An elevated Apolipoprotein B to Apolipoprotein A ratio may be associated with increased kidney stone recurrence

1. A higher ApoB/ApoA ratio was associated with a higher risk of kidney stone recurrence.

Evidence Rating Level: 2 (Good)

Kidney stone recurrence occurs in approximately one-third of patients after their initial episode. A high ApoB/ApoA ratio in the blood may exacerbate oxidative stress and inflammation that may contribute to stone formation and recurrence. This study examined the relationship between the ApoB/ApoA ratio and the recurrence of kidney stones. This retrospective cohort study analyzed electronic record data from a hospital in Anhui Province, China, and included patients >18 years with kidney stones who underwent surgical treatment from March 2016 to March 2022. Participants were stratified by ApoB/ApoA ratio levels into low (0.092–0.48), middle (0.48–0.62), and high (0.62–1.0) tertiles. In total, 923 participants were analysed, among whom 296 experienced kidney stone recurrence during a median follow-up period of 36 months. There were 307 participants in the low tertile (mean [SD] age = 51.97 ± 13.28 years, female 141 [45.93%]), 308 in the middle tertile (mean [SD] age = 50.21 ± 12.16 years, female 120 [38.96%]) and 308 in the high tertile (mean [SD] age = 50.42 ± 11.64 years, female 119 [38.64%]). A higher ApoB/ApoA ratio was associated with higher odds of kidney stone recurrence (adjusted odds ratio (aOR) = 2.48, 95% CI 1.04, 5.92). Propensity-matched analyses also found higher ApoB/ApoA ratios to be associated with higher odds of renal stone recurrence (aOR = 3.37, 95% CI 1.24–9.17). A positive linear correlation was found between the ApoB/ApoA ratio and the risk of kidney stone recurrence. Furthermore, patients in the highest ApoB/ApoA tertile had a 74% higher odds of kidney stone recurrence compared with those in the lowest tertile (aOR = 1.74, 95% CI 1.11, 2.74). Overall, this study found higher ApoB/ApoA ratios to be associated with a higher risk of kidney stone recurrence among a Chinese adult population. These findings highlight the potential of the ApoB/ApoA ratio as a biomarker and modifiable risk factor for kidney stone recurrence in this population. Future prospective studies are needed to validate this study’s findings. 

Click here to read this study in the European Journal of Medical Research

Image: PD

©2026 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.