Epidemiology of Stone Disease

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Epidemiology has improved our understanding and management of stone disease. Epidemiologic studies, by quantifying patterns and burden of disease, have helped identify risk factors, leading to changes in clinical practice and providing insights into pathophysiologic processes related to stone formation. Because nephrolithiasis is a complex disease, an understanding of the epidemiology, particularly the interactions among different factors, may help lead to approaches that reduce the risk of stone formation.

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Prevalence

Stone disease is common with the lifetime risk of stone formation in the United States exceeding 12% in men and 6% in women [1], [2]. However, the prevalence of nephrolithiasis, defined as a history of stone disease, varies by age, sex, and race. The prevalence appears to have increased in the last quarter of the twentieth century for men and women, blacks and whites (Fig. 1, Fig. 2) [2]. This apparent increase may reflect an actual increase in stone disease, or it may stem from increased

Incidence

Several population-based studies have demonstrated that incidence rates, defined as the onset of an individual's first kidney stone, vary by age, sex, and race. As with prevalence, the incidence rates are highest in white males. For men, the incidence begins to rise after age 20, peaks between 40 and 60 years at about 3/1000/y and then begins to decline [1], [7], [8]. For women, incidence rates seem to be higher in the late 20s (2.5/1000/y) and then decreasing to 1/1000/y by age 50. This rate

Recurrence rates

Early reports suggested that if left untreated the likelihood of forming another stone after the initial episode was 30% to 40% at 5 years [1]. These figures from observational studies are similar to the recurrence rates in the control arms of recently published randomized trials [12], [13]. Encouragingly, the treatment arms of many of the randomized trials have shown dramatic reductions of 50% or more in recurrence rates [12], [13], [14], [15]. These reductions by medication or dietary

Risk factors

Our understanding of the risk factors for stone formation has increased substantially over the past several decades. Risk factors are generally divided into nondietary, dietary, and urinary categories.

Summary

Epidemiologic studies have expanded our understanding of stone disease. It is clear that a variety of risk factors contribute to the risk of stone formation and that the importance of these risk factors varies by age and sex. The individual impact of traditional risk factors (eg, calcium, animal protein) has been quantified and new factors (eg, body size, phytate) have been identified. Results from these studies have forced a reappraisal of our view of risk factors for stone disease. The

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    This work was supported by grant DK59583 from the National Institutes of Health.

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