The Comprehensive Systematic Review of Relationship Between Uric Acid Levels And The Risk Of Kidney Stones

Introduction: Nephrolithiasis represents a significant global health burden with increasing prevalence. Although hyperuricemia has been implicated in kidney stone pathogenesis, evidence from Indonesian populations remains heterogeneous and has not been systematically synthesized. This systematic review aims to comprehensively evaluate the relationship between uric acid levels and kidney stone risk, quantify the strength of association, identify modifying factors, and address existing research gaps regarding population-specific evidence. Methods: A systematic review was conducted following standardized screening protocols. Eight electronic databases were searched for observational studies examining the association between serum/blood uric acid or dietary uric acid intake and kidney stone formation. Studies were included if they involved adult human participants (≥18 years), reported quantitative measures of association, and examined kidney stones broadly. Data were extracted regarding study design, population characteristics, uric acid measurement methods, kidney stone definition, effect estimates, and modifying factors. Results: The proportion of kidney stone patients with elevated serum uric acid ranged from 55.3% to 66%, with mean levels between 6.7–7.3 mg/dL. Case-control studies demonstrated strong positive associations between high uric acid consumption and kidney stone risk (OR=6.756; 95% CI: 2.156–21.163; p=0.001). Dietary purine intake showed the strongest effect (OR=13.417; 95% CI: 3.042–59.171). The systematic review identified a dose-response relationship wherein nephrolithiasis risk increases progressively with rising serum uric acid levels. Age (p=0.050) and blood pressure (p=0.050) demonstrated significant associations with hyperuricemia in stone patients. Acidic urinary pH (