Pakistan sits in the middle of the stone belt, with the people of Sindh and the Seraiki belt of Punjab among the worst sufferers. Stones in the kidneys cause pain, sepsis, loss of function, and sometimes death.

Stones constitutes 60 % of work load of urology. In many cases it is a silent disease and is diagnosed after kidney function is lost. Therefore early diagnosis and treatment are mandatory to avoid complications.

The preferred treatment now a days is non-invasive “extracorporeal shock wave lithotripsy”. Thus it is important that this treatment be available at every district hospital of the country and be provided free to every citizen. A significant number of patients are unable to get timely treatment because of poverty and subsequently develop complications.

Studies on the geographic variation in the prevalence of kidney stone disease have shown a 50pc higher prevalence in the south east ( the ‘kidney stone belt’ ) than the northwest possibly associated with a changing state of dehydration related to high summer time temperatures and resulting in low urine volumes.

More people report with kidney stones in summer and they develop recurrent colics because of dehydration due to warm weather and less intake of water. The recommendations are to take as much water so to produce 2.5 liters of urine in 24 hours.

All stone formers should take more water, less animal protein, more vegetables and fruits. If they pass stone in urine they should get it analysed and take precautions accordingly with the advise of a urologist and a nutritionist.

They should get treatment when the stone is small because it is easy to treat a small stone with shock waves without any incision, anaesthsia and hospitalisation.

The SIUT runs a weekly stone clinic free on Monday where thousands get treatment and advise regarding the prevention of stone disease because 50 percent develop another stone within 10 years of the first occurrence. This recurrence can be reduced to 14 percent simply by changing life style.

Murli Dhar
Karachi

Published in Dawn, July 1st, 2014