The impact of societal changes on patterns of urolithiasis.
OBJECTIVE
The purpose of the present review is to track changes in prevalence and composition of stone disease as a result of lifestyle changes over the past century.


RESULTS
Increasing rates of obesity, diabetes mellitus and metabolic syndrome have resulted in increasing rates of nephrolithiasis among women, decreasing the male-to-female ratio from 1.3: 1 to 1.7: 1. Urine composition results have revealed a decrease in urinary pH (<5.5) and an increase in urinary uric acid supersaturation. This has resulted in increased rates of uric acid stones. Modern bariatric surgeries have further increased the risk of calcium oxalate stone formation. Offending agents, intentionally or unintentionally added to food or drug products, have also led to the appearance of previously unrecognized stone types, that is, melamine and indinavir calculi.


CONCLUSIONS
Societal changes have had a tremendous impact on stone prevalence and composition. Prompt healthier lifestyle education as well as tighter quality control in the Food and Drug Industry is paramount to reducing nephrolithiasis rates and its complications.
Zilberman
Dorit E
DE
Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Yong
Daniel
D
Albala
David M
DM
D048909:Diabetes Complications / Q000150:complications; D006801:Humans; D008019:Life Style; D053040:Nephrolithiasis / Q000209:etiology; D009765:Obesity / Q000150:complications; D012961:Sociology; D052878:Urolithiasis / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism