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Changing Epidemiology of Stone Composition from 1990 to 2010
Rachel A. Moses, MD, MPH1, Vernon M. Pais, Jr., MD1, Michal Ursiny, BS2, Edwin L. Prien, Jr., MD3, Nicole L. Miller, MD4, Brian H. Eisner, MD2.
1Section of Urology, Dartmouth Hitchock Medical Center, Lebanon, NH, USA, 2Department of Urology, Massachusetts General Hospital, Boston, MA, USA, 3Department of Medicine, Massachusetts General Hospital, Boston, MA, USA, 4Department of Urology, Vanderbilt School of Medicine, Nashville, TN, USA.
Background: This study’s purpose was to examine changes in the epidemiology of nephrolithiasis from 1990-2010.
Methods: A retrospective review was performed of all renal and ureteral stones submitted from the state of Massachusetts to a single laboratory (Laboratory for Stone Research, Newton, MA) for the years 1990 and 2010. Stone composition was determined by infrared spectroscopy and/or polarizing microscopy.
Results: A total of 11,099 stones were evaluated (56.7% from 1990, 43.3 % from 2010). From 1990 to 2010, the percentage of stones from females (i.e. female:male ratio) increased significantly (29.8% in 1990 to 39.1% in 2010, p < 0.001). Among women, from 1990 to 2010, there was a significant increase stones which were > 50% uric acid (7.6% to 10.2%, p < 0.005), and a significant decrease in struvite stones (7.8% to 3.0%, p < 0.001), Among women with calcium stones, the % apatite per stone decreased significantly (20.0% versus 11.7%, p < 0.001). There were no changes in cystine stones in women (0.4% to 0.4%, p = 0.64). Among men, there were no changes in stones which were majority uric acid (11.7% to 10.8%, p = 0.2). Among men with calcium stones, the % apatite per stone increased significantly (9.8% versus 12.5%, p < 0.001). Males also demonstrated a significant increase in both cystine (0.1% to 0.6%, p < 0.001), and struvite stones (2.8% to 3.7%, p = 0.02). There was no change in the % calcium dihydrogen phosphate for either gender.
Conclusions: The epidemiology of stone disease continues to evolve and appears to vary according to gender. While some of these findings may be related to population changes in body mass index and obesity, the etiology of others remain unclear. These findings have implications for further research and for the long term care of patients with stone disease.
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