Metabolic And Pathophysiological Links Between Urolithiasis and Cholelithiasis: A Comprehensive Review

Urolithiasis and cholelithiasis are common disorders both of the urinary system (urolithiasis) and of the biliary system (cholelithiasis). Many of the metabolic, genetic and environmental risk factors involved in these two diseases are similar. There is new evidence that indicates that urolithiasis and cholelithiasis are likely not completely independent, but rather that there may be some common pathways involved in the process of stone formation in both the kidneys and the gall bladder. It is vital to understand how these two diseases are related for the purpose of enhancing our ability to detect, prevent and manage patients with both conditions. The present review summarises the currently published data regarding the metabolic abnormalities that are common to both urolithiasis and cholelithiasis (e.g., urine supersaturation, crystal nucleation, dyslipidemia, obesity, insulin resistance, alterations in the gut microbiome). Epidemiological studies have shown that there is co-occurrence of urolithiasis and cholelithiasis in several populations, while genetic and molecular studies have identified many shared susceptibility loci. Several of the same risk factors (e.g., dietary habits, metabolic syndrome, chronic kidney disease) also contribute to the combined disease burden of urolithiasis and cholelithiasis. Thus, utilising imaging and laboratory biomarker(s) as part of a bidirectional screening strategy may enhance our ability to diagnose urolithiasis and cholelithiasis. Management of patients with both urolithiasis and cholelithiasis may be accomplished through the use of diet counselling, pharmacological prophylaxes, and/or interventional procedures. A growing body of literature has demonstrated that urolithiasis and cholelithiasis share many metabolic and pathophysiological processes. By identifying the risk factors and pathomechanisms that are common to both diseases, we can implement diagnostic, preventive, and therapeutic strategies that are integrated for both urolithiasis and cholelithiasis, with the potential to reduce recurrence and improve patient outcomes. Longitudinal and mechanistic studies are needed to further define the causes of the relationship between urolithiasis and cholelithiasis and provide optimal patient care..