Prevalence, risk factors, and management strategies for kidney stones. A comprehensive review

Nº de DOI: 10.34896/RSI.2026.94.56.001

AUTHORS

1. Patricio Andrés Miranda Cevallos. General Practitioner. Attached to Carlos Andrade Marín Hospital. Graduate of the University of the Americas. (Quito-Ecuador). https://orcid.org/0000-0002-0511-6702
2. Viviana Lizbeth Naranjo Aldas. General Practitioner. Attached to Cevallos Health Center. Graduate of the Technical University of Ambato. (Quito-Ecuador). https://orcid.org/0000-0001-5259-2405
3. Eduardo Enrique Arbelaez Toala. General Practitioner. Attached to Private Clinics in Ecuador. Graduate of the University of Guayaquil. (Durán-Ecuador). https://orcid.org/0009-0000-1813-323X
4. Marcos Gabriel Velasco Rea. General Practitioner and Master’s Degree in Occupational Health and Safety. Attached to Pablo Arturo Suárez Hospital. Graduate of the Central University of Ecuador. (⁠Quito-Ecuador). https://orcid.org/0009-0003-9975-7184
5. Cristina Elizabeth Ramírez Balseca. General Practitioner. Attached to Private Clinics of Ecuador. Graduate of the Central University of Ecuador. (⁠Pelileo-Ecuador). https://orcid.org/0009-0008-7524-2510

ABSTRACT

Kidney stones, also known as nephrolithiasis, represent a common urological disorder characterized by the formation of crystalline concretions within the renal system, and their prevalence has been steadily rising globally, posing significant health, economic, and quality-of-life burdens.

KEY WORDS

Kidney stones, nephrolithiasis, epidemiology, prevalence, risk factors.

RESUMEN

Los cálculos renales, también conocidos como nefrolitiasis, representan un trastorno urológico frecuente, caracterizado por la formación de concreciones cristalinas en el sistema renal, cuya prevalencia ha aumentado de manera constante a nivel mundial, generando importantes cargas para la salud, la economía y la calidad de vida.

PALABRAS CLAVE

Cálculos renales, nefrolitiasis, epidemiología, prevalencia, factores de riesgo.

INTRODUCTION

Epidemiological studies indicate that the lifetime risk of developing kidney stones varies considerably across regions, with higher rates observed in North America, the Middle East, and parts of Europe, and recent decades have seen an alarming increase in incidence, likely influenced by lifestyle changes, dietary habits, and environmental factors. Demographically, adult men tend to be more frequently affected than women, although the gender gap appears to be narrowing, and certain age groups, particularly those between 30 and 50 years, are at heightened risk. The etiology of kidney stones is multifactorial, involving complex interactions among dietary and lifestyle factors—such as high intake of sodium, animal protein, and oxalate-rich foods—alongside genetic predispositions, metabolic abnormalities like hypercalciuria or hyperuricosuria, and environmental exposures including hot climates and occupational hazards that.

OBJECTIVE

To synthesize current knowledge on the global and regional prevalence of kidney stones, elucidate the key risk factors involved in their formation, and critically evaluate existing treatment and prevention strategies, thereby providing a comprehensive resource for clinicians, researchers, and public health policymakers dedicated to mitigating the impact of nephrolithiasis worldwide.

METHODOLOGY

This narrative review was conducted using a structured, multi-stage approach aimed at synthesizing current evidence on the epidemiology, risk factors, management, and prevention of kidney stone disease. A comprehensive search was performed across major scientific databases, including PubMed, Scopus, Web of Science, and Google Scholar, covering publications from 1990 to 2024. Search terms included combinations of: “kidney stones,” “nephrolithiasis,” “urolithiasis,” “epidemiology,” “risk factors,” “diet,” “genetics,” “metabolic disorders,” “management,” “prevention,” “surgical treatment,” and “recurrence.”

