Epidemological characteristics of urolithiasis in Kashmir division and relation to source of water

Objective: Kashmir has a high incidence of urolithiasis. This study was undertaken to understand the urinary composition, symptomology, diagnostic modality and relation of urolithiasis to water source in patients admitted in a tertiary care hospital of Kashmir division. Methods: A total of 186 24 hr urinary samples of patients with urolithiasis from a tertiary Care hospital were analyzed by enzymatic and spectrophotometric technique to measure the concentration of calcium, magnesium, oxalate, citrate, uric acid and phosphate. Results: Most of patients enrolled were in the age group of 15-39 yrs ,126 patients (67.7%) of study group. The youngest patient was 14 yrs old and the oldest was 67 yrs old. Most of the patients enrolled for study were males 119(64%) and females were 67(36%) .Patients enrolled were from different districts of Jammu and Kashmir, but most of the patients belonged to rural areas. Most of the patients had flank pain as a predominant presenting symptom (78%), UTI with or without obstruction (11.8%) and incidental asymptomatic patients with urolithiasis (10.2%). Most common diagnostic modality used was USG (83%), Plain X-ray KUB (8.6%),IVP (8.1%)in patients with PUJ/VUJ small calculi. On metabolic evaluation of 24 hour urinary constituents in our study group of 186 patients,113 (60.8%) patients were having hypercalciuria as predominant urinary abnormality with Mean ± SD 9.41±2.07 which was persistently higher than normal. However there was no significant variation on the basis of gender. Hypocitraturia was the second most common abnormality found in 112 (60%) stone formers with Mean ±SD of 1.32±0.18 which is usually not found normally, but was predominately found among males (62.2%) of our study group. Significantly increased concentration of uric acid were seen in 48(25.8%) stone formers which were again found to be statistically significant and their propensity was more in male gender. Urinary phosphate and oxalate concentration were raised in stone formers in 88 (47.3%) and 42 (25.3%) patients with Mean ± SD of 42.32±1.87 and 41.58±5.45 respectively. Hypomagnesuria was seen in 94 (50.5%) patients more in females as compared to males. Conclusion: The findings of the present work indicate that urolithiasis in the Kashmir division represent common urological problem and is correlated with the nutritional, environmental and genetic factors.