The formation of stone in the urinary system, i.e., in the kidney, urethra, or the urinary bladder is called urolithiasis. 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 also one of the most painful urologic disorders that occur in approximately 12% of the global population. Its re-occurrence rate in males is 70%-81% and 47%-60% in females. It is a highly prevalent clinical problem which has affected a large percentage of people across India in the past few years.
In our Kashmir, urolithiasis has become a common disorder and is increasing drastically in the past few years. It can affect all ages but here in Kashmir it is now seen mostly in the younger generation. According to the findings of Dr Sheikh Mohd Salem, et al, of Government Medical College Srinagar, urolithiasis in Kashmir division is a common urological problem and is growing by the day. The primary causes that seem to be responsible are Dietary habits, environmental factors, lifestyle, and genetic factors. According to urology specialists at SKIMS Soura, ten years ago they were seeing very few percent of renal stone in a week but now their number has increased three-fold.
High intake of salts, high protein diet, low intake of fluids, sedentary lifestyle, etc, are some reasons responsible for renal stone formation. Kashmir valley is a very cold place which receives heavy snow and rain round the year. People working in offices and students in educational institutions do not prefer to 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, which result 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 Kashmiri Nun Chai and salty meals, 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 occur with pain (colic) in the flanks or lower abdomen and may radiate to the groin. Blood in the urine or urinary tract infection can also occur. It is a commonly ignored malady which in the long run becomes 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 they developed chronic renal failure or other urinary disorders. Here are some precautions one could take to prevent stone formation and their recurrence:

Keep well hydrated
For the prevention of stone formation, one is advised to drink plenty of fluids. The aim is 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 known 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 the European Food Safety Authority in 2010 for male adults is to drink minimum of 2 litres per day, and a little less for female adults – 1.6 litres per day. This is for a moderate climate and with moderate level of physical activity. Drinking three to four liters of water a day helps dissolve urine salts that can otherwise lead to stones.

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 typical Kashmiri diet consists of 6-12 gm salt in a day. Then there are indirect sources of salt which we are unaware of, e.g., chips, pickles, chutneys, ketchups and sauces. 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 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) and avoidance of certain foods rich in oxalate or uric acid. In a nutshell, both healthy people as well as those with some underlying conditions are highly susceptible and should be aware about said diseases and its prevention measures for healthy and happy life.
Processed foods, canned goods and cold nuts must be reduced. Meat consumption is alright but only in moderation. Too much of animal protein may increase uric acid level and cause renal stones. If typical symptoms begin to show, it is advisable to seek medical advice (and treatment, if required) at the earliest.

The writer is a student at School of Biological Sciences, University of Kashmir. [email protected]

Mir Abrar