Urolithiasis: Comprehensive Review of Etiology, Diagnosis and Treatment
DOI:
https://doi.org/10.12775/QS.2025.39.58490Keywords
Urolithiasis, ESWL, URS, PCNL, renal colic, urinary tract infectionsAbstract
Urolithiasis, commonly referred to as kidney stone disease, is a prevalent and recurrent urological condition with significant global health and economic implications. The formation of urinary calculi results from a multifactorial interplay between genetic predisposition, metabolic abnormalities, dietary habits, and environmental factors. The incidence of urolithiasis has been rising worldwide, particularly in developed countries, contributing to an increasing burden on healthcare systems.
This review provides a comprehensive analysis of the etiology and risk factors associated with kidney stone formation, including dietary and non-dietary contributors such as high animal protein intake, calcium and oxalate metabolism, obesity, diabetes, and climate influences. Advances in diagnostic modalities, particularly the role of non-contrast computed tomography (CT), ultrasonography, and metabolic evaluation, have improved early detection and classification of urinary stones.
Treatment options range from conservative medical management to surgical interventions, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), with evolving techniques enhancing stone clearance and minimizing recurrence. Furthermore, lifestyle modifications, adequate hydration, and pharmacological interventions play crucial roles in the prevention of recurrent stone formation.
The growing prevalence of urolithiasis underscores the need for continuous advancements in both preventive and therapeutic strategies. Further research into stone pathophysiology, metabolic risk assessment, and novel treatment modalities is essential to reduce morbidity and healthcare costs associated with this condition.
References
1. Yasui T, Iguchi M, Suzuki S, Kohri K. Prevalence and epidemiological characteristics of urolithiasis in Japan: national trends between 1965 and 2005. Urology. 2008;71(2):209-213. https://doi.org/10.1016/j.urology.2007.09.034
2. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63(5):1817-1823. https://doi.org/10.1046/j.1523-1755.2003.00917
3. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003;44(6):709-713. https://doi.org/10.1016/s0302-2838(03)00415-9
4. Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol. 2000;37(1):23-25. https://doi.org/10.1159/000020094
5. Zerifi R, Bahlous A, Marakchi O, Daudon M, Bartagi Z, Abdelmoula J. Syndrome métabolique: physiopathologie et impact sur la lithogenèse [Metabolic syndrome: pathophysiology and impact on lithogenesis]. Ann Biol Clin (Paris). 2008;66(1):9-17. https://doi.org/10.1684/abc.2008.0187
6. Arumuham V, Bycroft J. The management of urolithiasis. Surg. 2016 Jul;34(7):352–60. https://doi.org/ 10.1016/j.mpsur.2016.04.007
7. Strohmaier WL. Course of calcium stone disease without treatment. What can we expect?. Eur Urol. 2000;37(3):339-344. https://doi.org/10.1159/000052367
8. Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160-165. https://doi.org/10.1016/j.eururo.2012.03.052
9. Daudon M, Jungers P, Bazin D, Williams JC Jr. Recurrence rates of urinary calculi according to stone composition and morphology. Urolithiasis. 2018;46(5):459-470. https://doi.org/10.1007/s00240-018-1043-0
10. Tasca A. Metabolic syndrome and bariatric surgery in stone disease etiology. Curr Opin Urol. 2011;21(2):129-133. https://doi.org/10.1097/MOU.0b013e3283435cbc
11. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455-462. https://doi.org/10.1001/jama.293.4.455
12. Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13 Suppl 3:S45-S50. PMID: 11132032 Available at: https://pubmed.ncbi.nlm.nih.gov/11132032/
13. Pinduli I, Spivacow R, del Valle E, et al. Prevalence of urolithiasis in the autonomous city of Buenos Aires, Argentina. Urol Res. 2006;34(1):8-11. https://doi.org/10.1007/s00240-005-0003-7
14. Medina-Escobedo M, Zaidi M, Real-de León E, Orozco-Rivadeneyra S. Prevalencia y factores de riesgo en Yucatán, México, para litiasis urinaria [Urolithiasis prevalence and risk factors in Yucatan, Mexico]. Salud Publica Mex. 2002;44(6):541-545. Available at: https://pubmed.ncbi.nlm.nih.gov/20383456/
15. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-1320. https://doi.org/10.1007/s00345-017-2008-6
16. Pearle MS, Calhoun EA, Curhan GC; Urologic Diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol. 2005;173(3):848-857. https://doi.org/10.1097/01.ju.0000152082.14384.d7
17. Antonelli JA, Maalouf NM, Pearle MS, Lotan Y. Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030. Eur Urol. 2014;66(4):724-729. https://doi.org/10.1016/j.eururo.2014.06.036
18. Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD. Burden of Urolithiasis: Trends in Prevalence, Treatments, and Costs. Eur Urol Focus. 2017;3(1):18-26. https://doi.org/10.1016/j.euf.2017.04.001
19. Sellaturay S, Fry C. The metabolic basis for urolithiasis. Surgery. 2008;26(4):136–40. https://doi.org/10.1016/j.mpsur.2008.03.002
20. Daudon M, Frochot V, Bazin D, Jungers P. Drug-Induced Kidney Stones and Crystalline Nephropathy: Pathophysiology, Prevention and Treatment. Drugs. 2018;78(2):163-201. https://doi.org/10.1007/s40265-017-0853-7
21. Curhan GC. Epidemiology of stone disease. Urol Clin North Am. 2007;34(3):287-293. https://doi.org/10.1016/j.ucl.2007.04.003
22. Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Arch Intern Med. 2004;164(8):885-891. https://doi.org/10.1001/archinte.164.8.885
23. Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional Management of Kidney Stones (Nephrolithiasis). Clin Nutr Res. 2015;4(3):137-152. https://doi.org/10.7762/cnr.2015.4.3.137
24. Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346(2):77-84. https://doi.org/10.1056/NEJMoa010369
25. López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol. 2010;25(1):49-59. https://doi.org/10.1007/s00467-008-0960-5
26. Borghi L, Meschi T, Maggiore U, Prati B. Dietary therapy in idiopathic nephrolithiasis. Nutr Rev. 2006;64(7 Pt 1):301-312. https://doi.org/10.1301/nr.2006.jul.301-312
27. Goldfarb DS. In the clinic. Nephrolithiasis. Ann Intern Med. 2009;151(3):ITC2. https://doi.org/10.7326/0003-4819-151-3-200908040-01002
28. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12(2-3):e86-e96
29. Worcester EM, Coe FL. Clinical practice. Calcium kidney stones. N Engl J Med. 2010;363(10):954-963. https://doi.org/10.1056/NEJMcp1001011
30. Sakhaee K, Maalouf NM, Sinnott B. Clinical review. Kidney stones 2012: pathogenesis, diagnosis, and management. J Clin Endocrinol Metab. 2012;97(6):1847-1860. https://doi.org/10.1210/jc.2011-3492
31. Nouvenne A, Meschi T, Guerra A, Allegri F, Prati B, Borghi L. Dietary treatment of nephrolithiasis. Clin Cases Miner Bone Metab. 2008;5(2):135-141 PMID: 22460996 ; PMCID: PMC2781209
32. Moftakhar L, Jafari F, Ghoddusi Johari M, Rezaeianzadeh R, Hosseini SV, Rezaianzadeh A. Prevalence and risk factors of kidney stone disease in population aged 40-70 years old in Kharameh cohort study: a cross-sectional population-based study in southern Iran. BMC Urol. 2022;22(1):205. Published 2022 Dec 19. https://doi.org/10.1186/s12894-022-01161-x
