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Epidemiology of Stone Disease in Pakistan

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Urolithiasis

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.

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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.

Author information

Authors and Affiliations

  1. Section of Urology, Department of Surgery, The Aga Khan University, Stadium Road, 3500, Karachi, Sindh, 74800, Pakistan

    Amanullah Memon M.B.B.S., FRCS (Ed), M. Hammad Ather M.B.B.S., FCPS (Urol), FEBU, Syed Raziuddin Biyabani M.B.B.S., FCPS (Urol), FEBU, Khurram Mutahir Siddiqui FCPS, FRCS (UK) FEBU, Farhat Abbas M.B.B.S., FCPS, FRCS, FRCSEd, FEBU, FACS, Wajahat Aziz M.B.B.S. & Jamsheer J. Talati M.B.B.S., FRCS (Ed)

  2. Department of Urology, PAEC General Hospital, Police Lanes, Islamabad, 44000, Pakistan

    Khursheed Anwar M.B.B.S., FRCS, Dip (Urol) & Kashif Bangash M.B.B.S., FCPS (I)

  3. Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Khyber Pukhtoonkhaw, Pakistan

    Nasir Orakzai M.B.B.S., FRCS & Liaqat Ali M.B.B.S., FCPS (Urology)

  4. Department of Urology, Bolan Medical College Ouetta, Barwary Road, Quetta, 87300, Pakistan

    Abdul Razzaq Nasir M.B.B.S., FCPS

  5. Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, 75500, Pakistan

    Jai Pal Paryani M.B.B.S., FCPS, FEBU

  6. Department of Pathology, Aga Khan University, Stadium Road, 3500, Karachi, 74800, Pakistan

    Farooq Ghani M.D., Ph.D. (Path) USA

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  1. Amanullah Memon M.B.B.S., FRCS (Ed)
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  14. Jamsheer J. Talati M.B.B.S., FRCS (Ed)
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Correspondence to Amanullah Memon M.B.B.S., FRCS (Ed) .

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Editors and Affiliations

  1. Department of Surgery Section of Urology, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

    Jamsheer J. Talati

  2. Karolinska Institutet, Solnavägen 1, Solna, Stockholm, 171 77, Sweden

    Hans-Goran Tiselius

  3. , Syracuse University, Crouse Hospital, 1226 East Water Street, New York, 13210, New York, USA

    David M. Albala

  4. , Department of Urology, Tongji Hospital, 1095 Jiefang Avenue, Wuhan, 430030, China, People's Republic

    ZHANGQUN YE

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© 2012 Springer-Verlag London

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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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  • DOI: https://doi.org/10.1007/978-1-4471-4387-1_3

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  • Print ISBN: 978-1-4471-4383-3

  • Online ISBN: 978-1-4471-4387-1

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