From the Guidelines
There is no established direct link between chronic kidney stone disease, specifically nephrolithiasis composed of monohydrate, and the development of renal cell carcinoma. The primary concern for individuals with a history of kidney stones should be managing the stone disease itself and monitoring overall kidney health. Key aspects of management include:
- Staying well-hydrated to achieve at least 2 L of urine per day, as recommended by the American College of Physicians 1, 2, 3.
- Following dietary recommendations specific to the stone type, such as reducing dietary oxalate and animal protein, and maintaining normal dietary calcium 1, 4, 5.
- Taking prescribed medications to prevent stone formation, such as thiazide diuretics, citrate, or allopurinol, if increased fluid intake fails to reduce stone formation 1, 4, 2.
- Attending regular follow-up appointments with a urologist to monitor both the stone disease and overall kidney function 6. If additional risk factors for kidney cancer are present, such as smoking, obesity, hypertension, or family history, discussing appropriate screening with a physician is prudent. However, the current evidence does not support routine screening for kidney cancer in patients with a history of kidney stones alone. The most recent and highest quality study, although not directly addressing the question, emphasizes the importance of managing stone disease and monitoring kidney health 1.
From the Research
Relationship Between Nephrolithiasis and Renal Cell Carcinoma
- There is no direct evidence in the provided studies to suggest that a history of chronic kidney stone disease, specifically nephrolithiasis composed of monohydrate, contributes to the development of renal cell carcinoma (kidney cancer) 7, 8, 9, 10, 11.
- However, studies have shown that nephrolithiasis is associated with multiple complications, including hypertension, cardiovascular disease, and chronic kidney disease (CKD) 9.
- CKD is a known risk factor for various complications, including end-stage kidney disease and death 7, 10.
- The relationship between kidney stone formation and kidney disease is complex, with proposed pathogenic mechanisms including recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities 9.
- Genetic abnormalities leading to stone formation, including cystinuria and primary hyperoxaluria, contribute to the burden of disease in the stone-forming population 9, 11.
Kidney Stone Disease and Chronic Kidney Disease
- Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications, including CKD 9.
- Significant epidemiologic associations with CKD and end-stage renal disease have been noted, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease 9.
- Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, and the presence of markers of renal injury in the urine of even asymptomatic stone formers 9.
Genetic Factors in Kidney Stone Disease
- Monogenic kidney stone disease is frequent in children, but unbiased prevalence data of heritable forms in adults is scarce 11.
- A systematic assessment of monogenic etiology in adult-onset kidney stone formers undergoing urological intervention found a diagnostic yield of 6.8% using targeted next-generation sequencing (tNGS) 11.
- The study identified cystinuria, distal renal tubular acidosis, and renal phosphate wasting as underlying hereditary disorders in adult-onset kidney stone formers 11.