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Indian Journal of Community Medicine

Epidemiology of Urolithiasis and Chemical Composition of Urinary Stones in Purnia Division of Bihar

Author(s): T.V.R.K. Rao, S.Bano, M. Das

Vol. 31, No. 2 (2006-04 - 2006-06)

Introduction

Urinary stone disease is a recurrent one. Ecological, environmental and geographical factors do also have some say in urolithiasis. Certain geographical regions have been identified as endemic stone belts1. Review of literature in urolithiasis in the recent past indicates that in India, there is an increased prevalence of the disease in northwestern region2-5. Purnia division, situated in the northeastern part of Bihar, has recently been showing a large number of urinary stone episodes. As such, we have presently studied the epidemiology of urolithiasis in Purnia division and also studied the chemical composition of the surgically removed urinary stones from the region.

Materials and Methods

The work was carried out over a period of three years, from January 1999 to December 2001. A month-wise data of urolithiasis cases reported and diagnosed during the period of work were collected from the government hospitals, private nursing homes and diagnostic centers located within Purnia division. The data were collected with the help of a carefully structured questionnaire. Age, sex and stone location site wise breakup of urolithiasis cases were assessed. 152 surgically removed urinary stones, including 104 of upper urinary tract and 48 of lower urinary tract, were collected from hospitals and nursing homes located in different towns of Purnia division. The stones were analyzed qualitatively for their chemical composition, adopting standard methods3. All chemicals used were of analytical reagent grade. Double distilled water was used for making solutions. Distribution of chemical composition of stones according to site of location in the urinary tract was assessed.

Results and Discussion

Age, sex and urinary tract location-wise data of urolithiasis cases are recorded in Table-I. Distribution of chemical composition of stones according to their site of location is mentioned in Table-II.

A study of our results suggests that there is a gradual increase of urolithiasis cases in Purnia division over the period, 1999-2001. In 1999 the total number of urolithiasis cases reported in the division were 298, in 2000 it increased to 355, whereas in 2001 it shot up to 409. The incidence seems to be high in Purnia district of the division, closely followed by Araria, Katihar and Kishanganj districts. Population wise the ratio seems to be highest for Araria district. The incidence seems to be highest in the months of May, June, July and August, that is summer season. June and July showed up as a peak period.

Age and sex wise breakup of urolithiasis cases (Table-I) in Purnia division reveal a greater percentage of males affected by this disease. The incidence among females seems to be quite low, (26.6%) as compared to males (73.4%). Age wise, maximum incidence has surfaced for middle-aged persons (35 to 44 years). Upper urinary tract calculi have shown up in higher percentage (60.8%) as compared to the lower urinary tract ones (39.2%). A large chunk of total calculi, reported, have been found in the renal pelvis and upper calycial system. Among pediatric calculi, majority of cases were bladder stones. One remarkable point that surfaced in the study is a gradual rise of incidence of urolithiasis in the adolescent age.

Table I: Age, Sex amd Urinary Tract Location wise distribution of Urolothiasis Cases Reported from Purnia Division (Bihar), in the Period, 1999-2001

Age Group Years Males Females Males + Females
UUT LUT Total UUT LUT Total UUT LUT Total
0-4 02 21 23 03 03 06 05 (0.5) 24 (2.3) 29 (2.7)
5-14 15 63 78 06 08 14 21 (2.0) 71 (6.7) 92 (8.7)
15-24 61 55 116 17 06 23 78 (7.3) 61 (5.7) 139 (13.1)
25-34 97 45 142 54 10 64 151 (14.2) 55 (5.2) 206 (19.4)
35-44 171 78 249 89 24 113 260 (24.5) 102 (9.6) 362 (34.1)
45-54 57 46 103 37 12 49 94 (8.9) 58 (5.5) 152 (14.3)
55 & Above 28 41 69 09 04 13 37 (3.5) 45 (4.2) 82 (7.7)
Total 431 349 780 215 67 282 646 416 1062
Figures In Parentheses Indicate Percentage., UUT = Upper Urinary Tract, LUT = Lower Urinary Tract

Table II: Distribution of Chemical Composition of stanas According to Site of Location in Urinary Tract

Type of Stone Site of Location
UUT LUT Total
Pure:
Calcium oxalate 12 (7.9) 08 (5.3) 20 (13.2)
Calcium Phosphate 05 (3.3) 02 (1.3) 07 (4. 6)
Uric acid 01 (0.7) 0 (0.0) 01 (0.7)
Sub Total 18 (11.8) 10 (6.6) 28 (18.4)
Mixed:
Calcium Oxalate & Phosphate 65 (42.8) 08 (5.3) 73 (48.0)
Calcium Oxalate, Phosphate & Uric Acid 05 (3.3) 07 (4.6) 12 (7.9)
Calcim Oxalate, Phosphate & Ammonium 09 (5.9) 12 (7.9) 21 (13.8)
Calcium Oxalate, Phosphate, Ammonia & Magnesium 06 (3.9) 08 (5.3) 14 (9.2)
Other 01 (0.7) 03 (2.0) 04 (2.6)
Sub Total 86 (56.6) 38 (25.0) 124 (81.6)
Total 104 (68.4) 48 (31.6) 152 (100.0)
Figures in parentheses indicate percentage. UUT = upper urinary tract LUT = lower urinary tract

Chemical composition of the urinary stones has also some relevance to the location of stone. Out of 152 surgically removed urinary stones, analyzed presently, 104 stones were of upper urinary tract and the remaining 48 belonged to the lower urinary tract (Table-II). Most of the stones were found to be of mixed crystalloid composition. A total of 81.6% stones were of mixed type, containing calcium oxalate, phosphate, magnesium ammonium phosphate (struvite), uric acid, ammonium urate etc., in two or more combinations. Only a total of 18.4% stones were found to be of pure (single constituent) type. These mostly consisted of calcium oxalate or calcium phosphate or uric acid. Most of the pure stones were calcium oxalate ones. Only one stones was found to be of pure uric acid, suggesting rarity of such stones. Among the mixed stones, a great majority (48%) were calcium oxalate and phosphate containing, out of these, a majority (42.8%) again were from upper urinary tract.

References

  1. Fazil Marikkar Y M Essentials of Nephrology and Urology, Ed. R. Kahivishweswaran Assoc. Eds. V.N. Acharya, M.S. Rao, Vinay Sakhuja and Suresh Bhat. Churchil Living Stone Pvt. Ltd. New Delhi. 1994 pp. 328.
  2. Malhotra K K, Ahuja, MS, Singh S M, Bapna BC. A Correlation Study of Urinary Calculus Disease. Ind J Med. Sci. 1968; 22: 380-387.
  3. Thind SK, Nath R. Chemical Analysis of Urinary Calculi in Chandigarh Area. Ind J Med Res 1969; 57: 1790-1801.
  4. Kabra SG, Gaur S V, Sharma S S Patni M K, Benarji P. Urolithiasis incidence of urinary calculi in south eastern Rajasthan. Report of 1144 cases. Ind J Surg 1972; 34 : 261- 269.
  5. Haldiya K R Bhandari N S Singh Madhu B, Beniwal V K, Lakshmi narayana J. Chemical composition of urinary Calculi in Desert Region of Rajasthan, India. J Hum Ecol 1999; 10: 69-72.

Deptt. of Chemistry, Purnia College, Purnia-854 301 (Bihar).
Received: 15.01.2004

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