Kidney stone causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

The common causes of nephrolithiasis include hypercalcemia, hyperparathyroidism, hypercalciuria, infection with urea splitting microorganisms like Proteus and Pseudomonas, gout, dehydration, inflammatory bowel disease. Less common causes of nephrolithiasis include drugs such as loop diuretics, Acetazolamide, ciprofloxacin, indinavir, guaifenesin triamterene and magnesium trisilicate.

Causes

Common Causes

The common causes of nephrolithiasis:

• Hypercalcemia
  • Hyperparathyroidism
• Hypercalciuria
• Infection with urea splitting microorganisms like Proteus and Pseudomonas
• Gout
• Dehydration
• Inflammatory bowel disease

Less Common Causes

Less common causes of nephrolithiasis include:

• Drugs:
  • Loop diuretics
  • Acetazolamide
  • Ciprofloxacin
  • Indinavir
  • Guaifenesin
  • Triamterene
  • Magnesium trisilicate
  • Cobicistat
  • Febuxostat
  • Sulfasalazine and other sulfa drugs
  • Topiramate
  • Zonisamide

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Ciprofloxacin, Cobicistat, Febuxostat, Guaifenesin, Indinavir, Ixabepilone, Loop diuretics, Magnesium trisilicate Oxcarbazepine, Pramipexole, Sulfasalazine, Tocilizumab, Topiramate,Triamterene, Zonisamide
Ear Nose Throat	No underlying causes
Endocrine	hyperparathyroidism, hypoparathyroidism, Diabetes mellitus
Environmental	No underlying causes
Gastroenterologic	Short bowel syndrome, Inflammatory bowel disease, Increased intestinal absorption of oxalates, Chronic Malabsorption syndrome
Genetic	X-linked recessive nephrolithiasis type 1, X-linked hypophosphataemia, Adenine phosphoribosyltransferase deficiency
Hematologic	Leukemia
Iatrogenic	No underlying causes
Infectious Disease	Urinary tract infection, Pseudomonas, Proteus, Klebsiella, Infection with urea splitting microorganisms, Berylliosis
Musculoskeletal/Orthopedic	Paget's Disease
Neurologic	No underlying causes
Nutritional/Metabolic	Xanthinuria type 2, Xanthinuria type 1, Primary type 1 Hyperoxaluria, Lower Dietarypotassium, Lower Dietary phytate, Lower dietary calcium, Hypervitaminosis D, Higher Dietary vitamin C, Higher Dietary sucrose, Higher Dietary sodium, Higher Dietary oxalate, Higher Dietary fructose, Higher Dietary animal protein, Excessive Vitamin C intake
Obstetric/Gynecologic	No underlying causes
Oncologic	Tumor hypercalcemia, Bone metastasis, Leukemia
Ophthalmologic	No underlying causes
Overdose/Toxicity	Alcohol abuse
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Urine PH less than 5.5, Type I (distal) renal tubular acidosis, Primary Hypokalaemic distal renal tubular acidosis , Medullary sponge kidney, Lower Urinary volume, Lower Urinary citrate, Hypophosphaturia, Hypocitraturia, Hyperuricosuria, Hyperuricemia , Hyperoxaluria, Hypercalciuria, Hypercalcemia, Horseshoe kidney, Higher Urinary pH (CaP stones), Higher Urinary oxalate (CaOx stones), Higher Urinary calcium, Distal (type 1) renal tubular acidosis, Cysteinuria, Chronic metabolic acidosis, Hyperoxaluria
Rheumatology/Immunology/Allergy	Sarcoidosis, Gout
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Urinary stasis, Urinary obstruction
Miscellaneous	Supersaturatin of stone forming compunds in urine, Presence of nidus for crystal precipitation, Obesity, Milk-alkali syndrome, Lower fluid intake, Lesch-Nyhan syndrome, Idiopathic, Dent's disease, Dehydration

Causes in Alphabetical Order

Adenine phosphoribosyltransferase deficiency Alcohol abuse Berylliosis Bone metastasis Chronic Malabsorption syndrome Chronic metabolic acidosis Cobicistat Ciprofloxacin Cysteinuria Dehydration Dent's disease Diabetes mellitus Distal (type 1) renal tubular acidosis Excessive Vitamin C intake Gout Guaifenesin Higher Dietary animal protein Higher Dietary fructose Higher Dietary oxalate Higher Dietary sodium Higher Dietary sucrose Higher Dietary vitamin C Higher Urinary calcium Higher Urinary oxalate (CaOx stones) Higher Urinary pH (CaP stones) Horseshoe kidney Hypercalcemia Hypercalciuria Hyperoxaluria Hyperparathyroidism Hyperuricemia Hyperuricosuria Hypervitaminosis D Hypocitraturia Hypoparathyroidism Hypophosphaturia Idiopathic Increased intestinal absorption of oxalates Indinavir Infection with urea splitting microorganisms Inflammatory bowel disease Loop diuretics Ixabepilone

Klebsiella Lesch-Nyhan syndrome Leukemia Low fluid intake Low urine pH Lower dietary calcium Lower Dietary phytate Lower Dietary potassium Lower Urinary citrate Lower Urinary volume Magnesium trisilicate Medullary sponge kidney Milk-alkali syndrome Obesity Paget's Disease Presence of nidus for crystal precipitation Primary Hypokalaemic distal renal tubular acidosis Primary type 1 Hyperoxaluria Primary type 2 Hyperparathyroidism Proteus Pseudomonas Sarcoidosis Short bowel syndrome Supersaturatin of stone forming compunds in urine Topiramate Tumor hypercalcemia Type I (distal) renal tubular acidosis Urinary obstruction Urinary stasis Urinary tract infection Urine PH less than 5.5 X-linked hypophosphataemia X-linked recessive nephrolithiasis type 1 Xanthinuria type 1 Xanthinuria type 2 Zonisamide

Causes based on type of Stones

Calcium Stones

• Bone metastasis
• Cushing's syndrome
• Distal renal tubular acidosis
• Excessive Vitamin C intake
• Hypercalcemia
• Hyperthyroidism
• Hyperoxaluria
• Hyperuricosuria
• Hypophosphaturia
• Idiopathic hypercalciuria
• Increased intestinal absorption of oxalates
• Leukemia
• Milk-alkali syndrome
• Osteoporosis
• Paget's Disease
• Sarcoidosis
• Tumor hypercalcemias
• Hypervitaminosis D

Infectious Stones

• Klebsiella
• Proteus
• Pseudomonas

Uric Acid Stones

• Alcohol abuse
• Dehydration
• Drugs
• Gout
• Purine metabolism
• Tumor
• Idiopathic

Congenital Stones

• Cystinuria

Genetic Causes

Metabolic imbalances lead to urine crystallization and defective genes that normally encode proteins that maintain metabolic balance causes heritable forms of nephrolithiasis, sometimes leading to CKD.

• Genetic forms of kidney stone disease include adenine phosphoribosyltransferase deficiency, Dent’s disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis, and primary hyperoxaluria, frequently lead to CKD and progress to kidney failure.
• These patients have the risk of recurrence after a transplantation as it doesnot address the underlying metabolic imbalance.

Syndromes like monogenic diabetes, monogenic hyperlipidemia or hypertension, and monogenic systemic lupus erythematosus are known to cause secondary kidney damage.

References