Kidney stones: prevention is better than cure
Prof Dr Liaqat Ali
Kidney stone disease is an ancient disease and earlier descriptions can be traced in Hippocratic Oath. It is the most prevalent disease in urological setups across the globe. The peculiar geography of Pakistan lies in ‘stone belt’, so the incidence of kidney stones is very high in the country. The exact etiology is not known, but the factors that contributes in kidney stone formation are genetic, environmental, climate and familial etc.
It is very unfortunate that due to lack of health education and awareness in Pakistan, stone disease is the number 4th cause of renal failure which is contrary to developed countries. Kidney stones can present as pain, fever, and complications like non-functioning kidney, acute kidney failure, pyonephrosis, or, end stage renal disease.
All these complications are inadvertently associated with high morbidity, repeated hospital admission, financial burden and even mortality. The end stage renal disease due to stone is very crippling condition that requires repeated hemodialysis and at times renal transplantation. Both of the modalities result in transforming a white collar bread owner family below the poverty line.
In the modern era of diagnostic excellence, kidney stones can easily be picked on simple ultrasound abdomen and CT scan. The early diagnosis of kidney stones opens a window for multiple successful treatment modalities like shockwave lithotripsy, percutaneous nephrolithotomy, and retrograde intra-renal surgeries etc. All are effective and safe methods with the aim to achieve complete stone clearance.
Similarly, the next step in this management is the prevention of recurrence of stone that is summarized in these mentioned points; regular follow up visits to urologists, healthy life, stone analysis and metabolic workup, and dietary modification.
The cornerstone of dietary modifications is to encourage oral fluids, especially plain water so as the patient is able to produce two liters of urine per day. Table salt should be avoided in calcium stone along with injudicious use of multivitamins containing calcium as a supplement. The natural dairy products are sufficient to maintain healthy calcium level. Carbonated drinks and proteins should also be restricted according to the advice of doctor.
It is worth to mention here that in dietary modification, the increase in water intake can also reduce the recurrence of stones from 25% to 9% that can save billions of rupees which are spend on the management of stone diseases according to Markov model.
So, let me conclude this article with a quote of Thomas A. Edison: The doctor of the future will give no medicine but will instruct his patient in the care of the human frame, in diet, and the cause and prevention of the disease.
The writer is working at the Department of Urology, Institute of Kidney Disease (IKD), Hayatabad Medical Complex (MTI-HMC), Peshawar. He has been managing all the complex renal stones since 2007. His involvement in patient care, surgical treatment, community awareness campaign, and innovative research in the field of urology has gotten national and international acclaim. The Department of Urology, IKD in liaison with NUST Islamabad, has also started innovative research on Nanotechnology and the study of elementome in renal stone diseases under his leadership.
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