Proliferating problem of kidney stones in India

The formations of human kidney stones are affecting a large population of various age groups in India. Indian cooking reflects the diversity of flavors and the innumerable regional dishes and different food habits ranging in different parts of India. People living in urban areas in India are embracing more packaged foods leading to premature obesity and increased body mass.  

Survey in 2018 says: 

In the Indian population, about 12% of people are expected to have urinary stones and out of which, 50% may end up with the loss of kidney functions.

Unlike in South India, where a few percentages affected by Urolithiasis, in North India, there is a steep 15% of the population within the realm of kidney stones.”

Therefore, considering the prospects of the kidney stone belt, majority falls under areas of Maharashtra, Gujarat, Rajasthan, Punjab, Haryana, Delhi, Madhya Pradesh, Bihar, and West Bengal

Frying and steaming are the two main methods of cooking in India. Hence, to quantify Indian food style and its relationship with kidney stones, let us discuss the possible ways to reduce the prevalence of kidney stones, which is directly or indirectly associated with food. 

Reasons why Indians have kidney stones

India is home to billions of people with diverse culture. A large percentage of the Indian population forms kidney stones in their lifetime. The researchers are continuously working to find why India is a stone belt? A survey shows why do Indians get kidney stones. 

 

These were the reasons that came up: 

  • Climate – North India has severely hot summers and this gives rise to conditions of severe sweating, leading to the passage of highly concentrated urine. This leads to kidney stones. 
  • Water intake – India is essentially a dry country with lack of potable water. This also affects people as intake of water is not proportionate to the amount of sweating.
  • Diet – Indian food is nothing without the spices and other stone forming elements. 
  • Lack of protein – Stones also form due to lack of protein in the diet. Indians usually are vegetarians and lack good quality protein in their diet like eggs and white meat.
  • Excess dairy consumption – Indians usually consume a lot of dairy-rich in fat and calcium yet poor in protein. High intake of milk, ghee and curd is common.
  • Phosphate rich wheat-based diet – People consume a diet rich in wheat and other cereals. This also leads to kidney stones. 
  • Long working hours – Indians are hard-working people and work longer than normal hours which can lead to stress, water loss and erratic diets.
  • Obesity and Diabetes – Indians are gradually shifting to packet foods which are resulting in obesity and other health problems especially diabetes. These two diseases lead to the production of acidic urine, again creating conditions perfect for urolithiasis.

All the above conditions make Indians more susceptible to kidney stones. 

Indian economy and kidney stone

In the Indian scenario, a major population is under the poverty line. Income plays a crucial role in determining the status of life and food intake in general. 

This down and out situation is quite related to chronic malnutrition, since it inhibits the purchase of essential nutritious foods for growth and development, as the price rates are not increasing with income proportionately. Thus, there are many indirect pathways, such as poor healthcare, malnutrition, abstemious food intake, that lead to kidney stones and many other medical conditions. 

Increasing symptoms of kidney stones

Kidney stones, medically known as nephrolithiasis, cause severe pain. For a lot of people, kidney stones can go undiagnosed (small in size)- but they can pass out when you pee. It’s fairly common for a stone to block part of the urinary system. If you’re suffering from a blockage you’ll have severe pain in the abdomen or groin – it can also sometimes cause a urinary tract infection (UTI).

People come to doctors complaining about these problems or symptoms: 

  • Pain in the lower back, sometimes in the groin. Men can have pain in their testicles and scrotum
  • Periods of intense pain in the back or side of your abdomen
  • Feeling restless and unable to lie still
  • Nausea
  • Needing to urinate more
  • Pain when you urinate
  • Blood in your urine

Kidney Stone surgical management

Kidney stones, if left untreated, can lead to other severe kidney problems in the future. Here are some available surgical treatments for kidney stones in India.

Ureteroscopy

This procedure treats the stones up to 2 cm in the ureter. A small scope is placed into the ureter and the laser is used to break the stone. The laser breaks the stone into a fine powder and it is cleared completely. A stent remains inside for two weeks. It’s a daycare procedure under anesthesia. Stones more than 2cm are generally cleared by laparoscopic or keyhole surgery where the ureter is opened and the whole stone is removed.

Lithotripsy

Small stones above 6mm up to 1.5cm can be broken with ESWL lithotripsy (shock wave). In a few sitting, the stone is focused with a shockwave under ultrasound guidance and broken into pieces. The doctors perform it in a procedure room without anesthesia. Each sitting takes about half an hour and the patient can go home the same day. The stones slip down naturally via the ureter and get move out through the urine. But the clearance rate of the stones is less with this method.

RIRS  (The Latest in Kidney stone management)

It is a procedure in which a flexible ureteroscope is placed into the kidney and with the help of laser, stones of any size up to 3cm, multiple or single can be fragmented completely. Get complete stone clearance in single sitting.

PCNL

This is a procedure for large kidney stones where a small 1cm incision is made on the abdomen side through which instruments are placed to reach the kidney stone under X-ray guidance, The stone breaks completely and the fragments are out through this small incision and we can achieve complete clearance of the stones.

3D Laparoscopy (keyhole)

This is keyhole surgery for very large and multiple stones involving the whole of the kidney. Here, the doctor bivalves the kidney and opens it, completely removing all the stones. Then, the two halves of the kidney are closed with sutures and it again functions as a normal kidney

Patients who get treatment for kidney stones, irrespective of any treatment, have a chance of recurrence of stones. Hence, they need to be on long term medication for stone prevention and need adequate follow up with a urologist for a safe and healthy kidney. 

Kidney Stone: A Global Problem

Kidney stones are increasing among adolescents, females not just in India, but also  African and American population. This is a striking change from the historic pattern where middle-aged men were at the highest risk for the painful condition.

These trends of increasing frequency of kidney stones among youth, particularly females, are also concerning when you consider that kidney stones have higher risk of chronic kidney disease, cardiovascular and bone disease, particularly among young women.

Currently, 41% of the population is within a high-risk zone. Computer model predicts 56% of the population will be in a high-risk zone by 2050 and 70% by 2095.

Climate change is expanding that swath of America, currently in the south and southeast, that suffers much higher rates of this sometimes-excruciating renal complication.

People more likely to suffer from kidney stones are: 

  • Population with physical disabilities, 
  • mental illness 
  • Sedentary lifestyle
  • Infants with unhealthy food habits
  • Elderly, especially those who have conditions like dementia
  • Workers who pave roads and toil on farms and
  • Others constantly in the sun

Factors such as age, race, and socioeconomic background may potentially mitigate an individual’s sensitivity to the climatic effect of climate. Although the threat of continued global warming presents many dire risks, increasing risk of nephrolithiasis may be one of the more prevalent results.

Future of kidney stones treatment

If the previous 15 years are an indication of the coming 15 years, we can expect many new innovations for kidney stones treatment. Researchers continue to investigate better approaches for recurrent occurrences. 

Above all, we must not forget that the cornerstone of our management must always be prevention; diet and lifestyle changes as medication cannot be ignored. As ureteroscopy and laser technology have become increasingly advanced, larger stones and perhaps more complex patients can benefit from this minimally invasive procedure. Future surgery may involve robotics.

Also Read: What are the 10 Signs and Symptoms of Kidney Stones in Females?

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