Etiological role of estrogen status in renal stone formation

Purpose: Estrogen may protect against kidney stone formation since nephrolithiasis is more common in men than in women. Moreover, the incidence of stones rises after menopause in women. We examined the contribution of estrogen to kidney stone risk by comparing outpatient evaluations in the 2 genders, and in estrogen treated and untreated postmenopausal women. Materials and Methods: We reviewed the results of the initial evaluation of 1,454 adult calcium oxalate stone formers, including 1,050 men and 404 women. Of the postmenopausal women 39 and 50 were estrogen treated and untreated, respectively. Samples of urine and blood were collected 1 week after the imposition of a diet restricted moderately in sodium and calcium, and modestly in oxalate and animal protein. Results: Compared with men the daily excretion of urinary calcium, oxalate and uric acid was lower in women. Women had lower saturations of calcium oxalate and brushite as well as lower excretion of undissociated uric acid. Compared with men urinary calcium was lower in women until age 50 years, when it equaled that of men. Citrate was equal in the genders until the age 60 years, when it tended to decrease in women. Compared with nontreated postmenopausal women those treated with estrogen had lower mean 24-hour calcium plus or minus SD (155 +/- 62 versus 193 +/- 90 mg. per day, p <0.02), mean 2-hour fasting urine calcium (0.08 +/- 0.05 versus 0.12 +/- 0.09 mg./mg. creatinine, p <0.01) and mean calcium oxalate saturation (5.07 +/- 2.27 versus 6.48 +/- 3.44, p <0.05). Conclusions: The lower risk of stone formation in women may be due to the lower urinary saturation of stone forming salts. Estrogen treatment may decrease the risk of stone recurrence in postmenopausal women by lowering urinary calcium and calcium oxalate saturation.