Journal of Clinical and Diagnostic Research. 2016 Jul, Vol-10(7): BC01-BC03 1 1 DOI: 10.7860/JCDR/2016/19714.8139 Original Article INTRODUCTION A heterogeneous distribution of renal stones seen throughout the world marks certain areas as stone belt. This belt encompasses Sudan, the Arab Republic of Egypt, Saudi Arabia, the United Arab Emirates, the Islamic Republic of Iran, Pakistan, India, Myanmar, Thailand and Indonesia to Philippines [1]. In India, the incidence of renal calculi is comparatively low in the southern part of country [2] and high prevalence areas include Maharashtra (7.6%) and Rajasthan [3-5]. Calcium oxalate has been found as the predominant constituent in nephrolithiasis in India [2,6]. Renal calculus disease (RCD) has been found to have a recurrence of 26-53% after a decade of follow-up [7-9]. Studies indicate that primary stone formation is usually associated with one or more metabolic derangements [10,11]. However, due to lack of algorithm based evaluation by clinicians, a thorough metabolic workup is overlooked in these patients [12]. Additionally, metabolic evaluation followed by selective therapy has shown to decrease the incidence of formation of new calculi [13,14]. The frequency and type is variable depending upon different climates [15,16] and in racial groups [17]. A study done in Saudi Arabia found a strong correlation between urinary stone colic and both temperature and atmospheric pressure. The results showed a steady increase in urinary stone colic in the hot season with a maximum rate in the months of June, July and August [15]. High temperature promoted stone formation in men working in steel industry in another study [16]. Soucie et al., in a large cross-sectional survey of 25,286 U.S. adults in the United States found that the prevalence of kidney stones was highest among White people and lowest in Black people. Hispanic and Asian people had an intermediate prevalence [18]. Knowledge of stone composition of a patient can help in unveiling aetiology, suggesting most suitable treatment modality and predicting chances of recurrence. It can thus improve the patient management. Strauss et al., reported in Caucasians that 51% of the subjects had idiopathic hypercalciuria or hyperuricosuria, while 19.8% had a systemic disorder producing stones [19]. Pak [10] reported absorptive hypercalciuria in 55.9%, renal hypercalciuria in 11.8%, primary hyperparathyroidism in 2.9%, hyperuricosuric calcium oxalate nephrolithiasis in 8.8% and no metabolic abnormality in 20.6% of their patients. Hosseini et al., reported from Iran that the most common abnormality observed was low 24 hour urine volume (58.24%), followed by hypercalciuria (17.18%) and hyperuricosuria (15.15%) [11]. These metabolic derangements favours recurrence. Outcome by treatment modalities like shock wave monotherapy is affected by stone number, composition and location also [20]. MATERIALS AND METHODS This cross-sectional study was conducted during a period of six months from Jan 2013 to June 2013. Renal stones were retrieved surgically by percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) and open surgeries after informed written consent from 50 patients coming to outpatient Department of Urology, Postgraduate Institute of Medical Sciences, Rohtak, India. Presence of renal stone was indicated by a history of renal colic, decrease in urine volume or hematuria and confirmed by ultrasonography, X-ray KUB. Computerized tomography was used in some radiolucent renal stones. Immobilized patients, patients with bowel disorders and those on drugs like calcium, antacids and vitamins were excluded. Past history of any metabolic or endocrinal disorder was elicited. Dietary history related to non- vegetarian and food rich in oxalates and calcium, hard water intake, amount of fluid intake, family history along with anthropometric measurements were recorded. Keywords: Renal stones, Stone composition, PCNL, Oxalate, Paradigm shift in renal stones Biochemistry Section An Increase Incidence in Uric Acid Nephrolithiasis: Changing Patterns ASHA KUMARI 1 , SUMIT DOKWAL 2 , PAWAN MITTAL 3 , RAJENDER KUMAR 4 , RICHA GOEL 5 , PIYUSH BANSAL 6 , HIMANSHU DEVENDER KUMAR 7 , JAIKRIT BHUTANI 8 Introduction: Nephrolithiasis is a complex disease affecting all age groups globally. As the causative factors for nephrolithiasis rises significantly, its incidence, prevalence and recurrence continues to baffle clinicians and patients. Aim: To study the prevalence of different types of renal stones extracted by Percutaneous Nephrolithotomy (PCNL) and open surgical procedures. Materials and Methods: Renal stones from 50 patients were retrieved by Percutaneous Nephrolithotomy (PCNL), Ureterorenoscopy (URS) and open surgical techniques for qualitative tests for detection of calcium, oxalate, uric acid, phosphate, ammonium ion, carbonate, cystine and xanthine. Results: Three patients had stone removed by open surgery and rest had undergone PCNL. Nine of the stones were pure of calcium oxalate, 9 were of pure uric acid and 32 were mixed stones. Forty one stones had calcium. Among the mixed stones, oxalate was present in 25 samples (39 of total), uric acid was seen in 17 (25 of total stones), phosphate was present in 23 (23 of total) and carbonate was present in 4 stones (4 of total). Only 1 patient had triple phosphate stone. 12 were of staghorn appearance of which 6 were of struvite type, 6 were pure uric acid and remaining were mixed oxalate-phosphate stones. Conclusion: Our study, though in a small number of hospital based patients, found much higher prevalence of uric acid stones and mixed stones than reported by previous hospital based studies in north India (oxalate stones~90%, uric acid~1% and mixed stones~3%). Biochemical analysis of renal stones is warranted in all cases.