IntroductionEpidemiologyI. Epidemiology of kidney stonesI.1. Prevalence of kidney stonesI.2. An increasing trend in childrenPathophysiology II. Pathophysiology of kidney stonesII.1. LithogenesisII.1.1. Urine supersaturation : the driving force of crystallogenesisII.1.2. Promoters and inhibitors of stone formationII.2. Urine volume and composition: a necessary balanceRisk factorsIII. Risk factors for kidney stonesIII.1. Individual, non-modifiable risk factorsIII.1.1 Family historyIII.1.2. Race and ethnicityIII.1.3. Age and genderIII.1.4. Current change in gender prevalenceIII.2. Lifestyle related factorsIII.2.1. Calcium intakeIII.2.2. Emerging dietary risk factorsIII.2.3. Association with other chronic diseasesDehydrationIV. Dehydration: a risk factor for kidney stonesIV.1. Low urine volume: a key risk factor for kidney stonesIV.2. Environmental factors predisposing to low urine volumeIV.2.1. Occupational risk of kidney stonesIV.2.2. Climate and temperature as risk factorsWater & recurrenceV. Prevention of stone recurrence with high water intakeV.1. Reduction of recurrence rate with increased water intakeV.2. Water intake and urinary parameters in stone formersWater & incidenceVI. Primary prevention of stones with high water intakeVI.1. Reduction of stone incidence with increased water intakeVI.2. Water intake and urinary parameters in healthy subjectsWater & health costsVII. Water intake and health costs of kidney stonesVII.1. Reduction of stone recurrence costs via adequate water intakeVII.2. Reduction of first stone costs with adequate water intakeRecommendationsVIII. Dietary and water recommendations for stone preventionVIII.1. Guidelines for the prevention of recurrence in patientsVIII.2. Dietary and water guidelines for general populationConclusion References
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- Lifetime prevalence of kidney stones approaches 10% of all adults worldwide, and has been constantly increasing in the last decades.
- The increase in kidney stone prevalence is associated with other chronic diseases such as obesity, diabetes and hypertension. Changes in diet and lifestyle can partly explain this phenomenon.
- Urolithiasis is a multifactorial disease; many factors can increase the risk of stone formation.
- Chronic dehydration is a major risk factor for kidney stones.
- Chronic dehydration results in a low urine volume and increases urine supersaturation.
- A high fluid intake increases urine volume, promotes urine dilution and reduces urine supersaturation.
- Increased fluid intake is an effective preventive measure for the prevention of kidney stones recurrence and may help reduce the risk of first episodes.
- Adequate water intake is cost-effective and can help reduce the economic burden of kidney stones.
- Water is essential and should be at the core of everyone’s daily intake. To prevent recurrence, official guidelines include a fluid intake sufficient to achieve a urine volume of at least 2.0L per day.