, Volume 43, Issue 1, pp 49–53 | Cite as

Dyslipidemia is associated with an increased risk of nephrolithiasis

  • James H. Masterson
  • Jason R. Woo
  • David C. Chang
  • Thomas Chi
  • James O. L’Esperance
  • Marshall L. Stoller
  • Roger L. SurEmail author
Original Paper


The pathophysiology of nephrolithiasis is multifactorial. Obesity, diabetes mellitus and hypertension are implicated in its formation. Dyslipidemia (DLD) recently has received attention as well. Congruent with a vascular etiology in stone formation, DLD theoretically would predispose patients to nephrolithiasis. We investigated a possible association of DLD with nephrolithiasis. A random cohort of 60,000 patients was established by collecting the first 5,000 patient charts per month in the year 2000. After excluding pediatric patients, a retrospective study was performed by reviewing age, sex, comorbidities, and last patient follow-up. Median lipid laboratory levels also were reviewed. Descriptive statistics were performed as well as Cox proportional-hazards regression analysis, and univariate and multivariate analyses. 52,184 (22,717 women/29,467 men) patient charts were reviewed. The average age was 31.0 ± 15.2 years. On univariate analysis, DLD was associated with nephrolithiasis with a hazard ratio (HR) of 2.2 [Confidence Interval (CI), 1.9–2.5; p < 0.001] and on multivariate analysis HR = 1.2 (1.0–1.5; p = 0.033). Low-density lipoprotein and triglycerides had no association with stone disease. Patients with high-density lipoprotein (HDL) values <45 for men and <60 for women had an HR of 1.4 (1.1–1.7, 95% CI, p = 0.003) on univariate analysis and on multivariate analysis; HR = 1.27 (1.03–1.56; p = 0.024) for nephrolithiasis. DLD was associated with an increased risk of stone disease though the only specific lipid panel associated with lower nephrolithiasis was HDL. Clinicians should consider obtaining lipid levels with the intent that treatment could potentially not only mitigate atherosclerotic disease but also decrease nephrolithiasis risk.


