Problems and prospects of neglected renal calculi in Pakistan: can this tragedy be averted?

To report our recent experience of treating patients with stones associated with renal failure, some of the factors underlying this problem, and few suggestions to avert this tragedy.

From January 2010 to December 2010, a total of 2838 new patients with stone disease were treated at a tertiary care center. The medical files of 278 patients presenting with stone disease and renal failure were reviewed and compared with a cohort of 878 patients with normal renal functions. Their demographic and clinicopathological parameters were noted and analyzed.

Of 2838 patients, 278 (9.7%) presented with acute and chronic renal failure, 40 (1.4%) with unilateral non-functioning kidneys, and 25 (0.8%) with pyonephrosis and perinephric abscess. Management in 278 subjects was divided into initial relief of obstruction by percutaneous nephrolithotomy and double-J stents followed by definitive management in the form of open surgery, percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and ureterorenoscopy to make these patients stone-free. Results of treatment showed that 72% of patients either recovered their renal functions or became dialysis-free at the end of the follow-up period.

Complications of renal calculi in the era of modern treatment can be prevented by public education and organizing courses for family physicians as well as opening new stone clinics in the rural areas of the country equipped with modern treatment facilities and strategies for prevention of renal calculi.