Urolithiasis in Tennessee: an occupational window into a regional problem.

Abstract

Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known. In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis. The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume. Future research should characterize the geographic boundaries of a southeastern "stone-belt" and explore genetic and dietary hypotheses that might explain it.