Lee Jun Ho, Bae Hoyoung
Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea.
Department of Urology, Boramae Medical Center, Seoul National University, Seoul, South Korea.
BMC Urol. 2025 Mar 12;25(1):48. doi: 10.1186/s12894-025-01735-5.
Nephrolithiasis, with a prevalence of 9% and increasing worldwide, has a recurrence rate close to 50%. Urinary stones significantly impact quality of life and impose substantial economic burdens on patients and healthcare systems. Systemic inflammation is postulated as a risk factor for urinary stones. Previous studies have identified associations between inflammatory markers and kidney stones, but these often rely on patient recall, introducing potential recall bias. This study investigates whether inflammatory markers vary according to the presence of nephrolithiasis using health check-up data from a large cohort in South Korea.
Data were collected from participants in health checkups at a university hospital in Seoul between 2010 and 2020. The study included 18,243 males and 12,919 females who underwent blood tests, KUB (Kidneys, Ureters, and Bladder) radiography, and ultrasound examinations. Only stones larger than 5 mm were counted, enrolling 328 males and 99 females with kidney stones. Exclusion criteria included pyuria, congenital renal deformities, renal cancer, kidney transplant, and diuretic use. Inflammatory markers assessed included the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammatory index (SII). The primary outcome was the presence of nephrolithiasis, detected using combined ultrasonography and KUB radiography. Logistic regression analyses determined the association between inflammatory markers and nephrolithiasis, adjusting for confounders such as age, BMI, blood pressure, triglycerides, LDL, HDL, creatinine, BUN, uric acid, fasting glucose, calcium, and medical history.
In females, an LMR ≤ 5.02 (OR: 2.30, 95% CI: 1.47-3.61, p < 0.001), NLR > 1.94 (OR: 1.97, 95% CI: 1.24-3.12, p = 0.004), and SII > 484.05 (OR: 2.12, 95% CI: 1.38-3.24, p < 0.001) were significantly associated with kidney stones after adjusting for confounders. In males, an LMR ≤ 7.79 (OR: 1.82, 95% CI: 1.33-2.49, p < 0.001) and NLR > 1.32 (OR: 1.55, 95% CI: 1.12-2.15, p = 0.009) were significantly associated with kidney stones, but SII > 560.11 was not (OR: 1.21, 95% CI: 0.87-1.68, p = 0.255), after adjusting. The significant relationships between these inflammatory markers and kidney stones were maintained only in participants aged ≥ 50 years. Specifically, in females aged ≥ 50 years, LMR ≤ 5.02 (OR: 2.38, 95% CI: 1.52-3.74, p < 0.001), NLR > 1.94 (OR: 2.05, 95% CI: 1.30-3.24, p = 0.002), and SII > 484.05 (OR: 2.18, 95% CI: 1.43-3.32, p < 0.001) were significant predictors of nephrolithiasis. In males aged ≥ 50 years, LMR ≤ 7.79 (OR: 1.90, 95% CI: 1.38-2.62, p < 0.001) and NLR > 1.32 (OR: 1.62, 95% CI: 1.17-2.25, p = 0.004) were significant predictors.
Elevated inflammatory markers are significantly associated with the presence of kidney stones, particularly in individuals aged 50 years or older. These findings suggest that systemic inflammation plays a crucial role in the pathogenesis of nephrolithiasis, especially in the older population. The results imply that inflammation contributes to the increasing prevalence of urinary stones with age, highlighting the importance of managing systemic inflammation in preventing nephrolithiasis. Future research would be needed to explore causal relationships and investigate whether anti-inflammatory interventions can reduce the risk of kidney stones.
肾结石的全球患病率为9%且呈上升趋势，复发率接近50%。尿路结石严重影响生活质量，给患者和医疗系统带来沉重经济负担。全身性炎症被认为是尿路结石的一个风险因素。以往研究已确定炎症标志物与肾结石之间存在关联，但这些研究往往依赖患者回忆，存在潜在的回忆偏倚。本研究利用韩国一个大型队列的健康检查数据，调查炎症标志物是否因肾结石的存在而有所不同。
收集2010年至2020年期间首尔一家大学医院健康检查参与者的数据。该研究纳入了18243名男性和12919名女性，他们接受了血液检查、腹部平片（包括肾脏、输尿管和膀胱）X线摄影以及超声检查。仅将直径大于5毫米的结石计算在内，纳入328名患有肾结石的男性和99名患有肾结石的女性。排除标准包括脓尿、先天性肾脏畸形、肾癌、肾移植以及使用利尿剂。评估的炎症标志物包括中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）以及全身免疫炎症指数（SII）。主要结局是通过超声检查和腹部平片联合检测到的肾结石的存在情况。逻辑回归分析确定炎症标志物与肾结石之间的关联，并对年龄、体重指数、血压、甘油三酯、低密度脂蛋白、高密度脂蛋白、肌酐、尿素氮、尿酸、空腹血糖、钙以及病史等混杂因素进行校正。
在女性中，校正混杂因素后，LMR≤5.02（比值比：2.30，95%置信区间：1.47 - 3.61，p < 0.001）、NLR > 1.94（比值比：1.97，95%置信区间：1.24 - 3.12，p = 0.004）以及SII > 484.05（比值比：2.12，95%置信区间：1.38 - 3.24，p < 0.001）与肾结石显著相关。在男性中，校正后LMR≤7.79（比值比：1.82，95%置信区间：1.33 - 2.49，p < 0.001）和NLR > 1.32（比值比：1.55，95%置信区间：1.12 - 2.15，p = 0.009）与肾结石显著相关，但SII > 560.11与肾结石无显著关联（比值比：1.21，95%置信区间：0.87 - 1.68，p = 0.255）。这些炎症标志物与肾结石之间的显著关系仅在年龄≥50岁的参与者中得以维持。具体而言，在年龄≥50岁的女性中，LMR≤5.02（比值比：2.38，95%置信区间：1.52 - 3.74，p < 0.001）、NLR > 1.94（比值比：2.05，95%置信区间：1.30 - 3.24，p = 0.002）以及SII > 484.05（比值比：2.18，95%置信区间：1.43 - 3.32，p < 0.001）是肾结石的显著预测因素。在年龄≥50岁的男性中，LMR≤7.79（比值比：1.90，95%置信区间：1.38 - 2.62，p < 0.001）和NLR > 1.32（比值比：1.62，95%置信区间：1.17 - 2.25，p = 0.004）是显著预测因素。
炎症标志物升高与肾结石的存在显著相关，尤其是在50岁及以上的个体中。这些发现表明全身性炎症在肾结石的发病机制中起关键作用，特别是在老年人群中。结果意味着炎症导致尿路结石患病率随年龄增长而上升，凸显了控制全身性炎症在预防肾结石中的重要性。未来需要进一步研究以探索因果关系，并调查抗炎干预措施是否可以降低肾结石风险。