33. Ranabir S, Baruah MP, Devi KR. Nephrolithiasis: Endocrine evaluation. Indian J Endocrinol Metab. 2012;16(2):228-235. https://doi.org/10.4103/2230-8210.93740
34. Holmes RP, Assimos DG. The impact of dietary oxalate on kidney stone formation. Urol Res. 2004;32(5):311-316. https://doi.org/10.1007/s00240-004-0437-3
35. Worcester EM, Coe FL. Nephrolithiasis. Prim Care. 2008;35(2):369-vii. https://doi.org/10.1016/j.pop.2008.01.005
36. Sayer JA, Moochhala SH, Thomas DJ. The Medical Management of Urolithiasis. British Journal of Medical and Surgical Urology. 2010;3(3):87-95. https://doi.org/10.1016/j.bjmsu.2010.02.004
37. Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116(3):c159-c171. https://doi.org/10.1159/000317196
38. Resnick M, Pridgen DB, Goodman HO. Genetic predisposition to formation of calcium oxalate renal calculi. N Engl J Med. 1968;278(24):1313-1318. https://doi.org/10.1056/NEJM196806132782403
39. Coe FL, Parks JH, Moore ES. Familial idiopathic hypercalciuria. N Engl J Med. 1979;300(7):337-340. https://doi.org/10.1056/NEJM197902153000703
40. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Family history and risk of kidney stones. J Am Soc Nephrol. 1997;8(10):1568-1573. https://doi.org/10.1681/ASN.V8101568
41. Curhan GC, Willett WC, Rimm EB, Speizer FE, Stampfer MJ. Body size and risk of kidney stones. J Am Soc Nephrol. 1998;9(9):1645-1652. https://doi.org/10.1681/ASN.V991645
42. Maalouf NM, Sakhaee K, Parks JH, Coe FL, Adams-Huet B, Pak CY. Association of urinary pH with body weight in nephrolithiasis. Kidney Int. 2004;65(4):1422-1425. https://doi.org/10.1111/j.1523-1755.2004.00522.x
43. Abate N, Chandalia M, Cabo-Chan AV Jr, Moe OW, Sakhaee K. The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int. 2004;65(2):386-392. https://doi.org/10.1111/j.1523-1755.2004.00386.x
44. Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994. Am J Kidney Dis. 2002;40(1):37-42. https://doi.org/10.1053/ajkd.2002.33911
45. Kramer HJ, Choi HK, Atkinson K, Stampfer M, Curhan GC. The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study. Kidney Int. 2003;64(3):1022-1026. https://doi.org/10.1046/j.1523-1755.2003.t01-2-00171.x
46. Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int. 2005;68(3):1230-1235. https://doi.org/10.1111/j.1523-1755.2005.00516.x
47. Kohjimoto Y, Sasaki Y, Iguchi M, Matsumura N, Inagaki T, Hara I. Association of metabolic syndrome traits and severity of kidney stones: results from a nationwide survey on urolithiasis in Japan. Am J Kidney Dis. 2013;61(6):923-929. https://doi.org/10.1053/j.ajkd.2012.12.028
48. 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;17(5):1422-1428. https://doi.org/10.1681/ASN.2005121246
49. Daudon M, Traxer O, Conort P, Lacour B, Jungers P. Type 2 diabetes increases the risk for uric acid stones. J Am Soc Nephrol. 2006;17(7):2026-2033. https://doi.org/10.1681/ASN.2006030262
50. Cappuccio FP, Siani A, Barba G, et al. A prospective study of hypertension and the incidence of kidney stones in men. J Hypertens. 1999;17(7):1017-1022. https://doi.org/10.1097/00004872-199917070-00019
51. Borghi L, Meschi T, Guerra A, et al. Essential arterial hypertension and stone disease. Kidney Int. 1999;55(6):2397-2406. https://doi.org/10.1046/j.1523-1755.1999.00483.x
52. Madore F, Stampfer MJ, Rimm EB, Curhan GC. Nephrolithiasis and risk of hypertension. Am J Hypertens. 1998;11(1 Pt 1):46-53. https://doi.org/10.1016/s0895-7061(97)00371-3
