January 9, 2021

Rise of Urolithiasis in Kashmir

The formation of stone in the urinary system, i.e. in the kidney, ureter, and urinary bladder or in the urethra is called urolithiasis or it refers to the accretion of hard, solid and nonmetallic minerals in the urinary tract. Urolithiasis is one of the major diseases of the urinary tract and is a major source of morbidity. Stone formation is one of the painful urologic disorder that occur in approximately 12% of the global population and its re-occurrence rate in males is 70-81% and 47-60% in female. It is a highly prevalent clinical problem which has affected a good percentage of people across whole India from last few years. In our valley Kashmir, urolithiasis has become a common disorder and is increasing drastically from last few years. it affect all ages from children to old people but here in Kashmir it is now seen mostly in younger generation. According to the findings of Dr Sheikh Mohd Saleem a noted Kashmiri Urologist the urolithiasis in the Kashmir valley iscommon urological problem and is growing rapidly day after day in our valley. The primary causes that were seen to be responsible for stone formation are, Dietary habits, environmental factors, life style, and genetic factors. According to urology specialists of SKIMS Soura, ten years before we were checking few percent of Renal stone patients in a week but now its Number has increased by three folds which clearly indicates that this disease has now become common in our valley. High intake of salts, high pretentious diet, low intake of fluids, sedentary life style, are some primary factors mainly responsible for the renal stone formation. Kashmir valley is a very cold place receiving heavy snow and rains round the year as compared to other parts of the country. People working in offices, especially students in educational institutions ,don’t take much fluids and avoid frequent urination during busy hours in cold winters due to which urine becomes super saturated with calcium ,uric acid and oxalates resulting in formation of Renal stones . In the initial phase these substances form crystals which are anchored in the kidney. Due to high salt intake through our cultural Kashmiri tea much popularlu called “Nun chai” and salty meals, around these crystals there is further deposition of substances and eventually a kidney stone is formed. Stones can either pass through the urinary passage and be extruded in the urine or lie asymptomatically in the kidney. It is when they get obstructed in any part of the kidney or urinary tract that symptoms develop. Symptomatic renal stones present with pain (colic) which can occur in the flanks or lower abdomen and may radiate to the groin, blood in the urine or urinary tract infection. It is commonly ignored malady in our societies which in long run become a major cause of Renal Failure. I have myself seen a lot of young patients who were diagnosed with renal stones but due to careless attitude, in later stage they were diagnosed with chronic renal failure or other urinary disorders. Here are some precautions one could take to prevent stone formation and their Recurrence are;
Keep well hydrated
For the prevention of stone formation one is advised to drink more fluids. The goal being to increase the amount of urine that flows through the kidneys and to lower the concentration of substances that promote stone formation. People have always believed water to prevent kidney diseases, which studies have also confirmed. But how much water should a healthy person take? The most recent official recommendation by European Food Safety Authority in 2010 for male adults is to drink minimum of 2 litres per day, and little less for female adults 1.6 litres per day; in a moderate climate and with moderate level of physical activity.
Reduce salt intake
Less than 4 gm of common salt (about 1 teaspoon) in the entire day is what one should aim at if suffering from high blood pressure or kidney disease. But a person on a typical Kashmiri food would consume about 6-12 gm salt in a day. Then there are indirect sources of salt which we are unaware of, e.g. chips, pickles and chutneys, ketchups and sauces etc. Easier said than done, many people have difficulty in reducing salt intake. Here are some tips. Try and limit the amount of processed food as natural sources of sodium are not that concentrated as compared to sodium in processed foods. The best ones are: cumin (zeera), chili, black pepper, cinnamon, ginger, garlic and onion powder. Spice blends like Garam masala are nice too. There are choose-the-lesser-evil options in the market as well. Black/rock salt (Pakistani noon) has lesser amount of sodium than white salt. LONA (available in market) has low sodium but can increase potassium level in blood in patients with kidney disease (which can be dangerous).Various dietary modifications are advised in the form of a cutting back on the consumption of meat, avoidance of caffeinated drinks, foods that contain fructose corn syrup (e.g. frozen junk foods, candy bars, soda etc) and avoidance of certain foods rich in oxalate or uric acid depending upon your stone composition. In nutshell both healthy people as well as those with some underlying conditions are highly susceptible and should be aware about said diseases and it’s prevention measures for healthy and happy life. Drinking adequate water –three to four liters a day, helps dissolve urine salts that can otherwise lead to stones .Eating less salt can further help by keeping urine calcium levels in check. Processed foods, canned goods and cold nuts must be reduced ,meat consumption is alright but only in moderation ,heavy animal intake protein should be consumed in proper limited manner because too much animal proteins may increase uric acid level ,urine acidosis ,in consequence cause renal stones ,however ,if typical symptoms begin to show ,it is advisable to seek medical advice( and treatment ,if required ) at the earliest .
(The author is a student at the School of Biological Sciences, University of Kashmir. Views are his own) [email protected]

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