KARACHI, Feb 25: Kidney stone is a challenge to therapy all over the world and an important cause of kidney failure and loss of life if neglected.

With the high prevalence of stone disease in Pakistan, the facilities for treatment in the country are insufficient and it is the joint venture of physicians and surgeons to manage kidney stones.

These views were expressed by Sindh Institute of Urology Transplant Director Dr Adibul Hasan Rizvi at a three-day urolithiasis symposium, highlighting the causes and management of kidney stone disease, which began here at the new premises of the institute near Civil Hospital on Friday.

The symposium, being hosted by the SIUT in association with the European Urolithiasis Society, was formally inaugurated by Karachi University's vice-chancellor Dr Pirzada Qasim.

About challenges and evolution in treating stone disease, Dr Adib Rizvi stated that it was after two decades that the institute realized of having treated only the stone disease and not identified the cause.

He said that technological advancements using various stone fragmentation energy resources as lithotripsy (breaking of stones by sound waves) or through minimally invasive methods were beneficial for patients of all age groups.

Open surgery was said to have decreased from 90 per cent in 1995 to less than 60 per cent at present. New technologies were said to be included over the years with electron microscopy, stone matrix analysis and dietary factors being presently used, he added.

He pointed out that the SIUT provided free treatment to all patients, which included a large population with stone disease. Prof Alen Rodgers from the University of Cape Town stressed on chemical analysis of stones and urine to identify proteins acting as inhibitors or promoters. He talked about mixed suspension and crystallizers which provide information on crystals.

"Diet plays an important role in stone formation and could be modified for prevention," Dr Rodgers observed. Dr S.R. Khan from the University of Florida, in his keynote address, said that crystals were formed in the urine of stone formers that caused inflammation and eventually destroyed the kidney tissue and lead to renal failure.

He discussed the history of kidney stone, known since the time of Hippocrates and Avicenna. Oxalate and citrate crystals, he said, had been associated with bladder and kidney stones since those times.

Focus on diet came much later and now genetic influence was being looked into, he said while emphasizing on prevention of crystal formation through medical and diet therapy.

Dr P. Nagarraj Rao from the UK said that progress had been made on the understanding of stone formation. He addressed important basic biochemical issues on this aspect.

Dr Deneize Puri said that paediatric stone formers consumed less protein, water and potassium and more oxalate, refined sugar and sodium in their diet. "This reflects an inadequacy of dietary protein and calcium in our patients in contrast to the western population, where excess of these nutrients are responsible for stone formation," she noted.

Prof Anwar Naqvi talked on neglected renal stone diseases, which was a growing challenge in Pakistan. "At SIUT, eight per cent of the stone population in adults and 17 per cent in children develop renal failure has been registered, the reason being late presentation and severe infection. And this calls for early identification of stone patients and prompt treatment," he added.

He was seconded by other Karachi-based urologists, including Dr Sajid Sultan, Dr Farhana Amanullah, Dr Ijaz Hussain, Dr Mohsina Ibrahim, Dr Amir and Dr Puri who reiterated the need for early diagnosis and prompt treatment of stone disease to save kidney.

Prevention was important by using plenty of fluids and balanced diet, they said mentioning that kidney and bladder stone disease was highly prevalent in developing countries affecting all age groups, from infants to adults and was an important cause of kidney failure.

Dr Shrivastav from India presented the results of 603 patients with complex renal stones and treated with the PCNL. "There was 85 per cent clearance with the PCNL alone and 90.1 per cent after auxiliary procedures," he said, adding that the PCNL is an effective and safe mode of therapy for kidney stones.

Speaking on stone disease and renal failure, Dr Sarica from Turkey said that infectious stones, especially the large and complex ones in both kidneys, were the most frequent cause of kidney failure.

"Other risk factors are stones causing obstruction, recurrent stone formation, urinary tract infection and crystal deposition in the kidney substance. Elimination of urinary infections and prophylaxis in recurrent stone formers is the most important measures to save the kidneys," he maintained. -PPI/APP