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Epidemiology of Stone Disease in Pakistan

Abstract

Urinary tract stones are a common affliction across river, desert, and mountainous regions of Pakistan. A third of the stones have a single component. The commonest stone is composed of oxalate, with phosphate and uric acid as additional components. Calcium oxalate monohydrate is more abundantly present than the dihydrate. Phosphate stones comprise only about 7 % of all stones, and struvite is uncommon. Populations in the north have a greater proportion of pure and predominantly oxalate stones. Rural areas in the south have phosphate stones. The government of British India documented the frequent occurrence of stone in this region from the nineteenth century. The commonest stone was vesical. Noted stone transitions include (1) the marked increase in the discovery of renal stones, (2) the disappearance (except in pockets) of the idiopathic adult vesical stone, and (3) the decrease in children in the proportions of stones that are vesical. Late presentation for treatment and consequent renal destruction are still frequent.

Notable is the lack of metabolic abnormality (except for ubiquitous hypocitraturia) in the majority of tested patients. Low calcium excretion and hypovitaminosis D are common. Diet includes unleavened bread, which has lost some of its phytic acid content during preparation, but nevertheless, like nuts and green legumes, has sufficient phytic acid to bind calcium and prevent absorption. Vitamin A supplementation is reported to be adequate. Dietary transitions have begun to affect the urban population and increase their serum uric acid. Practice patterns veer toward open surgery in those public hospitals that do not obtain adequate funds for costly equipment through philanthropy.

Evidence suggests that the transitions in stone frequency, incidence, and site are at least partly due to increased discovery of renal stone because of the availability of investigative technology consequent to economic advancement.

Keywords

  • Geographical variation
  • Stone composition
  • Urine composition
  • Calcium oxalate stones
  • Calcium phosphate stones
  • Infection stones
  • Uric acid stones
  • Cystine stones
  • Aspects on stone removal
  • Pediatric stones
  • Age-related stone formation
  • Recurrence
  • Stone site
  • Transitions

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Fig. 3.1
Fig. 3.2

Notes

  1. 1.

    Personal communication from Dr. Razzaq Nasir, 2011.

  2. 2.

    Statistics from Aga Khan University courtesy of Dr. Raziuddin Biyabani.

  3. 3.

    Personal communication from Dr. Jai Pal.

  4. 4.

    Personal communication.

  5. 5.

    Personal communication from Dr. Khursheed Anwar.

  6. 6.

    Personal communication from S. Raziuddin Biyabani.

  7. 7.

    Personal communication, Jai Pal.

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Acknowledgments

The authors wish to gratefully acknowledge the assistance of Prof. Shafique ur Rehman and Dr. Noor Ahmed, for ­provision of data, and Ammara Khan and Mubashir Hussain for researching literature.

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Memon, A. et al. (2012). Epidemiology of Stone Disease in Pakistan. In: Talati, J., Tiselius, HG., Albala, D., YE, Z. (eds) Urolithiasis. Springer, London. https://doi.org/10.1007/978-1-4471-4387-1_3

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