Abstract
Introduction: Urinary tract lithiasis is the third most prevalent condition in men. The composition of the stones is 80% calcium. The main metabolic alterations are hypercalciuria, hyperuricosuria, hypocitraturia, hyperoxaluria, low urine volume, urinary tract infection, primary hyperparathyroidism, renal tubular acidosis, and cystinuria. In this scenario, uric acid stones represent about 5 to 10% of all kidney stone formation. The high prevalence of obesity or metabolic syndrome, diabetes, and hypertension is also commonly associated with nephrolithiasis. Objective: To elucidate the main metabolic and epigenetic predictors of lithiasis, focusing on the nutritional management of treatment. Methods: The systematic review rules (PRISMA) were followed. The search was carried out from June to August 2025 in the Scopus, Embase, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Common descriptive statistical analysis was performed using mean, standard deviation, and minimum/maximum values of general numerical clinical data. Binary Logistic Regression analysis was performed, with p<0.05, with statistical significance at the 95% confidence interval (CI) in relation to the reference group adopted for each variable. The Odds Ratio (OR) was calculated to determine the probability ratio between the analyzed groups, respecting the 95% CI. Results and Conclusion: A total of 138 articles were found. A total of 64 articles were fully evaluated, and 32 were included in this systematic review. Considering the Cochrane tool for risk of bias,
the overall assessment resulted in 9 studies at high risk of bias and 24 studies that did not meet the GRADE criteria. Most studies showed homogeneity in their results, with X2=91.4%>50%. The symmetrical funnel plot does not suggest a risk of bias between small sample-size studies. It was identified that the predictors male gender, altered BMI, alcoholism, hypertension, diabetes mellitus, dyslipidemia, and altered parathyroid hormone showed a strong probability of contributing to the event of kidney stones. Furthermore, it showed important correlations and odds ratios (OR) of the variables BMI, DM, and staghorn calculi with metabolic alterations, highlighting hypercalciuria and BMI in categories 2 and 3 (p=0.001; OR=3.28), hypocitraturia and staghorn calculi (p=0.003; OR=2.21), hyperuricosuria and BMI in categories 2 and 3 (p=0.017; OR=2.01), hyperoxaluria and BMI in categories 2 and 3 (p=0.002; OR=2.81), urinary tract infection and DM (p=0.005; OR=1.73), urinary tract infection and staghorn calculi (p=0.003; OR=1.77), parathyroid hormone alteration and BMI in categories 2 and 3 (p=0.008; OR=2.69), and hyperphosphaturia and BMI in categories 2 and 3. (p=0.021; OR=1.99). Therefore, metabolic syndromes, obesity, hypertension, diabetes mellitus, dyslipidemia, and altered parathyroid hormone, as well as epigenetic factors such as alcoholism and high-protein diets, were shown to be important triggers of metabolic alterations in kidney stones and, consequently, lithiasis. Furthermore, this study allowed us to understand how many times each predictor can influence these metabolic alterations, thus representing important targets for the treatment of lithiasis.