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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I. Epidemiology of kidney stones

I.1. Prevalence of kidney stones

Lifetime prevalence for kidney stones approaches 10% but it can vary according to geography (Shah and Whitfield 2002). Figure 1 shows values of lifetime prevalence around the world.


Increasing prevalence of kidney stones is a global phenomenon and is particularly observed in developed countries, where kidney stones are the more common (Daudon et al. 2012; Lopez and Hoppe 2010; Ramello et al. 2000). It has been attributed to increasing living standards and changes in dietary habits following World War II (Bartoletti et al. 2007; Daudon et al. 2012). For instance high calorie content of the diet and high intakes of animal protein and salts, often associated with the consumption of ready-made dishes, may be part of the explanation (Bartoletti et al. 2007; Daudon et al. 2012). Increasing prevalence of overweight and obesity may also be correlated to this increase of kidney stone disease as body mass index (BMI) has repeatedly been linked to the risk of stone formation (Leonetti et al. 1998; Siener et al. 2004). 


Roll over the countries for more information




Scales et al. 2012
Argentina:4,0%*Buenos Aires



Pinduli et al. 2006



Indridason et al. 2006
Greece: 15,2%*Rural Thebes



Stamatiou et al. 2006
Germany: 4,7%*



Hesse et al. 2003
Turkey: 11,1%*
Muslumanoglu et al. 2011
Iran: 5,7%*



Safarinejad 2007
Korea: 3,5%*Seoul



Kim et al. 2002
Japan: 6,9%*



Iguchi et al. 1996
Taiwan: 9,6%*



Lee et al. 2002


Figure 1. World map of kidney stone lifetime prevalence for the general population, and for men (M) and women (W).

(Hesse et al. 2003; Iguchi et al. 1996; Indridason et al. 2006; Kim et al. 2002; Lee et al. 2002; Muslumanoglu et al. 2011; Pinduli et al. 2006; Safarinejad 2007; Scales, Jr. et al. 2012; Stamatiou et al. 2006). 


I.2. An increasing trend in children

Cases of kidney stones have often been reported in infants and children but are rare and mainly related to urinary tract infections or abnormalities of the urinary tract (Trinchieri et al. 2008). In Iran for instance, a recent study performed on 100 children with stone under the age of 14, showed that 54 of them presented with a urinary tract infection (Sepahi et al. 2010). Metabolic abnormalities are also common in children with kidney stones, the most common being hypercalciuria (excess of calcium in urine) and hypocitraturia (insufficient citrate in urine) (Thomas 2010). 


Altough it is rare, kidney stones among children are becoming more prevalent (Clayton and Pope 2011; Lopez and Hoppe 2010; Sas 2011; Thomas 2010). In Minnesota, a retrospective analysis of childhood incidence of kidney stones showed that, for children under the age of 18, the incidence increased from 13 per 100,000 person-year in the period of 1984-1990 to 36 per 100,000 person-years in 2003-2008 (Dwyer et al. 2012). In South Carolina, an increase of childhood incidence of kidney stones was also reported. Among 1,535 children who had had an episode of nephrolithiasis between 1996 and 2007, the incidence increased from 7.9 per 100,000 in 1996 to 18.5 per 100,000 children in 2007. Interestingly, a higher rate of increase was noted among girls (Sas et al. 2010; Sas 2011).


This increase in childhood prevalence of urolithiasis is often attributed to changes in habits, and in particular in diet (Lopez and Hoppe 2010; Sarica et al. 2009). 

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