Background: Urolithiasis is one of the most important causes of acute and chronic urinary failure.presenting with acute renal colic, severe loin pain, frequent urination, dysuria, oliguria and haematuria. It can be precipitated by dehydration and reduced urine output, increased protein intake, heavy physical exercise, and various medicines. The treatment of urolithiasis involves emergency management of renal (ureteral) colic, including surgical interventions where indicated, and medical therapy for stone disease. This cross-sectional study was undertaken to find the prevalence of urolithiasis in patients presenting with acute kidney injury and to study the biochemical parameters associated with urolithiasis.

Objectives: To find the prevalence of renal urolithiasis presenting with acute kidney injury and to document the clinical findings, risk factors and outcomes of urolithiasis in patients coming to the nephrology department of this tertiary care hospital.

Methodology: After approval for study was obtained from the Institutional Review Board and Ethics Committee data for this cross-sectional study was collected from the medical records of patients admitted for urolithiasis in this institution from April 2016. The sample size was calculated to be 246, for single proportion, for a confidence interval of 95% and precision of 5% using the estimated prevalence of urinary stones of 20%. The data was analysed using SPSS software to find the prevalence and risk factors of Urolithiasis in acute kidney injury.

Results and Conclusions: In our study we found urolithiasis was commonly seen in male patients between the ages of 50 and 60 years, who presented commonly with flank pain and vomiting. Serum creatinine was elevated in around two thirds of the patients and the commonest feature on urine analysis was haematuria. Most of the patients (70%) were surgically managed. The prevalence of acute kidney injury due to urolithiasis was 23% and chronic kidney disease was 3%.

Keywords: Urolithiasis, kidney stones, calculi, lithotripsy, acute kidney injury.

1. Romero V, Akpinar H, Assimos DG. Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors. 2010 Reviews in Urology. 12:2/3. e86-96.
2. Sharma SK, Samal IR, Soumya N P. Urinary Stones In Southern India: Biochemical Analysis And Its Clinical Implications. Jan 2015. International Journal of General Medicine and Pharmacy (IJGMP).2015;4:1.
3. Bharathi Pauline Suganthi Vijaya, M. Amirthaveni. A Comparative Study of 24 Hour Urinary Composition between Urinary Stone Formers and Healthy Volunteers. 2007; 44:5:250-260.
4. Gasinska A, Gajewska D. Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones. Roczn, Pzh 2007,58, Nr 1,61-67
5. Pak CY, Sakhee K, Moe O, et al: Biochemical profile of stone forming patients with diabetes mellitus. Urology 61:523–527, 2003
6. Bihl G., Meyers A.: Recurrent renal stones disease-advances in pathogenesis and clinical management. Lancet, 2001, 358, 651-656.
7. Madhvi A, Malhotra SR. Renal Calculi - Prevalence, Risk Factors and Dietary Management:AReview.Indian Journal of Nutrition and Dietetics.2016:53:2.228-240.
8. PreziosoD, StrazzulloP,LottiT, Bianchi G, Borghi l, Caione P et al. Dietary treatment of urinary risk factorsfor renal stone formation. A review of CLU Working Group. ArchivioItaliano di Urologia e Andrologia 2015; 87, 2 105-120.
9. Vasanthamani G, Sushmitha Y 1997. Impact of diet counseling on patients suffering from urinary stones. Indian NutrDietet, 34: 24-28.
10. Carpentier X, Daudon M, Traxer O, Jungers P, Mazouyes A, Matzen G et al. Relationship between the carbonate rate of carbapatite, morphological characteristics of calcium phosphate stones and etiology. 2009. Urology 73:968.
11. Levey AS, Coresh J et al. Clinical Practice Guidelines Clinical Practice Guidelines for Chronic Kidney Disease:Evaluation, Classification and Stratification published by National Kidney Foundation Disease Outcomes Quality Initiative (DOQI). Available at https://www.kidney.org
12. Singh VV, Rai PK. Kidney stone analysis techniques and the role of major and trace elements on their pathogenesis: a review. Biophys Rev (2014) 6:291–310.
13. Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney International, 2005, 68:1230-1235.
14. Assimos Diabetes Mellitus and Kidney Stone Formation Rev Urol. 2006;8(1):44.
15. Grases F, Sanchis P, Isern B, Peirello J, Costa-Bauza A. 2007. Uric acid as inducer of calcium oxalate crystal development. Scandinavian J Urol Nephrol, 41: 26-31.
16. Abate N, Chandalia M, Cabo-Chan Jr. Moe OW, Sakhaee K. The metabolic syndrome and uric acid nephrolithiasis: Novel features of renal manifestation of insulin resistance. Kidney International. 2004;65:386–392.
17. Strazzullo P, Barba G, Vuotto P, et al. Past history of nephrolithiasis and incidence of hypertension in men: a reappraisal based on the results of the Olivetti prospective heart study. Nephrol Dial Transplant. 2001;16: 2232-2235 .
18. Boyd C, Wood K, Whitaker D, Assimos DG. The influence of metabolic syndrome and its components on the development of Nephrolithiasis
19. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31
20. Lopes JA, Jorge S. In Depth Review of the RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013; 6: 8–14.

Dr Anna Mathew

Professor and HOD, Department of Pharmacology, MOSC Medical College, Kolenchery, Kerala 682311