This article reviews the relationship between metabolic syndrome (MetS) and 
nephrolithiasis, as well as the clinical implications for patients with this 
dual diagnosis. MetS, estimated to affect 25% of adults in the United States, is 
associated with a fivefold increase in the risk of developing diabetes, a 
doubling of the risk of acquiring cardiovascular disease, and an increase in 
overall mortality. Defined as a syndrome, MetS is recognized clinically by 
numerous constitutive traits, including abdominal obesity, hypertension, 
dyslipidemia (elevated triglycerides, low high-density lipoprotein cholesterol), 
and hyperglycemia. Urologic complications of MetS include a 30% higher risk of 
nephrolithiasis, with an increased percentage of uric acid nephrolithiasis in 
the setting of hyperuricemia, hyperuricosuria, low urine pH, and low urinary 
volume. Current American Urological Association and European Association of 
Urology guidelines suggest investigating the etiology of nephrolithiasis in 
affected individuals; however, there is no specific goal of treating MetS as 
part of the medical management. Weight loss and exercise, the main lifestyle 
treatments of MetS, counter abdominal obesity and insulin resistance and reduce 
the incidence of cardiovascular events and the development of diabetes. These 
recommendations may offer a beneficial adjunctive treatment option for 
nephrolithiasis complicated by MetS. Although definitive therapeutic 
recommendations must await further studies, it seems both reasonable and 
justifiable for the urologist, as part of a multidisciplinary team, to recommend 
these important lifestyle changes to patients with both conditions. These 
recommendations should accompany the currently accepted management of 
nephrolithiasis.