The prevalence of kidney stone disease is increasing, afflicting 7%–11% of the United States population. Multiple systemic conditions, including obesity and diabetes, are also on the rise. Further, the literature has demonstrated a strong association between metabolic syndrome, its components, and kidney stone disease. In this article, we aim to review the associations of metabolic syndrome and nephrolithiasis, discussing the pathophysiology, urinary parameters, and clinical presentations. With this knowledge, urologists will have a more comprehensive understanding of this complex population of metabolic stone formers enabling improved patient management and treatment of stone disease.