A 70-year-old man presents with right flank pain that radiates to his groin. He has a long history of heavy smoking and alcohol use and reports passing a kidney stone approximately 20 years prior to this event. His past medical history is also remarkable for diabetes mellitus, high cholesterol, and obesity. A computed tomography scan reveals a right 7-mm ureteral stone. In addition, coronal imaging was obtained, and is shown. Which of the following is the greatest risk factor for the development of this patient's additional findings on the imaging study shown?