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The prevalence and incidence of nephrolithiasis is reported to be increasing across the world This article reviews information regarding stone incidence and prevalence from a global perspective. The bod# of evidence suggests that the incidence and prevalence of kidne# stones is increasing globall# these increases are seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force 1n addition, global warming ma# influence these trends.
The prevalence and incidence of nephrolithiasis is reported to be increasing across the world This article reviews information regarding stone incidence and prevalence from a global perspective. The bod# of evidence suggests that the incidence and prevalence of kidne# stones is increasing globall# these increases are seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force 1n addition, global warming ma# influence these trends.
The prevalence and incidence of nephrolithiasis is reported to be increasing across the world This article reviews information regarding stone incidence and prevalence from a global perspective. The bod# of evidence suggests that the incidence and prevalence of kidne# stones is increasing globall# these increases are seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force 1n addition, global warming ma# influence these trends.
Victoriano Romero, MD, Haluk Akpinar, MD, and Dean G Assimos, MD Additional article information Abstract The prevalence and incidence of nephrolithiasis is reported to be increasing across the world Herein, we review information regarding stone incidence and prevalence from a global perspective A literature search using !ubMed and "vid was performed to identif# peer$reviewed %ournal articles containing information on the incidence and prevalence of kidne# stones &e# words used included kidne# stone prevalence, incidence, and epidemiolog# Data were collected from the identified literature and sorted b# demographic factors and time period A total of '( articles were identified containing kidne# stone$ related incidence or prevalence data from )* countries+ ,- provided suitable information for review Data regarding overall prevalence or incidence for more than a single time period were found for ' countries .incidence data for - countries+ prevalence data for ( countries/ These included ( 0uropean countries .1tal#, German#, 2cotland, 2pain, and 2weden/, 3apan, and the 4nited 2tates The bod# of evidence suggests that the incidence and prevalence of kidne# stones is increasing globall# These increases are seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force 1n addition, global warming ma# influence these trends Key words: 7ephrolithiasis, &idne# stones, 2tone incidence, 0pidemiolog# The prevalence and incidence of nephrolithiasis is reported to be increasing across the world This article reviews information regarding stone incidence and prevalence from a global perspective Methods A literature search using !ubMed and "vid was performed to identif# peerreviewed %ournal articles containing information on the incidence and prevalence of kidne# stones &e# words used included kidne# stone prevalence incidence, and epidemiolog# Data were collected from the identified literature and then sorted b# demographic factors and time period Results A total of '( articles were identified containing kidne# stone$related incidence or prevalence data from )* countries+ ,- articles provided suitable information for review Data regarding overall prevalence or incidence for more than a single time period were found for ' countries .incidence data for - countries+ prevalence data for ( countries/ These included ( 0uropean countries .1tal#, German#, 2cotland, 2pain, and 2weden/, 3apan, and the 4nited 2tates Prevalence 1n the 4nited 2tates, overall stone prevalence has doubled since the 89:-;89') time period, and appears to have stabili<ed since the earl# 89=*s 8;, "ther countries with documented increases in prevalence include German#, 2pain, and 1tal# -;' Regional reports from Milan, 1tal#, also document an increased prevalence = "nl# 2cotland had a slight decrease in prevalence from ,=,> in 89'' to ,(> in 89=' 9,8* .Table 8 and Table )/ Table 8 Reported &idne# 2tone !revalence b# 6ountr# and ?ear Table ) Reported &idne# 2tone 1ncidence b# 6ountr# and ?ear 6ountries or regions reporting prevalence rates for 8 #ear onl# included 1celand+ @uenos Aires, Argentina+ Thebes, Greece+ 7ortheast Thailand+ 2eoul, &orea+ @alearic 1slands, 2pain+ Hellin, 2pain+ Taiwan, 6hina+ and 0astern Tennessee .Table ,/ -,88;89 Table , Reported Regional &idne# 2tone !revalence Rates per 6ountr# and ?ear 1n countries reporting prevalence rates in the 89=*s and 899*s, the nonweighted, average global prevalence was ,)(> in the 89=*s and (:-> in the 899*s ,;',9,8* The highest prevalence rates across all