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Kidney stones are an acute disease that causes pain, hospitalization and long-term complications, such as chronic kidney disease. During the last 20 years, its prevalence has been increasing, and, therefore, the costs of treatment. Among the risk factors, diabetes mellitus and the use of some medications are described, but metabolic syndrome and obesity have been added, due to an unbalanced diet and lack of exercise, and dehydration, increasingly associated with global warming.
This observational, descriptive, cross-sectional study was carried out, searching the records of patients treated in the emergency room in 2016, with a diagnosis of kidney, urinary or urinary tract stone, as according to the ICD-10 classification, to evaluate incidence, risk factors and associated health costs. During that year, 49,401 patients over 18 years of age requested care at the emergency room of the Dr. Gustavo N. Collado Hospital, and of these, 476 patients came due to colicky pain in the urinary tract. The presence of the stone was confirmed by imaging study.
The incidence of lithiasis was 0.9%. Using a systematic sample, 204 records were obtained, for which records of sociodemographic and clinical variables were completed. 56.9% were men, with an average age of 51 years. Forty one percent had no comorbidities, high blood pressure was present in 38%, followed by diabetes mellitus in 19%. A 58% had a body mass index (BMI) greater than 29.04 (SD 5.25). The main occupations were office work, followed by home administration (92% women), as detailed in graph 1. To characterize the lithiasis, 93% underwent urologic tomography, 63% were unilateral lithiasis and 48% presented hydronephrosis. Of these cases, 43% were recurrent, and after discharge, 66% were referred to urology, 6% to nephrology, and 28% had no referral. A cost analysis was carried out, according to the type of intervention required, whether medical, surgical or spontaneous resolution while waiting for care, as described in graph 2.
World statistics show that the incidence of kidney stones has increased by 5 to 7%, with a recurrence rate of up to 50% in 5 years. Because the prevalence of chronic diseases such as diabetes and hypertension has increased, the prevalence of kidney damage secondary to unresolved kidney stones has increased by up to 3%. As cases increase, the associated economic costs and the risk of requiring dialysis also increase. The prevalence in women has been increasing, probably associated with obesity, hormonal risk factors and a sedentary lifestyle. In some series, an increase in cases has been seen in the warmer months, probably associated with dehydration, which could favor the crystallization of solutes. Panama is a country with a tropical climate, so patients come all year round with kidney stones. Once the patient is identified, they must be referred to Nutrition to assess metabolic aspects and to the Nephrologist, to evaluate risk factors and avoid recurrences. Health promotion systems must consider kidney stones as an important pathology that must be included in campaigns recommending healthy lifestyles, to avoid high treatment costs.