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• May 2026

The Kidney Stone Epidemic:Why Rates Are Rising—and What to Do About It

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The Kidney Stone Epidemic: Why Rates Are Rising—and What to Do About It

For most people, a kidney stone comes out of nowhere. One day you’re fine, the next you’re in an emergency room trying to describe flank pain to a triage nurse. What rarely gets explained in that moment is that the stone was probably months or years in the making—and that it wasn’t bad luck so much as a predictable result of how most Americans are living. Stone disease in the U.S. has more than doubled in prevalence since the 1970s. That isn’t a reporting artifact. People are actually making more stones.

Understanding why matters, because most of this is preventable. The conditions driving the increase aren’t mysterious—they’re the same trends reshaping American health across the board: less water, more processed food, more obesity, hotter summers. This post walks through what’s actually going on and what you can do about it.

How Common Is Kidney Stone Disease?

About 1 in 11 Americans will have a kidney stone at some point—up from roughly 1 in 20 four decades ago. A large epidemiological study found that U.S. prevalence nearly doubled between the late 1970s and the 2000s, with the sharpest increases in women and younger adults¹. That puts lifetime risk at roughly 1 in 5 men and 1 in 10 women. Those aren’t fringe numbers.

That translates directly into what emergency departments are seeing. Lincoln’s ERs handle stone presentations year-round, with a predictable surge in summer when temperatures climb and people aren’t drinking enough. Most of these patients had no idea they were at risk.

Why Are Stones on the Rise?

Stones form when urine becomes concentrated enough that minerals—calcium, oxalate, uric acid—start to crystallize. Several population-level shifts are making that happen more often:

Body weight. A major JAMA study found that obesity roughly doubles the risk of stone formation in both men and women, with additional risk accumulating as weight increases over time⁴. Obesity rates in Nebraska have climbed steadily. Stone rates have followed.

Diet. High sodium drives calcium into the urine. Excess animal protein lowers urinary citrate and raises uric acid. Sugary drinks—particularly colas—directly increase stone risk⁹. None of this is unusual dietary behavior. It’s typical.

Dehydration. Concentrated urine is the common denominator across almost every stone type. Chronic low-level dehydration—the kind that produces dark yellow urine at the end of a busy workday—is enough to tip the balance toward crystal formation.

Climate. Higher ambient temperatures increase both urine concentration and urinary calcium excretion. Research projects that continued warming will push the so-called “kidney stone belt” northward—eventually reaching Nebraska³.

Metabolic syndrome. Hypertension, insulin resistance, and central obesity all track with elevated stone risk through shared effects on urinary chemistry⁵. Diabetes is an independent risk factor for uric acid stones specifically. All of these trends are moving in the same direction at once.

What We’re Seeing in Lincoln

The summer surge is real. Lincoln’s ERs handle stone presentations year-round, but the July and August volume is something emergency physicians here know well. Most patients come in with severe flank pain, get a CT, confirm the stone, and go home with pain management and a referral. Some need urgent intervention for obstruction or infection. Most don’t—at least not right away.

What’s changed over the past decade is who’s showing up. Younger patients. More women. More patients with diabetes, hypertension, and obesity alongside the stone. That clinical profile changes the workup and the prevention conversation significantly.

Without any change in diet, fluid intake, or metabolic status, roughly 35–50% of stone patients will have another episode within five years¹⁰. The ER visit is usually the beginning of the story, not the end of it.

Simple Changes That Make a Real Difference

The AUA’s medical management guideline is clear that lifestyle modification is first-line prevention for recurrent stone disease⁷. The interventions with solid evidence behind them aren’t complicated:

1. Drink more water. The AUA recommends fluid intake sufficient to produce at least 2.5 liters of urine per day—roughly 3 liters of total intake for most people. Pale yellow urine is the target. Dark yellow means you’re behind. Spread intake throughout the day and increase it during heat or physical activity.
2. Cut back on sodium. High sodium drives urinary calcium up, which raises calcium stone risk. Staying under 2,300 mg per day is harder than most people expect once you start reading labels on processed food and condiments⁸.
3. Moderate animal protein. Red meat, poultry, fish, and eggs all increase urinary uric acid and lower citrate—both of which favor stone formation. This isn’t about eliminating protein. It’s about not treating high-protein diets as uniformly virtuous⁸.
4. Skip the sugary drinks. Colas in particular are associated with higher stone risk through the effects of phosphoric acid and fructose on urinary chemistry⁹. Water, coffee, and tea are better choices. Lemonade—diluted, low-sugar—has some evidence for benefit because of its citrate content.
5. Manage your weight. The connection between obesity and stone risk is direct and well-documented⁴. This is one area where the general health advice and the stone-specific advice converge completely.

When to See a Urologist

If you’ve had a stone, or if you’re having flank pain that might be one, Nebraska Urology handles the full scope—acute management through prevention planning. For patients who’ve passed or had a stone removed, we offer a metabolic evaluation: 24-hour urine collection plus targeted bloodwork to identify what’s actually driving formation.

Some patients need medication. Some have underlying conditions—hyperparathyroidism, renal tubular acidosis, cystinuria—that diet and hydration alone won’t fix. The workup tells us which situation we’re dealing with. If you’ve passed a stone, save it. Composition guides prevention. And don’t wait for the second one to come in.

Frequently Asked Questions

What actually causes a kidney stone?