reports were for uranium workers in eastern Tennessee .8=(>/ and adults in 7ortheast Thailand .8:9>/ .Table ,/ 8(,89 Incidence 1n the 4nited 2tates, overall incidence increased during 89'8 to 89'= 8,)* 1n the #ear )***, an incidence of 888: per 8**,*** was reported for 8=$ to :-$#ear$old emplo#ees covered b# ) large insurance carriers )8 This incidence is significantl# higher than those from the aforementioned periods 2tudies performed in Rochester, M7, showed a stead# incidence increase from the 89(*s through 899*, with a drop somewhat in )*** )),), 1n 3apan, the incidence of nephrolithiasis has doubled over a -*$#ear time period, both in men and women These increases were most prominent in the last 8* to )* #ears, with rates among men increasing sharpl# since the 899*s, and rates among women increasing more graduall# since the 89=*s )-;): 6ountries or regions reporting incidence rates for onl# 8 #ear include 2eoul, &orea, and - 2panish cities .Granada, Tudela, Marina Alta, 2aragossa/ -,8: .Table -/ Table - Reported Regional &idne# 2tone 1ncidence Rates per 6ountr# and ?ear Se and A!e 1ran, 3apan, and the 4nited 2tates had stone incidence reports stratified b# age ));)-,)' .Aigures 8; , / 1ncidence rates reported b# age group consistentl# show a rise$and$fall pattern as a population ages Age at peak incidence was similar among these , countriesB Age at peak incidence was similar among these , countries, ranging from -* to -9 #ears, e5cept for 3apanese women for whom the peak incidence occurred between ages (* to (9 #ears The actual incidence rate was similar for men age -* to -9 #ears in the 4nited 2tates and 3apan but lower in 1ran Aigure 8 )**( 1ran kidne# stone incidence b# age group A rise$and$fall pattern is observed for reported incidence rates in 1ran during )**( !eak incidence is observed in the -*$ to -9$#ear$old age group 2tone prevalence increased with increasing age in German#, 1celand, 1ran, 1tal#, Greece, Turke#, and the 4nited 2tates .Aigures -;8*/, although there is a sharp decrease in prevalence in 1talians, age C :* #ears, living in Milan ),(,',88,8),8-,)' .Aigure 88/ 1n &orea, prevalence rates decreased as men aged, but increased in women and peaked at age :* to :9 #ears 8: .Aigure 8)/ 1n the 4nited 2tates, a stud# during the 89': through 89=* time period showed that prevalence rates decreased in women over age (9 and men over age :9, but b# 8998 prevalence rates continued increasing as the population got older among all age groups ) .Aigure 8*/ Aigure - German# kidne# stone prevalence b# age group An increasing prevalence is observed for Germans as the# age This trend is observed in both 89'9 and )**8 Aigure 8* 42 kidne# stone prevalence b# age group 1n 89'=, prevalence in 42 men and women demonstrates a rise$and$fall pattern as the population ages, with peak prevalence occurring between age :* and :9 #ears in men, and between age (* and (9 in women 1n 8998, """ Aigure 88 Milan, 1tal#, kidne# stone prevalence b# age group An increasing prevalence is observed with increasing age among those living in Milan, but a prevalence decrease occurs after age C :* #ears Aigure 8) 899= &orea kidne# stone prevalence b# age group &orean men demonstrated a decrease in stone prevalence with increasing age &orean women demonstrated a rise$and$fall pattern, with peak incidence occurring between age :* and :9 #ears More men form stones than women The se5 ratios range from )(B8 in 3apan to 88(B8 in 1ran )',)=
However, there are age ranges in some countries where this ratio is reversed This occurrence was reported for 8-$ to )-$#ear$olds in German#, )8$ to ,*$#ear$olds in Milan, 1tal#, :*$ to '9$#ear$olds in &orea, )*$ to )9$#ear$olds in the 4nited 2tates, and , age groups in Greece .age D )*, age ,* to ,9 #ears, and age (* to (9 #ears/ ),',=,8-,8: Although women demonstrated higher prevalence rates in these instances, the difference between men and women was minimal Race Data comparing stone disease differences between races within one countr# were available onl# for the 4nited 2tates ) !revalence and incidence rates were highest for whites, followed b# Hispanics, blacks, and Asians .Aigure 8,/ "f interest, stone disease rates have nearl# doubled in 42 blacks in the :*$ to '-$#ear old age group when comparing the 89': through 89=* and 89== through 899- time periods .Aigure 8-/ Ehite men have the highest kidne# stone incidence rate whereas Asian women have the lowest rate .Aigure 8,/ Eithin individual races, men still have a higher disease burden when compared with women from the same race Aigure 8, 42 kidne# stone prevalence rates b# race Data for kidne# stone prevalence rates show rates being lowest in Asian women .A/ and highest in white men .