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Objective: To evaluate trends in the incidence of kidney stones and characteristics associated with changes in the incidence rate over 3 decades., Patients and Methods: Adult stone formers in Olmsted County, Minnesota, from January 1, 1984, to December 31, 2012, were validated and characterized by age, sex, stone composition, and imaging modality. The incidence of kidney stones per 100,000 person-years was estimated. Characteristics associated with changes in the incidence rate over time were assessed using Poisson regression models., Results: There were 3224 confirmed symptomatic (stone seen), 606 suspected symptomatic (no stone seen), and 617 incidental asymptomatic kidney stone formers. The incidence of confirmed symptomatic kidney stones increased from the year 1984 to 2012 in both men (145 to 299/100,000 person-years; incidence rate ratio per 5 years, 1.14, P<.001) and women (51 to 217/100,000 person-years; incidence rate ratio per 5 years, 1.29, P<.001). Overall, the incidence of suspected symptomatic kidney stones did not change, but that of asymptomatic kidney stones increased. Utilization of computed tomography for confirmed symptomatic stones increased from 1.8% in 1984 to 77% in 2012; there was a corresponding higher increased incidence of symptomatic small stones (≤3 mm) than of larger stones (>3 mm). Confirmed symptomatic kidney stones with documented spontaneous passage also increased. The incidence of kidney stones with unknown composition increased more than that of stones with known composition., Conclusion: The incidence of both symptomatic and asymptomatic kidney stones has increased dramatically. The increased utilization of computed tomography during this period may have improved stone detection and contributed to the increased kidney stone incidence., (Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials., (Copyright © 2014 by the American Society of Nephrology.)

The objective of this study is to compare the prevalence and risks factors for urolithiasis among health care professionals who work in the operating room (OR) versus other locations. Electronic surveys, focusing on a history of urolithiasis, were sent to 3,921 randomly selected employees at our institution, 34 % (1,340) of which worked in an OR. Additional information regarding potential risk factors such as quantity of daily fluid intake, stress level, activity level, body mass index, relevant medical conditions and family history of urolithiasis were obtained and analyzed. Of those surveyed, 46 % (1,802/3,921) responded. The prevalence of urolithiasis for all responders was 10.9 % (196/1,802). Those individuals working in an OR had a higher prevalence of stone disease compared to those who work elsewhere [14.6 % (64/439) versus 9.7 % (132/1,363); p = 0.004]. Specifically, physicians that work in an OR had the highest prevalence of urolithiasis [17.4 % (20/115) versus 9.7 % (132/1,363); p = 0.009). Additionally, physicians that work in an OR reported significantly less fluid intake (p = 0.04) and higher stress levels (p < 0.0001) compared to employees not working in an OR. On multivariate analysis, working in an OR remained associated with a significantly increased risk stone formation (HR 1.43; p = 0.04). Our survey found that health care professionals working in an OR setting, and physicians in particular, are at higher risk of urolithiasis.

Background and Objectives: The contribution of urolithiasis, if any, to the development of ESRD is unclear., Design, Setting, Participants, & Measurements: All stone formers in Olmsted County, Minnesota, first diagnosed between 1984 and 2008 were identified by diagnostic codes with up to four controls matched on age and sex. Charts were reviewed to validate symptomatic stone formers in a random subset. Incident ESRD events were identified by the US Renal Data System., Results: Altogether, 51 stone formers and 75 controls developed ESRD among 6926 stone formers and 24,620 matched controls followed for a mean of 9 years. Stone formers had an increased risk of ESRD after adjusting for diabetes, hypertension, dyslipidemia, gout, and CKD (hazard ratio: 2.09; 95% confidence interval: 1.45-3.01). This increased risk of ESRD remained in the subset of 2457 validated symptomatic stone formers (hazard ratio: 1.95; 95% confidence interval: 1.09-3.49). The attributable risk of ESRD from symptomatic urolithiasis was 5.1% based on a prevalence of 5.4% for stone formers. For stone formers versus controls who developed ESRD, there was an increased likelihood of past hydronephrosis (44% versus 4%), recurrent urinary tract infections (26% versus 4%), acquired single kidney (15% versus 3%), neurogenic bladder (12% versus 1%), and ileal conduit (9% versus 0%), but not diabetes (32% versus 49%) or hypertension (44% versus 52%)., Conclusions: Symptomatic stone formers are at increased risk for ESRD independent of several cardiovascular risk factors. Other urological disease is relatively common among stone formers who develop ESRD.

Kidney stones are a risk factor for chronic kidney disease (CKD), which, in turn, is a risk factor for myocardial infarction (MI). The objective of this study was to determine whether kidney stones associate with an increased risk for MI. We matched 4564 stone formers (1984 through 2003) on age and gender with 10,860 control subjects among residents in Olmsted County, Minnesota. We identified incident MI by diagnostic codes and validated events by chart review through 2006. We used diagnostic codes to determine incidence of kidney stones and presence of comorbidities (CKD, hypertension, diabetes, obesity, dyslipidemia, gout, alcohol dependence, and tobacco use). During a mean of 9 years of follow-up, stone formers had a 38% (95% confidence interval 7 to 77%) increased risk for MI, which remained at 31% (95% confidence interval 2% to 69%) after adjustment for CKD and other comorbidities. In conclusion, kidney stone formers are at increased risk for MI, and this risk is independent of CKD and other risk factors.

Advances in radiology have led to improvements in care for patients with urinary tract stones. One of the most promising imaging techniques is dual-energy CT, which enables more accurate characterization of stone disease than other imaging techniques and helps direct therapy at the time of the initial imaging evaluation. Improvements in percutaneous therapy have led to less-invasive and less-costly treatments for nephrolithiasis. This article describes some of these new approaches to diagnosing and caring for patients with renal stone disease.

Background: Kidney stones are associated with increased risk of chronic kidney disease (CKD); however, risk factors in the general community are poorly defined., Study Design: A nested case-control study was performed in residents of Olmsted County, MN, who presented with a kidney stone at the Mayo Clinic in 1980-1994 to contrast patients with kidney stones who developed CKD with a group that did not., Setting & Participants: Participants were selected from the Rochester Epidemiology Project, an electronic linkage system among health care providers in Olmsted County, MN. Cases were identified by diagnostic code for CKD and confirmed to have an estimated glomerular filtration rate < 60 mL/min/1.73 m(2). Controls were matched 2:1 to cases for age, sex, date of first kidney stone, and length of medical record., Predictor: Charts were abstracted to characterize stone disease, hypertension, diabetes, obesity, tobacco use, ileal conduit, symptomatic stones, type and number of stones, urinary tract infections, number and type of surgical procedures, and medical therapy., Outcomes & Measurements: Kidney stone patients with CKD were compared with matched stone patients without CKD., Results: There were 53 cases and 106 controls with a mean age of 57 years at first stone event and 59% men. In kidney stone patients, cases with CKD were significantly more likely (P < 0.05) than controls to have had a history of diabetes (41.5% vs 17.0%), hypertension (71.7% vs 49.1%), frequent urinary tract infections (22.6% vs 6.6%), struvite stones (7.5% vs 0%), and allopurinol use (32.1% vs 4.7%) based on univariate analysis., Limitations: Potential limitations include limited statistical power to detect associations, incomplete data from 24-hour urine studies, and that stone composition was not always available., Conclusion: As in the general population, hypertension and diabetes are associated with increased risk of CKD in patients with kidney stones. However, other unique predictors were identified in patients with kidney stones that increased the possibility of CKD. Further studies are warranted to elucidate the nature of these associations., (Copyright 2009 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)