Most kidney stones form when urine becomes too concentrated with calcium oxalate, calcium phosphate, or uric acid — minerals that crystallize when there isn’t enough fluid to keep them dissolved. The root cause is usually a combination of chronic underhydration, diet (too much sodium or animal protein), and metabolic factors like obesity, diabetes, or high blood pressure. Genetics plays a role in some patients, and in a smaller number, an underlying condition like hyperparathyroidism drives stone formation regardless of diet.

What does a kidney stone feel like?

The classic presentation is sudden, severe flank pain — often described as worse than childbirth — that may radiate to the groin or lower abdomen. Nausea, vomiting, and blood in the urine are common. Some stones are silent and discovered incidentally on imaging. If you have severe flank pain, fever, or inability to urinate, go to the ER — those symptoms can indicate obstruction or infection, both of which need urgent attention.

How much water do I actually need to prevent kidney stones?

The AUA guideline recommends producing at least 2.5 liters of urine per day, which typically requires drinking around 3 liters (roughly 100 oz) of total fluid. The simplest check is urine color — pale yellow is the target. Dark yellow means you need more. Hot days, exercise, and high-protein meals all increase how much you need. Spread intake throughout the day rather than drinking large volumes at once.

Will I need surgery for a kidney stone?

Most stones pass on their own, particularly those under 5 mm. Larger stones, stones causing obstruction, or stones associated with infection often require intervention — either ureteroscopy with laser lithotripsy, shockwave lithotripsy, or in rare cases a percutaneous procedure. The need for surgery depends on stone size, location, whether it’s moving, and whether you’re developing complications. A urologist can review your imaging and give you a realistic picture of whether watchful waiting is appropriate.

Once I’ve had a kidney stone, am I likely to get another one?

Yes — without any prevention effort, recurrence rates approach 20% at five years and continue to climb over time.10 The good news is that this risk is modifiable. A metabolic evaluation after a first stone — 24-hour urine plus bloodwork — identifies the specific

chemistry driving your stones, and targeted interventions (dietary, medication, or both) can substantially reduce recurrence risk. Don’t skip the follow-up appointment.

Author: AJ Pomajzl, MD

Board – Certified Urologist

Nebraska Urology

Lincoln, NE

Sources

1. Scales CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160-165. PMID: 22498635 U.S. kidney stone prevalence reached 8.8% by 2007-2010, representing a marked increase from prior decades, with the sharpest rises among women, younger adults, and non-white populations.
2. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12(2-3):e86-e96. PMID: 20811557 Global review of 75 studies confirming that stone disease prevalence and incidence have increased substantially across multiple countries, with diet and global warming identified as key driving forces.
3. Brikowski TH, Lotan Y, Pearle MS. Climate-related increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci. 2008;105(28):9841-9846. PMID: 18626008 Climate modeling projects that rising temperatures will expand the U.S. kidney stone belt northward, potentially adding 1.6 to 2.2 million additional lifetime cases by 2050 with a 25% increase in healthcare costs.
4. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455-462. PMID: 15671430 Prospective study of 241,000+ participants showing obesity significantly increases kidney stone risk — approximately doubling it in women (RR ~1.9-2.1) and increasing it by 30-40% in men; weight gain adds further risk independent of starting weight.
5. Obligado SH, Goldfarb DS. The association of nephrolithiasis with hypertension and obesity: a review. Am J Hypertens. 2008;21(3):257-264. PMID: 18219300 Review linking kidney stones with components of metabolic syndrome — hypertension, insulin resistance, and central obesity — with shared pathophysiology suggesting lifestyle modification addresses multiple risks simultaneously.
6. Fakheri RJ, Goldfarb DS. Ambient temperature as a contributor to kidney stone formation: implications of global warming. Kidney Int. 2011;79(11):1178-1185. PMID: 21451456 Review confirming that heat plays a significant role in kidney stone formation, with seasonal summer peaks in stone presentations observed consistently across multiple studies; climate-related increases disproportionately affect men.
7. Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324. PMID: 24857648 The AUA guideline recommends fluid intake sufficient to produce at least 2.5 liters of urine daily as the single most important dietary intervention for preventing recurrent kidney stones, alongside dietary sodium and protein modification.
8. 8. Taylor EN, Curhan GC. Diet and fluid prescription in stone disease. Kidney Int. 2006;70(5):835-839. PMID: 16837923 Review establishing that stone recurrence rates may reach 30-50% within five years without intervention, and summarizing the evidence for individualized dietary modification — fluid intake, sodium restriction, and animal protein moderation — as the foundation of recurrence prevention.
9. 9. Ferraro PM, Taylor EN, Gambaro G, Curhan GC. Soda and other beverages and the risk of kidney stones. Clin J Am Soc Nephrol. 2013;8(8):1389-1395. PMID: 23676355 Prospective study of 194,000+ participants showing sugar-sweetened colas increase stone risk by 23%; coffee, tea, and wine associated with meaningfully lower risk — beverage choice is a modifiable and underappreciated prevention factor.
10. 10. Rule AD, Lieske JC, Li X, et al. The ROKS nomogram for predicting a second symptomatic stone episode. J Am Soc Nephrol. 2014;25(12):2878-2886. PMID: 25104803 Among 2,239 first-time stone formers, symptomatic recurrence occurred in 20% at 5 years and 31% at 10 years; the ROKS nomogram identifies clinical predictors of highest recurrence risk to guide prevention strategy.