Inclusion criteria comprised peer-reviewed articles, systematic reviews, clinical guidelines, epidemiological reports, and interventional studies addressing prevalence, demographic distribution, pathophysiological factors, treatment modalities, and preventive strategies for kidney stones. Exclusion criteria included case reports, studies with insufficient methodological detail, and publications not available in English.

Evidence was screened for relevance, and key themes were extracted related to global and regional prevalence, dietary and genetic determinants, environmental exposures, and contemporary treatment and prevention strategies. The narrative synthesis approach was chosen to integrate heterogeneous evidence sources and provide a comprehensive, holistic overview of kidney stone disease. No meta-analysis was performed due to variability in study designs and reported outcomes.

RESULTS 

Epidemiology and Prevalence of Kidney Stones:

What are the global and regional prevalence rates of kidney stones?

The prevalence of kidney stones demonstrates considerable variability at both global and regional levels, reflecting a complex interplay of environmental, dietary, and socioeconomic factors¹. For example, in North America, the prevalence rate is notably high, ranging from 7-15%, a figure that is mirrored in the United States where about 1 in 11 people are affected, and the occurrence rate has risen significantly from 3.80% in the late 1970s to 8.80% in the late 2000s [1]. In contrast, European countries report a lower prevalence, generally between 5-9%, while Asian nations, including China, exhibit even lower rates, with Asia overall ranging from 1-5% and China specifically at 4%¹. However, some regions such as Saudi Arabia experience exceptionally high prevalence rates, with approximately 20% of the population affected, underscoring the regional disparities that may stem from differences in climate, dietary habits, and genetic predisposition¹. These variations not only impact public health burden but also shape regional healthcare markets, as seen in North America’s leading role in the kidney stone market due to its high prevalence¹. Addressing such disparities calls for region-specific prevention strategies and policy interventions, tailored to local environmental and lifestyle risk factors, in order to reduce the growing burden of kidney stones worldwide.

Which demographic groups are most affected by kidney stones?

Kidney stone prevalence exhibits significant variation across demographic groups, with distinct patterns emerging when considering age, sex, and ethnicity. Men in the United States face a notably higher lifetime risk of developing kidney stones (19 percent) compared to women (9 percent), and this increased susceptibility is observed consistently across various age demographics^2,3. Age further stratifies risk: while kidney stones may develop at any stage of life, adults aged 30 to 60, particularly those between 40 and 60, demonstrate the highest incidence, reflecting how both biological and lifestyle factors converge during midlife to heighten vulnerability^2,3. Sex-specific trends reveal that men are most affected in their 40s and 50s, whereas women experience two distinct peaks—one in their 30s and another post-menopause—suggesting the influence of hormonal shifts and other age-related physiological changes³. Ethnicity is another critical factor, with Caucasians demonstrating a higher propensity to develop kidney stones compared to African Americans, which points to possible genetic and environmental contributors interacting within these populations². These demographic nuances underscore the interconnectedness of genetic predisposition, lifestyle, and physiological transitions, emphasizing the need for tailored prevention strategies and public health interventions to address the specific risks faced by each group.

Risk Factors Associated with Kidney Stone Formation:

What dietary and lifestyle factors increase the risk of kidney stones?

A complex interplay of dietary and lifestyle factors substantially heightens the risk of kidney stone formation, with interconnections spanning hydration, nutrient intake, and food choices. Among the most significant contributors is low water consumption, which reduces urine output and increases the concentration of stone-forming substances in the urinary tract, thereby elevating risk^4,5. Diets deficient in dairy products, calcium, fruits, and vegetables have also been consistently linked to increased kidney stone incidence, as low calcium intake can paradoxically raise urinary oxalate levels—a key component in many kidney stones—while a lack of fruits and vegetables may limit citrate excretion, a natural inhibitor of stone formation⁴. Furthermore, excessive salt, added sugar, and processed food consumption—including cakes, biscuits, and soft drinks—exacerbates the risk by promoting calcium excretion and altering urinary composition, demonstrating the interconnected impact of both macro- and micronutrient imbalances and unhealthy lifestyle habits⁴. These dietary patterns are often compounded by broader lifestyle factors, such as physical inactivity or unhealthy food preferences, which together create a multifaceted risk environment for kidney stone development⁶. Addressing these interlinked risk factors through comprehensive dietary modification, increased hydration, and lifestyle interventions is essential for effective prevention and risk reduction⁶.

