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Kidney Stones

I have had a kidney stone. Will I get another one?

Korean national data put a number on it, and the number is high enough to change what should happen after the first stone.

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Answer

About one in five Korean patients diagnosed with a urinary stone has another within five years: in a National Health Insurance Service cohort of roughly one million people, 21.3 percent recurred inside five years, and the estimated lifetime prevalence of urinary stones in Korea is 11.5 percent.

Key takeaways

  • In a Korean National Health Insurance Service national sample cohort, 21.3 percent of patients diagnosed with urolithiasis had a recurrence within five years.
  • The estimated standardised lifetime prevalence of urinary stones in Korea is 11.5 percent — 12.9 percent in men and 9.8 percent in women.
  • The eleven-year cumulative incidence was 5.71 percent, highest in the 60-to-69 age group at 9.08 percent.
  • A regional review of urolithiasis across Asia reports recurrence of 21 to 53 percent within three to five years.
  • The 2024 European Association of Urology guideline recommends that every stone be analysed and every patient have baseline metabolic screening, with two 24-hour urine collections for calcium-stone formers at high risk of relapse.
  • Uric acid, infection and cystine stone formers are classified as high risk of relapse outright.

A stone that has been passed or removed is usually treated as an event that is over. The national figures describe something closer to a condition in remission.

The Korean number

A study of the National Health Insurance Service national sample cohort — about one million people, followed from 2002 to 2013 — recorded 57,921 diagnosed cases of urolithiasis. Of those patients, 21.3 percent had a recurrence within five years.

21.3%

of Korean patients diagnosed with a urinary stone had a recurrence within five yearsTae BS et al., Journal of Korean Medical Science, 2018

A regional review covering Asia puts recurrence higher still, at 21 to 53 percent within three to five years, depending on the population studied. The Korean figure sits at the bottom of that range and is drawn from an entire insured population rather than a hospital series, which is the reason to prefer it.

What that figure is actually counting

A recurrence in claims data is a new diagnostic code, not a new stone confirmed against the earlier images. It cannot separate a genuinely new stone from a residual fragment that finally moved, and it cannot count stones that formed silently in patients who were never scanned again. So 21.3 percent is the rate at which Korean stone patients came back into the system — a real and useful thing to know, and not quite the same quantity as the rate at which Korean bodies form second stones.

Whether anything can be done about it

The 2024 European Association of Urology guideline update sets out what a recurrence rate of this size implies. Every stone should have an attempt made to analyse it. Every patient should have baseline metabolic screening. Patients with calcium stones who are at high risk of relapse should have extensive screening with two 24-hour urine collections and receive treatment aimed at what the collections show.

Some patients are classed as high risk from the outset rather than after a second stone: those whose stones are uric acid, infection-related or cystine. Which of those a patient is depends on the stone, which is the argument for analysing it while it is available.

Sources

  1. 1

    Tae BS, Balpukov U, Cho SY, Jeong CW

    Eleven-year cumulative incidence and estimated lifetime prevalence of urolithiasis in Korea: a National Health Insurance Service-National Sample Cohort based study

    Journal of Korean Medical Science 2018;33(2):e13

    doi:10.3346/jkms.2018.33.e13 · PMID:29215822

    https://doi.org/10.3346/jkms.2018.33.e13
  2. 2

    Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, Davis N, Tzelves L, et al.

    Metabolic evaluation and recurrence prevention for urinary stone patients: an EAU guidelines update

    European Urology 2024;86(4):343-363

    doi:10.1016/j.eururo.2024.05.029 · PMID:39069389

    https://doi.org/10.1016/j.eururo.2024.05.029
  3. 3

    Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, Zeng G

    Epidemiology of urolithiasis in Asia

    Asian Journal of Urology 2018;5(4):205-214

    doi:10.1016/j.ajur.2018.08.007 · PMID:30364478

    https://doi.org/10.1016/j.ajur.2018.08.007