Dr Aditya Yelikar
Kidney stone disease is a morbid, painful, costly and without follow-up and medical intervention, recurrence rates have been reported to be as high as 50% within 5-6 years. Common symptoms of kidney stones are pain in abdomen/back, blood in urine, burning while passing urine, urinary tract infections, disturbances in urinary flow, nausea/vomiting, fever. Kidney stones usually affect age group of 30-60 years. In India, 12% population is expected to have kidney stones out of which 40-50% end up with loss of renal function. The risk factors for stone formation are mainly due to dietary indiscretions, modern lifestyle, obesity, physiological-metabolic disturbances or anatomic abnormalities, diseases like diabetes and hypertension. Rising global temperature may also lead to increase in kidney stones. As per capita income increases, the average diet changes, with an increase in saturated and unsaturated fatty acid, animal protein and sugar along with a decrease in dietary fibre, vegetable protein and unrefined carbohydrates. The epidemiology of urolithiasis differs according to geographical area and historical period. India, Pakistan and Southern China comprise an important part of the stone belt in Asia. Calcium oxalate/phosphate accounts for 65-75% of the stones .Hypercalciuria (excess of calcium salts in urine) is the most common cause for stone formation. Kidney stones have been associated with an increased risk of chronic kidney diseases, end stage renal failure, cardiovascular diseases, diabetes and hypertension.
Dietary recommendations:
Dietary treatment of calcium oxalate stones includes reducing or eliminating nutritional oxalate intake by restricting cocoa drinks, chocolate, candies, excessive black tea/coffee intake (more than 2-3 cups/day), spinach rhubarb, asparagus, celery, parsley and tomatoes. Calcium oxalate stone formers should limit intake of almonds, peanuts, cashews, walnuts, beetroot, cocoa, chocolate, tomato, strawberries, eggplant, soy products, tofu, wheat bran and rice bran.
How can you prevent stone formation/recurrence?
12 steps in kidney stone prevention:
1)Continuous intake of water (2.5-3 litres/day) rather than acute bursts. Fluid losses due to perspiration, hot working conditions, sunbathing and various sporting activities have to be made up for. Adequate fluid intake also prevents urinary tract infection
2)Physical activity
3)Weight reduction (BMI 18-25 )
4)Reduce/avoid coffee (1-2 cups/day)
5)Increase fruits and vegetables in diet
6)Avoidance of excess calorie intake or nutritional imbalance
7)Fish oil supplementation is useful
8)Reduce non-dairy animal protein in diet (meat)
9)Have a cup of lemonade/orange juice daily
10)Reduce/avoid salt in diet
11)Avoid vitamin C supplements
12)Reduce/restrict oxalate rich foods (as mentioned above )
In just the last decade, incidence of stone disease has increased from approximately 6% to 11% among men, and 4% to 7% among women, between 1994 and 2021. Of note, the gender gap is also closing, with the male/female incidence ratio shrinking from 3.4 to 1.3.
(The writer is consultant urologist, andrologist and renal transplant surgeon, Aurangabad).