Urolithiasis Dyslipidemia High-density lipoprotein 



We especially thank Sean Malloy for his diligence and hard work in creating a data set for analysis for this project.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63(5):1817–1823PubMedCrossRefGoogle Scholar
  2. 2.
    Saigal CS, Joyce G, Timilsina AR (2005) Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int 68(4):1808–1814PubMedCrossRefGoogle Scholar
  3. 3.
    Taylor EN, Stampfer MJ, Curhan GC (2005) Obesity, weight gain, and the risk of kidney stones. JAMA 293(4):455–462PubMedCrossRefGoogle Scholar
  4. 4.
    Rendina D, Mossetti G, De Filippo G, Benvenuto D, Vivona CL, Imbroinise A et al (2009) Association between metabolic syndrome and nephrolithiasis in an inpatient population in southern Italy: role of gender, hypertension and abdominal obesity. Nephrol Dial Transplant 24(3):900–906PubMedCrossRefGoogle Scholar
  5. 5.
    Bagga HS, Chi T, Miller J, Stoller ML (2013) New insights into the pathogenesis of renal calculi. Urol Clin North Am 40(1):1–12PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Inci M, Demirtas A, Sarli B, Akinsal E, Baydilli N (2012) Association between body mass index, lipid profiles, and types of urinary stones. Ren Fail 34(9):1140–1143PubMedCrossRefGoogle Scholar
  7. 7.
    Itoh Y, Yoshimura M, Niimi K, Usami M, Hamamoto S, Kobayashi T et al (2011) The role of long-term loading of cholesterol in renal crystal formation. Arch Ital Urol Androl 83(1):23–25PubMedGoogle Scholar
  8. 8.
    Program National Cholesterol Education (2002) (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Third report of the national cholesterol education program (ncep) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106(25):3143–3421Google Scholar
  9. 9.
    Torricelli FC, De SK, Gebreselassie S, Li I, Sarkissian C, Monga M (2014) Dyslipidemia and kidney stone risk. J Urol 191(3):667–672PubMedCrossRefGoogle Scholar
  10. 10.
    Lipid Metabolism-Atherogenesis Branch, National Heart, Lung, and Blood Institute (1984) The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA 251(3):351–364Google Scholar
  11. 11.
    Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM et al (2007) HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 357(13):1301–1310PubMedCrossRefGoogle Scholar
  12. 12.
    Eisner BH, Porten SP, Bechis SK, Stoller ML (2010) Diabetic kidney stone formers excrete more oxalate and have lower urine pH than nondiabetic stone formers. J Urol 183(6):2244–2248PubMedCrossRefGoogle Scholar
  13. 13.
    Abate N, Chandalia M, Cabo-Chan AV Jr, Moe OW, Sakhaee K (2004) The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int 65(2):386–392PubMedCrossRefGoogle Scholar
  14. 14.
    Selby JV, Austin MA, Newman B, Zhang D, Quesenberry CP Jr, Mayer EJ et al (1993) LDL subclass phenotypes and the insulin resistance syndrome in women. Circulation 88(2):381–387PubMedCrossRefGoogle Scholar
  15. 15.
    Hoofnagle AN, Vaisar T, Mitra P, Chait A (2010) HDL lipids and insulin resistance. Curr Diabetes Rep 10(1):78–86CrossRefGoogle Scholar
  16. 16.
    Stoller ML, Meng MV, Abrahams HM, Kane JP (2004) The primary stone event: a new hypothesis involving a vascular etiology. J Urol 171(5):1920–1924PubMedCrossRefGoogle Scholar
  17. 17.
    Curhan GC, Willett WC, Speizer FE, Stampfer MJ (2001) Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int 59(6):2290–2298PubMedGoogle Scholar
  18. 18.
    Kang HW, Lee SK, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim WJ (2014) Hypertriglyceridemia and low high-density lipoprotein cholesterolemia are associated with increased hazard for urolithiasis. J Endourol 28(8):1001–1005PubMedCrossRefGoogle Scholar
  19. 19.
    Kurogi K, Sugiyama S, Sakamoto K, Tayama S, Nakamura S, Biwa T et al (2013) Comparison of pitavastatin with atorvastatin in increasing HDL-cholesterol and adiponectin in patients with dyslipidemia and coronary artery disease: The COMPACT-CAD study. J Cardiol 62:87–94PubMedCrossRefGoogle Scholar
  20. 20.
    Sur RL, Masterson JH, Palazzi KL, L’esperance JO, Auge BK, Chang DC et al (2013) Impact of statins on nephrolithiasis in hyperlipidemic patients: a 10-year review of an equal access health care system. Clin Nephrol 79(5):351–355PubMedCrossRefGoogle Scholar
  21. 21.
    Rendina D, De Filippo G, De Pascale F, Zampa G, Muscariello R, De Palma D et al (2013) The changing profile of patients with calcium nephrolithiasis: a comparison of two patient series observed 25 years apart. Nephrol Dial Transplant 28(Suppl 4):iv146–iv151PubMedCrossRefGoogle Scholar
  22. 22.
    Ferrandino MN, Peitrow PK, Preminger GM (2011) Evaluation and medical management of urinary lithiasis. In: Wein AJ (ed) Campbell-Walsh urology, 10th edn. Saunders Elsevier, Philadelphia, p 46Google Scholar
  23. 23.
    Cupisti A, D’Alessandro C, Samoni S, Meola M, Egidi MF (2014) Nephrolithiasis and hypertension: possible links and clinical implications. J Nephrol [Epub ahead of print]Google Scholar
  24. 24.
    Taylor EN, Fung TT, Curhan GC (2009) DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol 20(10):2253–2259PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • James H. Masterson
    • 1
  • Jason R. Woo
    • 2
  • David C. Chang
    • 3
  • Thomas Chi
    • 4
  • James O. L’Esperance
    • 1
  • Marshall L. Stoller
    • 4
  • Roger L. Sur
    • 2
    Email author
  1. 1.Department of UrologyNaval Medical Center San DiegoSan DiegoUSA
  2. 2.Department of Urology, UC San Diego Health SystemVA San Diego Healthcare System, UC San Diego Comprehensive Kidney Stone CenterSan DiegoUSA
  3. 3.Department of SurgeryUC San Diego School of MedicineSan DiegoUSA
  4. 4.Department of UrologyUC San Francisco Medical CenterSan FranciscoUSA

Personalised recommendations