other dietary factors, dietary supplements, and specific food were not related to kidney stone formation in Guangzhou, China. The results confirmed that specific diet can affect stone formation in the Chinese population, and varied risk factors were found for different genders.

Cost-Effectiveness of Primary Prevention Strategies for Nephrolithiasis

Stone disease is a highly prevalent condition associated with substantial cost and morbidity. We evaluated the cost-effectiveness of a primary prevention strategy. A decision analysis model was constructed to compare the cost of ad hoc management of symptomatic stones vs the cost of primary prevention. A literature search was performed to determine the incidence of stone disease, the effectiveness of nonmedical prevention strategies and cost associated with stone management. One and 2-way sensitivity analyses were performed to determine conditions under which a strategy of primary prevention might be cost-effective. Assuming a 1% incidence of stones, a 50% risk reduction and a $100 cost per individual per year for primary prevention, the model was used to calculate the overall costs per individual per year without and with a primary prevention strategy of $46 and $123, respectively. One-way sensitivity analyses indicated that primary prevention was cost-effective if the incidence of stones exceeded 4.3% yearly or the cost of prevention was less than $23 per person yearly. Varying other factors (risk reduction, probability of requiring surgery, hours of lost work, emergency room cost) failed to reach cost equivalence under any circumstances or required unrealistic assumptions. Preventive strategies were more costly than no prevention unless the incidence of stone disease was at least 1%, the cost did not exceed $20 per person per year and the prevention strategy was at least 50% effective in preventing stones. Primary prevention strategies for stone disease have not been sufficiently evaluated but can theoretically be cost-effective if the population has a sufficiently high incidence of stone disease and the strategy is of low cost and moderately effective.

Impact of Urine Sodium on Urine Risk Factors for Calcium Oxalate Nephrolithiasis

Increased sodium intake is thought to promote nephrolithiasis by dietary sodium hypercalciuric effects. However, equivocal data exist on whether increased urine sodium actually increases the nephrolithiasis risk. We examined the relationship between urine sodium and urine risk factors for nephrolithiasis. We retrospectively reviewed the records of 880 patients evaluated at a metabolic stone clinic to determine the relationship between urine sodium and urine calcium, volume and calcium oxalate supersaturation. Patients were separated into sodium excretion quintiles. Tests of linear trend were performed by examining the linear contrast in coefficients and using Cuzick's nonparametric linear trend test. Multivariate linear regression with urine sodium as a continuous variable was done to assess the relationship between urine sodium and other urine variables. Tests of linear trend showed that urine calcium and volume increased with increasing urine sodium (each p <0.01) but urine calcium oxalate supersaturation decreased with increasing urine sodium (p <0.01). Multivariate linear regression was adjusted for age, sex, body mass index and urine constituents. Urine sodium was positively associated with urine calcium (beta = 0.28, 95% CI 0.15 to 0.41, p <0.001) but negatively associated with urine calcium oxalate supersaturation (beta = -0.013, 95% CI -0.016 to -0.011, p <0.001). There was a trend toward a positive association of urine sodium and volume (beta = 0.001, 95% CI -0.00019 to 0.002, p = 0.10). Increasing urine sodium does not appear to increase the risk of calcium oxalate nephrolithiasis. Global sodium restriction may not necessarily alter the risk of stone formation, ie cause changes in calcium oxalate urine supersaturation, in patients with a history of nephrolithiasis.

Changes in Urinary Stone Risk Factors in Hypocitraturic Calcium Oxalate Stone Formers Treated With Dietary Sodium Supplementation

We investigated the effects of supplemental dietary sodium on risk factors for urinary stone disease in stone forming patients with hypocitraturia. Ten patients diagnosed with recurrent isolated hypocitraturic calcium urolithiasis were identified. Baseline 24-hour urinalysis was performed with patients on their regular diet, including citrate replacement with 20 mEq potassium citrate 3 times per day. Strict daily dietary logs were kept for a 7-day period, during which patients had normal oral intake and potassium citrate replacement. Patients then received supplemental sodium chloride for 1 week (1 gm orally 3 times per day), in addition to their regular diets and potassium citrate supplementation. Dietary logs were continued and 24-hour urinalysis was performed at the end of 1 week of supplemental sodium. Risk factors for urinary stone disease were compared using the Student t test and ANOVA. Two patients were unable to comply with sodium supplementation based on 24-hour urinalysis and, therefore, they were excluded from study. The remaining 8 patients were analyzed. Patients on supplemental dietary sodium demonstrated significantly increased mean urinary voided volume (933 ml per day above baseline, p <0.05) and mean urinary sodium excretion (66 mEq per day above baseline, p <0.05). There was no statistically significant change in urinary calcium, oxalate or uric acid. The urinary supersaturation relative risk ratio decreased for calcium oxalate stones (0.93 vs 0.63, p <0.05), while those of brushite, struvite and uric acid were not different before vs after supplemental sodium. Dietary sodium supplementation resulted in an increased voided urine volume and decreased the relative risk supersaturation ratio for calcium oxalate stones in patients with a history of hypocitraturic calcium oxalate nephrolithiasis. Urinary calcium excretion as well as other urine parameters that are risk factors for nephrolithiasis was not changed. Sodium restriction may be inappropriate in patients with hypocitraturia and recurrent urinary stones. Sodium supplementation may be beneficial in these patients because it results in voluntary increased fluid intake.

Urolithiasis in Pediatric Patients: A Single Center Study of Incidence, Clinical Presentation and Outcome

The incidence of kidney stones in adults has increased in the last 30 years. This retrospective, single site review was done to test the hypotheses that the incidence of urolithiasis in pediatric patients increased from 1994 to 2005, and that metabolic abnormalities were more common in patients with renal stones in the final 3 years of the study period. Charts from 2 time periods were reviewed, 1994 to 1996 (period 1) and 2003 to 2005 (period 2). Clinical and laboratory data, including demographics, presenting complaints, laboratory assessment, treatment and outcome, were tabulated in patients with confirmed urolithiasis. The number of patients with urolithiasis increased from 7 in period 1 to 61 in period 2. When expressed as cases per 100 new patients the incidence increased 4.6 times (p = 0.014). Focusing on period 2, 28% of patients were younger than 10 years. While blood tests were generally normal, 76% of patients had at least 1 abnormality in the 24-hour urine collection. Hypocitraturia, which was the most common metabolic abnormality, was noted in 52% of patients. The small number of patients in period 1 precluded determination as to whether metabolic abnormalities were more common in period 2. Surgery and/or lithotripsy was required in 12 children. Stone disease recurred in 39% of the patients. The incidence of urolithiasis in the pediatric population increased nearly 5-fold at our institution during the last decade. We recommend that the primary diagnostic test be a 24-hour urine collection. The most common metabolic abnormality was hypocitraturia, followed by hypercalciuria. Recurrence of stones is common (approximately 40% rate) and followup is advised.

Dietary Factors and the Risk of Incident Kidney Stones in Men

Diet plays an important role in the pathogenesis of kidney stones. Because the metabolism of many dietary factors, such as calcium, may change with age, the relation between diet and kidney stones may be different in older adults. Uncertainty also remains about the association between many dietary factors, such as vitamin C, magnesium, and animal protein, and the risk of kidney stone formation. To examine the association between dietary factors and the risk of incident, symptomatic kidney stones in men and to determine whether these associations vary with age, a prospective cohort study was conducted of 45,619 men without a history of nephrolithiasis. Self-administered food frequency questionnaires were used to assess diet every 4 yr. A total of 1473 incident symptomatic kidney stones were documented during 477,700 person-years of follow-up. For men aged <60 yr, the multivariate relative risk (RR) for stone formation in the highest quintile of dietary calcium as compared with the lowest quintile was 0.69 (95% confidence interval [CI], 0.56 to 0.87; P = 0.01 for trend). By contrast, there was no association between dietary calcium and stone formation in men aged 60 yr or older. The multivariate RR for men who consumed 1000 mg or greater of vitamin C per day compared with those who consumed less than the recommended dietary allowance of 90 mg/d was 1.41 (95% CI, 1.11 to 1.80; P = 0.01 for trend). Other dietary factors showed the following multivariate RR among men in the highest quintile of intake compared with those in the lowest: magnesium, 0.71 (95% CI, 0.56 to 0.89; P = 0.01 for trend); potassium, 0.54 (95% CI, 0.42 to 0.68; P < 0.001 for trend); and fluid, 0.71 (95% CI, 0.59 to 0.85; P < 0.001 for trend). Animal protein was associated with risk only in men with a body mass index <25 kg/m(2) (RR, 1.38; 95% CI, 1.05 to 1.81; P = 0.03 for trend). Sodium, phosphorus, sucrose, phytate, vitamin B(6), vitamin D, and supplemental calcium were not independently associated with risk. In conclusion, the association between calcium intake and kidney stone formation varies with age. Magnesium intake decreases and total vitamin C intake seems to increase the risk of symptomatic nephrolithiasis. Because age and body size affect the relation between diet and kidney stones, dietary recommendations for stone prevention should be tailored to the individual patient.