How do genetic and metabolic factors contribute to kidney stone formation?

Beyond environmental and lifestyle factors, genetic and metabolic determinants play a pivotal role in kidney stone formation by influencing mineral metabolism, cellular processes, and tissue health. Hereditary conditions such as mutations in the XDH and MOCOS genes, which underlie hereditary xanthinuria, as well as mutations in SLC22A12 associated with hereditary hypouricemia, directly disrupt purine and uric acid metabolism, predisposing affected individuals to the accumulation of insoluble metabolites and subsequent stone development⁷. These genetic influences are further underscored by heritability estimates ranging from 45–60%, and the identification of multiple nephrolithiasis-associated loci, such as those impacting calcium-sensing receptor signaling and vitamin D metabolism, which modulate urinary calcium excretion and serum calcium levels—parameters integral to stone pathogenesis⁸. Metabolically, disruptions in lipid metabolism, including abnormal lipid droplet accumulation and the induction of ferroptosis—a form of iron-dependent cell death—drive oxidative stress and inflammatory responses that compromise renal tubular cell integrity, facilitate crystal adhesion, and accelerate renal papillary calcification⁹. Notably, mitochondrial dysfunction, exacerbated by persistent hyperoxaluria and continuous oxidative stress, perpetuates a cycle of damage that not only furthers stone formation but also impairs overall kidney function⁹. The intimate interplay between these genetic susceptibilities and metabolic disturbances highlights the necessity for integrated approaches in risk assessment, early genetic testing for high-risk individuals, and the development of targeted interventions—such as modulation of calcium and lipid metabolism or the use of antioxidants—to mitigate the burden of kidney stone disease.

Management and Prevention Strategies for Kidney Stones:

What are the current medical and surgical options for treating kidney stones?

The management of kidney stones has evolved to include a diverse array of medical and surgical options, tailored to the size, location, and composition of the stone as well as the patient’s overall health status^10,11. Medical management is often sufficient for smaller stones, as most pass spontaneously without the need for intervention¹². However, when stones are too large, cause persistent pain, obstruct urine flow, or result in complications such as bleeding or infection, surgical intervention becomes necessary^11,12. Among the primary surgical techniques, Percutaneous Nephrolithotomy (PCNL) and suction-assisted ureteroscopy with laser lithotripsy are frequently employed for large or complex stones, PCNL involves direct removal of stones through a small incision in the back, while ureteroscopy uses a laser to fragment the stone inside the urinary tract¹⁸. In cases where stones are lodged in the ureters or have migrated from the kidney, endoscopic approaches like ureteroscopy or shock wave lithotripsy are considered, with the choice guided by the stone’s characteristics and the likelihood of complete clearance in a single procedure^10,12. Importantly, the preference for minimally invasive or outpatient procedures reflects a broader trend toward reducing patient morbidity, expediting recovery, and minimizing the risk of future complications¹⁰. Ultimately, individualized treatment planning—balancing efficacy, patient safety, and quality of life—remains critical, underscoring the need for multidisciplinary collaboration and ongoing assessment of treatment outcomes.

How effective are dietary and pharmacological prevention strategies?

Given the potential influence of diet on kidney stone formation, understanding the effectiveness of dietary and pharmacological prevention strategies becomes crucial. Dietary intervention studies, such as the Dietary Approaches to Stop Hypertension (DASH) trial, have demonstrated that diets rich in fruits, vegetables, and low-fat dairy can reduce blood pressure, which is a key surrogate marker for cardiovascular risk and may also be relevant in assessing kidney stone risk due to shared dietary mediators such as sodium and calcium intake¹³. However, large-scale randomized dietary trials such as PREDIMED and the Women’s Health Initiative illustrate the significant challenges in altering participants’ habitual dietary patterns, with compliance often suboptimal and requiring considerable effort from both researchers and participants¹³. Furthermore, the high costs and logistical demands associated with long-term dietary studies make it unlikely that multiple foods, substitutions, and dietary patterns can be rigorously tested for their impact on hard disease outcomes such as kidney stone recurrence or chronic kidney disease progression¹³. These interconnections highlight the need for innovative strategies to improve compliance and cost-effectiveness in dietary trials, as well as the development of reliable surrogate endpoints, to more effectively evaluate and implement prevention strategies for kidney stone disease.

