Time changes in the spectrum of urinary stone composition: a role for climate variations?

Abstract

Background An increase of the frequency of uric acid urinary stones compared to calcium-containing ones has been recently described. This study was aimed at assessing the frequency of different types of urinary stones in the population of northern Italy in the period 2016–18 compared to 2001–2003. Methods Analyses by infrared spectroscopy of 1007 stones endoscopically removed at two institutions in the area of Milan (Northern Italy) were retrospectively considered. Stones were classified as calcium oxalate monohydrate (COM) and dihydrate (COD), mixed uric acid/calcium oxalate (UC); uric acid (UA), struvite (ST); apatite (CAP); mixed calcium oxalate / apatite (CAPOX); others. The patients were divided into two groups: 2001–2003 and 2016–2018. The average temperature values of the region over the two time periods were obtained by the national statistical institute. Results The average age of the 2001–2003 group (45.8+/− 15.4 years) was significantly lower than the average age of the 2016–18 group (57.9+/− 14.8) (0.000). M / F ratio was similar in the two groups: 119 / 69 (1,0.58) in 2001–2003 and 527 / 292 (1,0.55) in 2016–18 (p = 0.862). COM stones tended to more frequent in 2016–18 group than in 2001–03. COD stones were significantly more frequent in 2001–03 than in 2016–18. ST stone frequency was increased from 2001 to 03 to 2016–18. No increase of uric acid containing stones was observed in 2016–18. Results were confirmed after adjustment by age. Averages annual regional temperatures increased from 14 °C to 15.4 °C during the two observation periods. Conclusions No increase of UA stones was observed, probably due to the limited impact of the global warming in our temperate climate.

Prevalence and trends of urolithiasis among adults

“…Uric acid stones have increased in men, whereas carbonate apatite stones have decreased significantly in women in the same cohort [27 ▪ ]. Inversely, no significant rise in uric acid stones was observed in a study conducted in Italy [24]. Also, in Turkey, calcium oxalate (CaOx) stones have markedly increased from 2006 to 2019 [19].…”

“…Table 1 summarizes the findings of the studies that met our inclusion criteria. Twenty-three studies were identified reporting on urolithiasis epidemiology, prevalence, and trends from 11 different countries in the past 2 years [6 ▪▪ ,12,13 ▪ ,14 ▪ ,15,16 ▪▪ ,17,18 ▪ ,19–26,27 ▪ ,28–33].…”

“…In a nationally representative study that assessed the annual incidence of kidney stones in the United States, the mean age of stone formers has significantly increased from 45 years in 2005 to 51.7 years in 2015 [18 ▪ ]. Similarly, in northern Italy, the average age of patients was significantly lower in the 2001–2003 group (45.8 years) than in the 2016–2018 group (57.9 years) [24]. In contrast, several studies in China found that the peak prevalence of urolithiasis was in middle-aged individuals and then decreased with age [14 ▪ ,16 ▪▪ ,33].…”

Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to vacuum-cleaner procedure in patients at high risk for infections: a single-center experience

“…First, the prevalence of stone disease rises worldwide and a growing number of patients will need a minimally invasive procedure to treat kidney stones [ 29 ]; second, recurrent urinary tract infections and related antibiotic treatment are frequent and serious issues in the everyday clinical practice, thus predisposing patients to further infective danger [ 30 , 31 ]; third, also connected to the previous observation, the rate of infected stones (e.g. struvite) in increasing, at least in Western countries [ 32 ]; forth, continued improvements in life expectancy have seen the growth of the elderly population, with associated chronic diseases (e.g. diabetes mellitus, immune disorders) [ 33 ].…”

The role of the general practictioner in the management of urinary calculi

“…The prevalence of urinary stones increased from 1986 to 1998 by 40% in males and by 20% in females (10). From 2001-2003 to 2016-18, the mean age of patients increased from 45.8+/-15.4 years to 57.9+/-14.8 years and the frequency of calcium oxalate monohydrate stones increased from 44 to 51% (21). From 1986-1998 to 2005-2010, a change of the urinary biochemical characteristics of renal stone formers patients in Italy was observed.…”