The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study

Approximately 10 million adults in the United States have experienced the passage of a kidney stone, and up to 5 million have been diagnosed with gout by a physician. Previous reports have suggested that gout increases the risk for the development of kidney stones, but there are no prospective data. We used data from a cohort of 51,529 male health care professionals to examine the independent association between gout and kidney stone disease. In a cross-sectional analysis of gout and kidney stone disease reported on the 1986 baseline questionnaire, the prevalence of kidney stone disease was almost twofold higher in men with history of gout compared to those without (15% vs. 8%). After adjusting for age and body mass index (BMI), a history of gout remained significantly associated with kidney stone disease (OR 1.88; 95% CI 1.68 to 2.11). We then prospectively examined the risk of incident kidney stones in men with and without a confirmed diagnosis of gout after excluding men who reported a history of kidney stone disease or gout on the baseline questionnaire. A confirmed diagnosis of gout increased the multivariate relative risk of incident kidney stones (RR 2.12; 95% CI 1.22 to 3.68). In contrast, a history of kidney stone disease was not associated with increased risk of gout (RR 1.05; 95% CI 0.54 to 2.07). In conclusion, a history of gout independently increases the risk for incident kidney stones in men. Physicians should provide dietary counseling, such as increasing fluid intake and decreasing salt consumption, to subjects with gout in addition to other risk factors, such as family history of kidney stones, in order to decrease the likelihood of stone formation.

A prospective study of hypertension and the incidence of kidney stones in men.

To examine whether hypertension predicts the incidence of kidney stone disease. Prospective cohort study (the Olivetti Prospective Heart Study). The Olivetti factory in Southern Italy. Five hundred and three male workers, aged 21 - 68 years, with no evidence of kidney stone disease at baseline. Follow-up 8 years. Anthropometry, blood pressure, biochemistry and history of kidney stone disease were evaluated at the baseline examination in 1987. Occurrence of kidney stone disease was evaluated again in 1994-1995. Hypertension was defined as systolic blood pressure > or = 160 or diastolic blood pressure, > or = 95 mmHg or both, or being on drug therapy for hypertension. Occurrence of kidney stone disease was defined as radiological or echographic evidence of calculi or documented passage of one or more stones. At baseline, 114/503 men (22.7%) had hypertension and 32 were on drug treatment. After 8 years, 52 (10.3%) incident cases of kidney stone disease were detected. The majority (n = 45) had a documented passage of one or more stones. The incidence of kidney stone disease was higher in hypertensive than in normotensive men (19/114 (16.7%) versus 33/389 (8.5%); P = 0.011). Hypertensive men had a greater risk of developing kidney stones than normotensive ones (RR 1.96; 95% confidence interval 1.16-3.32). The risk was unaffected by the exclusion of treated hypertensives (2.01; 1.13-3.59) and after adjustment for age (1.89; 1.12-3.18), body weight (1.78; 1.05-3.00) or height (2.00; 1.19-3.38). Hypertension in middle-aged men is a significant predictor of kidney stone disease rather than a consequence of renal damage caused by the kidney stones.

P003 Hypertension predicts the incidence of kidney stones in men: A prospective study

P003 Hypertension predicts the incidence of kidney stones in men: A prospective study

A Prospective Study of the Intake of Vitamins C and B6, and the Risk of Kidney Stones in Men

A Prospective Study of the Intake of Vitamins C and B6, and the Risk of Kidney Stones in Men