DISCUSSION

The findings of this comprehensive review underscore the complex interplay of epidemiological, genetic, environmental, and lifestyle factors influencing kidney stone prevalence and management strategies worldwide. The marked regional disparities, with North America exhibiting the highest prevalence and certain Middle Eastern countries like Saudi Arabia experiencing even more elevated rates, highlight the importance of contextualized prevention efforts that consider local environmental exposures, dietary habits, and genetic predispositions. The demographic trends, notably the higher risk among middle-aged men and differences observed across ethnic groups, suggest underlying biological and societal factors that warrant further exploration to tailor targeted interventions. The association between dietary habits—particularly low hydration, inadequate calcium intake, and high consumption of salt, sugar, and processed foods—and increased stone formation emphasizes the necessity of public health campaigns promoting dietary modifications. Nonetheless, implementing sustainable lifestyle changes remains challenging, highlighting gaps in adherence and long-term compliance that future research should address through behavioral interventions. The role of genetic and metabolic factors, including hereditary metabolic disorders and loci linked to calcium regulation, points to opportunities for personalized medicine approaches, although these remain underexplored in large-scale studies. Environmental and occupational exposures further complicate the picture, especially in high-risk industries, indicating a need for stricter regulatory policies and protective measures. Advances in minimally invasive surgical techniques have improved management outcomes, however, recurrence remains a significant concern, emphasizing the importance of personalized, multidisciplinary prevention strategies. Despite these insights, limitations such as variability in diagnostic criteria, potential reporting biases, and the scarcity of randomized controlled trials on prevention strategies constrain the generalizability of current recommendations. Future research should focus on longitudinal studies to elucidate causal relationships, large-scale trials testing dietary and pharmacological interventions, and the development of predictive models for recurrence risk. Ultimately, an integrated approach that combines epidemiological surveillance, genetic research, lifestyle modification, and advanced clinical management is essential to reduce the global burden of kidney stones effectively.

CONCLUSIONS

1. Kidney stone disease represents a significant and growing global health burden driven by the interplay of environmental, dietary, genetic, and metabolic factors. Substantial geographic disparities—such as high prevalence in North America and the Middle East compared to lower rates in parts of Asia—underscore the need for region-specific prevention strategies adapted to climatic, socioeconomic, and cultural contexts. Demographic differences, including higher incidence among men, individuals aged 30–60, and certain ethnic groups, highlight the influence of biological and lifestyle determinants that may guide targeted risk-reduction interventions.
2. Dietary habits remain central to stone formation, with insufficient hydration, low calcium intake, and consumption of high-salt and processed foods serving as modifiable contributors. However, adherence to sustained dietary and lifestyle changes remains limited, pointing to behavioral and structural barriers that must be addressed through comprehensive education and public health policies. Genetic predispositions and metabolic dysfunction—particularly those affecting calcium, oxalate, and uric acid metabolism—further complicate risk profiles and suggest opportunities for precision medicine interventions.
3. Advances in minimally invasive surgical management have significantly improved patient outcomes, yet recurrence remains a persistent challenge. This underscores the importance of ongoing surveillance, individualized management plans, and coordinated multidisciplinary care. Despite substantial progress, limitations in existing evidence—such as heterogeneity across studies and the scarcity of large-scale randomized trials—continue to constrain the strength of current recommendations. An integrated, patient-centered approach remains essential for reducing the long-term burden of kidney stone disease worldwide.

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