@/ 6!2, 6ancer !revention 2tud#+ 7HA702, 7ational Health and 7utrition 05amination 2urve# Aigure 8- 42 kidne# stone prevalence b# race and age group An increasing prevalence with increasing age is observed in 42 white and black men for both reporting periods !revalence has nearl# doubled for black men in the :*$ to '-$#ear$old age group between the """ Radio!ra#hic Studies Three studies published between 8998 and )**, e5amined as#mptomatic stone prevalence rates b# performing ultrasonograph# on randoml# selected sub%ects )9;,8 The stone rates in as#mptomatic sub%ects were ,*>, )8>, and )*> in !akistan, Denmark, and 3apan, respectivel# $iscussion and %onclusions "ur review demonstrates that there has been an increase in the prevalence and incidence of kidne# stones in the 4nited 2tates and other parts of the world The cause of these changes is unclear &idne# stone formation is usuall# due to genetic and environmental factors Although genetic factors influence stone risk, changes in the gene pool occur at a slow rate Therefore, it is unlikel# to be the driving force for these trends 0nvironmental factors are also varied and comple5, but their influence is more apparent as changes in these factors occur over much shorter intervals Ee believe that changes in ) of the most important environmental factors$diet and climate$have the most significant impact on these trends There is historical evidence of the influence of diet on stone formation The first documented increase in stone disease occurred during the 8:th centur# when 0uropean 2tein$2chneiders .stone cutters/ found that their services were more in demand ,) During this period, there were improvements in food production and corn became a popular food staple ,, The increased consumption of starch# foods derived from corn promoted obesit#, currentl# a known risk factor for stone formation ,,(,,- The impact of agricultural moderni<ation remains toda#, and is reflected b# the epidemic in obesit# seen in man# countries, especiall# the 4nited 2tates The prevalence of obesit# has been tracked in the 4nited 2tates since 89:* "besit# in adults has risen from 8-:> in the 89'8 through 89'- time period to ,()> in the )**( through )**: time period ,( Moreover, a similar trend is present for children, with 88> to 8'=> being in the overweight categor# in the )**( through )**: time period ,( The consumption of fast foods and high fructose corn s#rup preparations has been thought to promote this epidemic 1n the 4nited 2tates alone, the percentage of meals coming from fast$food eateries or restaurants rose from 9:> to ),(> during the timeframe of 89'' to 899: ,: These dietar# changes have also been reported in man# other countries including 6hina, 1ndia, 0g#pt, Russia, and the !hilippines ,:;,9 High fructose consumption has been demonstrated to be a risk factor for stone formation -* "ther dietar# risk factors for stone formation have been identified There is strong evidence that diminished fluid and calcium consumption are risk factors 8-,-8;-- 1ncreased o5alate consumption has also been demonstrated to promote stone formation -(,-: 0pidemiologic studies have demonstrated that increased sodium and animal protein intake have an eFuivocal impact on stone risk However, a randomi<ed prospective dietar# intervention stud# demonstrated that reduction of sodium and animal protein and maintenance of normal dietar# calcium intake attenuates stone activit# in recurrent h#percalciuric stone formers -8 There is evidence that the consumption of animal protein has increased in a number of countries, paralleling the acceleration of stone disease ,:;,9 There are also studies that demonstrate an increased intake of sodium and sodium$rich foods in certain cohorts -' Global climate change is another environmental factor that affects stone disease rates Aor man# #ears the concept of global warming has been debated, and toda# it is more accepted as a legitimate phenomenon The general consensus is that average global temperatures have increased -= 1n addition, studies have documented the association between increased environmental temperatures and increased kidne# stone rates -9 Two recent studies have shown the temporal relationship between e5posure to high temperatures and the subseFuent development of kidne# stones 0vans and 6ostabile (* compared the time of arrival of 42 soldiers to &uwait and the time to development of acute renal colic at a 42 militar# hospital Doumerc and colleagues (8 recorded temperature and number of renal colic admissions at a Arench tertiar# care center between )**) and )**- These ) studies reported time dela#s between e5posure to higher temperatures and clinical manifestation of s#mptoms of 9, da#s and ) months, respectivel# 1maging studies to identif# stones prior to e5posure to warmer temperatures were not done in these studies Aurthermore, epidemiologic studies in the 4nited 2tates have shown that regions with higher average temperatures have the highest stone rates ),,,() The correlation between