Renal calculus disease

1. Renal calculus disease- complications and Prevention
Epidemiology of nephrolithiasis varies according to the geographical area & socio
– economic conditions. Renal calculus disease is a very common problem in western
Maharashtra, which is often addressed as ‘Stone Belt’.
What is the cause of recurrent renal stone?
Most important cause of renal calculus disease is Genetic. We all know well
that stones run in families.
Also other important factor is Geographic – the solute content of the water,
anatomic abnormalities of urinary tract, repeated urinary tract infections,
hyperparathyroidism, Gout, obesity and diabetes mellitus.
Diet and renal calculus disease:
Low water intake, low calcium intake (not high), and low potassium (fruits)
intake associated with increased intake of renal calculus. High intake of animal
proteins (especially red meat), oxalate (green leafy vegetables), vitamin C, Sodium
(salt), & vitamin D are associated with increased incidence
Complications of renal calculus disease
Increase incidence of complicated urinary tract infection.
Renal failure: urinary tract obstruction, which is a reversible cause of renal failure.
Pyelonephritis, repeated surgeries and ESWL, tubulointerstitial nephritis can all
cause renal failure.
A significant number of patients on dialysis, in our area, are because of repeated
renal calculus disease- causing obstruction, repeated infections, repeated surgeries
and finally destruction of the kidney.
What can we do about this problem?
1) Usually once our patients get operated, they don’t follow-up, repeat USG on
a timely basis. Remember, once a stone is formed, there is very high

2. incidence of recurrence of stones over the years, which may be totally
asymptomatic. So we need to inform our patients that once they have formed
stones, there is always a high risk of recurrence of stones, which might be
completely asymptomatic- they need to follow up regularly, repeat
ultrasound on regular basis.
2) The problem also exists with the treating doctors-
a. They don’t explain patients about potential of recurrence, incomplete
removal etc.
b. Most importantly, they do not take any efforts in sending the stone
for analysis.
c. There are various types of renal stones- most common type is calcium
oxalate. Others are phosphate, uric acid, stuvite and cystine. Ideally if
the type of stone is know- either the surgeon sends it for analysis or
the patient brings the passed stone, it helps in designing a particular
type of diet and give drugs (medications) to prevent recurrent stones-
this will avoid repeated infections, surgeries, destruction of the kidney
and ultimately renal failure.
d. If the composition (type) of the stone is not known, we need to send
the 24 hours urine for Na, K, Chloride, Calcium, uric acid, citrate and
phosphate. This will guide us to design the diet and treatment for
Prevention of stones
e. Finally there are some general measures which might help the
patients- low sodium and animal protein diet, low oxalate and high
citrated, atleast 3 L of water every day. Important to note: we don’t
consume a lot of animal proteins. We hardly have adequate proteins
in our diet. So before we advice someone regarding protein restricted
diet, we should atleast know what is his protein intake. He should
meet a dietician who can SPECIFICALLY design his diet, not just a
blanket chart for everyone.
Hope this information helps you in your practice and in better management of our
patients with renal calculus disease
Thanks
Dr Vilas Naik, MD, DM (Nephrology)
Fellowship in Nephrology and Kindey Transplant
University of Toronto, Canada
Formula for eGFR calculation:
(140 -- age) X weight ( multiply by 0.85 for females)
72 X serum creatinine