53. Madore F, Stampfer MJ, Willett WC, Speizer FE, Curhan GC. Nephrolithiasis and risk of hypertension in women. Am J Kidney Dis. 1998;32(5):802-807. https://doi.org/10.1016/s0272-6386(98)70136-2
54. Gillen DL, Coe FL, Worcester EM. Nephrolithiasis and increased blood pressure among females with high body mass index. Am J Kidney Dis. 2005;46(2):263-269. https://doi.org/10.1053/j.ajkd.2005.04.030
55. Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol. 2009;20(10):2253-2259. https://doi.org/10.1681/ASN.2009030276
56. Taylor EN, Stampfer MJ, Mount DB, Curhan GC. DASH-style diet and 24-hour urine composition. Clin J Am Soc Nephrol. 2010;5(12):2315-2322. https://doi.org/10.2215/CJN.04420510
57. Atan L, Andreoni C, Ortiz V, et al. High kidney stone risk in men working in steel industry at hot temperatures. Urology. 2005;65(5):858-861. https://doi.org/10.1016/j.urology.2004.11.048
58. Chen YK, Lin HC, Chen CS, Yeh SD. Seasonal variations in urinary calculi attacks and their association with climate: a population based study. J Urol. 2008;179(2):564-569. https://doi.org/10.1016/j.juro.2007.09.067
59. Lee S, Kim MS, Kim JH, et al. Daily Mean Temperature Affects Urolithiasis Presentation in Seoul: a Time-series Analysis. J Korean Med Sci. 2016;31(5):750-756. https://doi.org/10.3346/jkms.2016.31.5.750
60. Brikowski TH, Lotan Y, Pearle MS. Climate-related increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci U S A. 2008;105(28):9841-9846. https://doi.org/10.1073/pnas.0709652105
61. Frassetto L, Kohlstadt I. Treatment and prevention of kidney stones: an update. Am Fam Physician. 2011;84(11):1234-1242. PMID: 22150656 Available at: https://www.aafp.org/pubs/afp/issues/2011/1201/p1234.html
62. Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350(7):684-693. https://doi.org/10.1056/NEJMcp030813
63. Pfau A, Knauf F. Update on Nephrolithiasis: Core Curriculum 2016. Am J Kidney Dis. 2016;68(6):973-985. https://doi.org/10.1053/j.ajkd.2016.05.016
64. Gottlieb M, Long B, Koyfman A. The evaluation and management of urolithiasis in the ED: A review of the literature. Am J Emerg Med. 2018;36(4):699-706. https://doi.org/10.1016/j.ajem.2018.01.003
65. Krambeck AE, Lieske JC, Li X, Bergstralh EJ, Melton LJ 3rd, Rule AD. Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. J Urol. 2013;189(1):158-164. https://doi.org/10.1016/j.juro.2012.09.023
66. Pietrow PK, Karellas ME. Medical management of common urinary calculi. Am Fam Physician. 2006;74(1):86-94 Available at: https://www.aafp.org/pubs/afp/issues/2006/0701/p86.html
67. Wright PJ, English PJ, Hungin AP, Marsden SN. Managing acute renal colic across the primary-secondary care interface: a pathway of care based on evidence and consensus [published correction appears in BMJ. 2003 Jan 4;326(7379):18.]. BMJ. 2002;325(7377):1408-1412. https://doi.org/10.1136/bmj.325.7377.1408
68. Bultitude M, Rees J. Management of renal colic. BMJ. 2012;345:e5499. Published 2012 Aug 29. https://doi.org/10.1136/bmj.e5499
69. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-474. https://doi.org/10.1016/j.eururo.2015.07.040
70. Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324. https://doi.org/10.1016/j.juro.2014.05.006
71. McCarthy CJ, Baliyan V, Kordbacheh H, Sajjad Z, Sahani D, Kambadakone A. Radiology of renal stone disease. Int J Surg. 2016;36(Pt D):638-646. https://doi.org/10.1016/j.ijsu.2016.10.045
72. Mandeville JA, Gnessin E, Lingeman JE. Imaging evaluation in the patient with renal stone disease. Semin Nephrol. 2011;31(3):254-258. https://doi.org/10.1016/j.semnephrol.2011.05.006
73. Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014;371(12):1100-1110. https://doi.org/10.1056/NEJMoa1404446
74. El Khebir M, Fougeras O, Le Gall C, et al. Actualisation 2008 de la 8e Conférence de consensus de la Société francophone d'urgences médicales de 1999. Prise en charge des coliques néphrétiques de l'adulte dans les services d'accueil et d'urgences [2008 update of the 8th Consensus Development Conference of the Francophone Society of Medical Emergencies of 1999. The treatment of adult renal colic by the emergency services and in emergency rooms]. Prog Urol. 2009;19(7):462-473. https://doi.org/10.1016/j.purol.2009.03.005
75. Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324. https://doi.org/10.1016/j.juro.2014.05.006
76. Assimos D, Krambeck A, Miller NL et al: Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol 2016; 196: 1161. Available online: https://www.auanet.org/guidelines-and-quality/guidelines/kidney-stones-surgical-management-guideline (accessed on 01 February 2025)
77. Skolarikos, A.; Jung, H.; Neisius, A.; Petˇrík, A.; Somani, B.; Tailly, T.; Gambaro, G. Uroweb-European Association of Urology [Internet]. EAU Guidelines on Urolithiasis-INTRODUCTION-Uroweb. Available online: https://uroweb.org/guidelines/urolithiasis (accessed on 01 February 2025).
78. Akram M, Jahrreiss V, Skolarikos A, et al. Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. J Clin Med. 2024;13(4):1114. Published 2024 Feb 16. https://doi.org/10.3390/jcm13041114
79. Doré B. Techniques et indications de la lithotritie extracorporelle (LEC) en urologie [Extra corporeal shock wave lithotripsy (ESWL) procedure in urology]. Ann Urol (Paris). 2005;39(3-4):137-158. https://doi.org/10.1016/j.anuro.2005.07.002
80. Dasgupta R, Cameron S, Aucott L, et al. Shockwave Lithotripsy Versus Ureteroscopic Treatment as Therapeutic Interventions for Stones of the Ureter (TISU): A Multicentre Randomised Controlled Non-inferiority Trial. Eur Urol. 2021;80(1):46-54. https://doi.org/10.1016/j.eururo.2021.02.044
81. Cui X, Ji F, Yan H, et al. Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology. 2015;85(4):748-756. https://doi.org/10.1016/j.urology.2014.11.041
82. Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L, Somani BK. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol. 2020;38(5):1329-1333. https://doi.org/10.1007/s00345-019-02878-5
83. Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2014;(11):CD007044. Published 2014 Nov 24. https://doi.org/10.1002/14651858.CD007044.pub3
84. Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review. Curr Urol Rep. 2018;19(4):27. Published 2018 Mar 7. https://doi.org/10.1007/s11934-018-0764-5
85. Whitehurst L, Jones P, Somani BK. Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World J Urol. 2019;37(5):759-776. https://doi.org/10.1007/s00345-018-2424-2
86. Liu M, Chen J, Gao M, et al. Preoperative Midstream Urine Cultures vs Renal Pelvic Urine Culture or Stone Culture in Predicting Systemic Inflammatory Response Syndrome and Urosepsis After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. J Endourol. 2021;35(10):1467-1478. https://doi.org/10.1089/end.2020.1140
87. Assimos D, Krambeck A, Miller NL et al: Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol 2016; 196: 1161. Available online: https://www.auanet.org/guidelines-and-quality/guidelines/kidney-stones-surgical-management-guideline (accessed on 01 February 2025)
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