Nephrolithiasis In Pakistan


Nephrolithiasis is a common disease that has striking impact on quality of life. Nephrolithiasis specifically refers to calculi in the kidneys. These calculi almost always originate in the kidneys, although they may continue to grow once they lodge in the ureter. Chemically there are different types of stones, like Calcium Oxalate, Uric acid, Striate and Cystic. Stone disease is a major problem in Pakistan. In Pakistan the peak age group is between 10 and 12 years, the male to female ratio being 1.9: 1. The incidence (per 100 000) in the extreme north ranges from 2.4 in Chital to 9.4 in Gigot. Across Pakistan, the incidence ranges from 7.4 in the north, to 28 in the west, to 200 per 100 000 in the south. A survey of operations (1985-1987) gives a minimal incidence of 8.3 per 100 000 for the whole of Punjab, 4.2 for the north and 16.4 for the south. Considerable progress has been made in the medical and surgical management of nephrolithiasis over the past 20 years. Approximately 10 to 20 percent of all kidney stones require surgical removal, which is determined based upon the presence of symptoms and the size and location of the stones. Larger stones and proximal ureteral stones are less likely to pass spontaneously. Urological intervention for stones is highly rewarding and that is why less than 2% of total number of CKD patients in USA develops renal injury due to renal stones. Same is the case with other advance countries. It is unfortunate that this highly reversible cause of kidney injury still accounts 8-10 % of the CKD patients in Pakistan mainly due to late treatment.