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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Stone disease is also called lithiasis or urolithiasis, while nephrolithiasis refers more precisely to stones located in the kidney. Kidney stones have been known for centuries and affect around 10% of the global population (Shah and Whitfield 2002). Costs of care are considerable, and annual expenses were estimated at more than $2 billion in the United States alone (Pearle et al. 2005). Besides, in first stone patients, recurrence rate approaches 50% within five years after the first episode (Ettinger 1979; Hosking et al. 1983; Sutherland et al. 1985). Despite high costs and recurrence rate, stone disease is not widely recognized as an important health issue. Yet, many researchers have addressed the question of preventive measures. Nutrition for instance is a key parameter in the process of stone formation, as urine composition reflects mainly our food and fluid intakes. High water intake in particular has long been the only method used by doctors for the prevention of recurrence (Borghi et al. 1999c; Ramello et al. 2000). However, scientific evidence of the efficiency of water intake for prevention was limited for many years. In the last two decades, new research brought insights regarding the beneficial impact of a high water intake for primary and secondary prevention of urolithiasis.


This document overviews the current knowledge about the epidemiology and pathophysiology of urolithiasis, and summarizes the state of the art knowledge regarding water intake and kidney stones.

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