In India, approximately 5 -7 million patients suffer from stone disease and at least 1/1000 of Indian population needs hospitalization due to kidney stone disease. In India, the "stones belt" occupies parts of Maharashtra, Gujarat, Punjab, Haryana, Delhi and Rajasthan. In these regions, the disease is so prevalent that most of the members of a family will suffer from kidney stones sometime in their lives. The incidence of renal calculi is comparatively low in the southern part of country compared to other parts. Calcium oxalate (CaOx) urolithiasis accounts for approximately 75% of urinary stone disease. Such high incidence of calcium oxalate stones have been attributed to major consumption of cereals like millet, which are high in calcium and phosphate, beside factors like lack of animal proteins and increased consumption of oxalate rich vegetables. For a patient unfortunate enough to form a stone, the chance of recurrence is high (30% in next 10 years for calcium stone former). It was observed that the highest incidence of renal stones was in the age group of 31-60 years. The incidence in males and females was in the ratio of 3.3:1.
Data available from St. Stephen's Hospital, showed that urolithiasis accounted for 30.7% of the total operative case load, Benign prostatic hyperplasia (BPH) accounted for 16.3%, urethral strictures for 14.6%, oncology-6% (predominantly bladder tumor), andrology- 1.5%, female urology-1.1% and access for renal replacement therapy-10.3%. (St. Stephen's Hospital, Urology OT register: 2007)
Data available from Sir Ganga Ram Hospital revealed that urolithiasis formed 34% of the operative case load, BPH 33.1%, followed by uro-oncology 22.4%, renal transplantation 13%, reconstructive urology 4.4%, andrology 3.3% and pediatric urology (reconstructive) 2.4%. (Sir Ganga Ram Hospital, Urology OT records: 2007.)
So majority of the work of urologist revolves around renal stone disease.With this stone disease it is essential to find out the basic reason why stone formation takes place and start these measures in recurrent stone formers so that he will not form stones in future.
Adequate water intake,alkalinisers,hydrochlorthiazides, appropiate diet forms the baseline therapy to prevent the recurrence of the stone disease.
Now a days there are capsules containing oxalobactor formigenes(700 million), lactobacillus acidophilus and rhamnosus.Oxalobactor is a gram negative anaerobic bacterium that metabolises oxalate in the intestinal tract.The colonisation with oxalobactor formigenes is associated with a 70% reduction in the risk of recurrent calcium oxalate stone formation.
|OXALATE DEGRADATION BY OXALOBACTOR FORMIGENES|