increased environmental temperature and increased number of stone events supports the conclusion that global warming has an impact on the development of stones This has been recentl# addressed in a stud# b# @rikowski and associates -9 The# e5amined how global warming alters regional distribution of kidne# stones using a modeling techniFue The# predicted that, based on the effects of global warming, the percentage of people living in areas designated as high risk for kidne# stone formation would increase from -*> in )*** to (:> b# )*(*, and up to '*> b# )*9( This would result in a significant Gclimate$relatedH increase in kidne# stone events "ur review demonstrated that there were decreases in stone prevalence among older age groups This could be due to differences in sampling methods or sub%ects with stones d#ing at a #ounger age The latter is certainl# plausible as kidne# stone formation has been linked to a number of medical comorbidities including obesit#, diabetes mellitus, h#pertension, chronic kidne# disease, and cardiovascular problems (,,-,(,;(: The bod# of evidence suggests that the incidence and prevalence of kidne# stones is increasing globall# These increases are seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force 1n addition, global warming ma# influence these trends "verall stone prevalence has doubled in the 4nited 2tates since the 89:- through 89') time period, although it appears to have stabili<ed since the earl# 89=*s "ther countries with documented increases in prevalence include German#, 2pain, and 1tal# "nl# 2cotland had a slight decrease in prevalence from ,=,> in 89'' to ,(> in 89=' 1ran, 3apan, and the 4nited 2tates had stone incidence reports stratified b# age 1ncidence rates reported b# age group consistentl# show a rise$and$fall pattern as a population ages !eak incidence was age -* to -9 #ears for all , countries, but for 3apanese women, peak incidence occurred at age (* to (9 #ears The actual incidence rate was similar for men age -* to -9 #ears in the 4nited 2tates and 3apan but lower in 1ran The incidence and prevalence of kidne# stones is increasing globall# and is seen across se5, race, and age 6hanges in dietar# practices ma# be a ke# driving force influencing these trends as well as the effects of global warming
Aigure ) 3apan kidne# stone incidence b# age group 1ncidence data reported for 3apanese men .A/ and women .@/ show a consistent rise$and$fall pattern in ever# #ear of reporting Male peak incidence occurs between ages -* and -9 #ears, whereas female peak incidence """ Aigure , 89=: 4nited 2tates kidne# stone incidence b# age group A rise$and$fall pattern is observed for reported incidence rates in the 4nited 2tates during 89=: !eak incidence is observed between ages -( and -9 #ears Aigure ( 899: 1celand kidne# stone prevalence b# age group An increasing prevalence is observed in 1celand as the population ages This trend is observed in both men and women Aigure : )**( 1ran kidne# stone prevalence b# age group !revalence increases with increasing age among 1ranIs population up until age (* to (9 #ears, after which it remains stable Aigure ' 899, 1talian kidne# stone prevalence b# age group An increasing prevalence with increasing age is observed in 1tal# for both men and women Aigure = )**: Thebes, Greece, kidne# stone prevalence b# age group An increasing prevalence is observed with increasing age among those living in Thebes for both men and women Aigure 9 89=9 Turke# kidne# stone prevalence b# age group An increasing prevalence of kidne# stones is observed as the population ages Article infor&ation Rev 4rol )*8* 2pring$2ummer+ 8).)$,/B e=:;e9: !M61DB !M6)9,8)=: Victoriano Romero, MD, Haluk Akpinar, MD, and Dean G Assimos, MD Eake Aorest 4niversit# 2chool of Medicine, Einston$2alem, 76 6op#right J )*8* MedReviews, KK6 This article has been cited b# other articles in !M6 Articles from Reviews in 4rolog# are provided here courtes# of MedReviews, ''% References 8 Hiatt RA, Dales KG, Ariedman GD, Hunkeler 0M AreFuenc# of urolithiasis in a prepaid medical care program Am 3 0pidemiol 89=)+88(B)((;):( L!ubMedM ) 2tamatelou &&, Arancis M0, 3ones 6A, et al Time trends in reported prevalence of kidne# stones in the 4nited 2tatesB 89':;899- &idne# 1nt )**,+:,B8=8';8=), 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The primar# stone eventB a new h#pothesis involving a vascular etiolog# 3 4rol )**-+8'8B89)*;89)- L!ubMedM (- Rule AD, @ergstralh 03, Melton K3, ,rd, et al &idne# stones and the risk for chronic kidne# disease 6lin 3 Am 2oc 7ephrol )**9+-B=*-;=88 L!M6 free articleM L!ubMedM (( Ta#lor 07, 2tampfer M3, 6urhan G6 Diabetes mellitus and the risk of nephrolithiasis &idne# 1nt )**(+:=B8),*;8),( L!ubMedM (: Hamano 2, 7akatsu H, 2u<uki 7, et al &idne# stone disease and risk factors for coronar# heart disease 1nt 3 4rol )**(+8)B=(9;=:, L!ubMedM