Kidney stone disease (KSD), also known as nephrolithiasis, is a highly prevalent condition worldwide, representing one of the most common urological disorders.
It is a hard deposit formed from minerals and salts in the urinary tract. Once considered uncommon in many parts of Africa, it is now showing a rise in incidence, changing patterns and repeated warnings that prevention and early diagnosis must be prioritised.
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According to a 2021 global survey, there were 106 million new cases reported, with the incidence rising substantially since 2000, reflecting a 27 per cent increase.
In Nigeria, systematic reviews indicate a large increase of 100 per cent in age-standardised prevalence between 1990 and 2019.
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Also, a report shows that sonographic screening in the University of Abuja Teaching Hospital between June 2014 and May 2015 reported a urolithiasis prevalence of 13.4 per 1,000 (1.34 per cent).
In the study, a total of 2,310 patients underwent abdominopelvic ultrasound in the department who were aged between two and 64 years.
Other Nigerian centre series reports widely variable prevalence, particularly among adults of working age. (depending on method and setting).
Common symptoms
Kidney stones are solid mineral deposits that form within the kidneys and urinary tract. While the condition is more common among adults, children and infants can also be affected.
According to an online publication, these stone formations are typically due to an oversaturation of the urine with oxalate, calcium, uric acid, or cysteine, which gradually accumulate and form crystals that increase in size over time, leading to characteristic symptoms.
The report states that their symptoms include flank pain, haematuria, nausea, vomiting, or obstruction, which may require emergency department visits.
However, these symptoms are uncommon in young children, who may present with abdominal pain, vomiting, fever, and signs of urinary tract infection.
Smaller children often present with non-specific signs, while some cases are asymptomatic and detected incidentally.
Also, calcium-oxalate and calcium-phosphate stones predominate globally and are the most commonly reported types in Nigerian clinical series.
Other types include uric-acid stones, infection-related struvite stones (linked to certain bacteria), and rare genetic cystine stones.
The report also notes that many hospitals in Nigeria do not routinely perform stone composition analysis after removal.
The absence of routine analysis impedes targeted prevention, such as dietary or medical measures tailored to the stone type, and weakens secondary-prevention efforts.
Who is most at risk?
According to another report, risk factors identifiable in Nigerian and global literature include low fluid intake and chronic dehydration, especially relevant in hot climates and for people doing outdoor work.
Dietary factors in high salt, high animal-protein diets and foods rich in oxalate raise risk for calcium stones.
Also, metabolic conditions such as obesity, insulin resistance and certain metabolic derangements increase stone formation.
Genetic and anatomical factors such as family history, congenital abnormalities and variations in appendix/kidney anatomy can play major roles.
Paediatric series show that children can and do form stones; in some Nigerian cohorts more than half of paediatric presentations were already complicated by obstruction or infection at the time of hospital arrival.
Treatment pathways
According to the survey, management depends on stone size, location and patient factors.
Conservative/medical management is associated with small stones (<5–6 mm) often passed with hydration, analgesics and medical expulsion therapy. Extracorporeal shock wave lithotripsy (ESWL) is associated with non-invasive fragmentation for selected renal and upper-ureteric stones. Ureteroscopy (URS) with laser lithotripsy is increasingly used for ureteric and intrarenal stones with high stone-free rates. Percutaneous nephrolithotomy (PCNL) is preferred for large (>20 mm) or staghorn stones.
Across Nigeria, availability of ESWL and PCNL is concentrated in tertiary and private centres, a mismatch with the growing number of patients needing specialised care.
READ ALSO: Eat vegetables in moderation to prevent kidney stones, says urologist
Prevention
The report shows that the most effective preventive measure is adequate hydration aiming for urine output that keeps urine dilute (roughly 2–3 litres of fluid intake depending on climate and activity).
Dietary advice includes moderating salt and excessive animal protein, maintaining normal dietary calcium (rather than restricting it), and avoiding excessive intake of high-oxalate foods in susceptible individuals.
Weight management and control of metabolic conditions will also reduce long-term risk.
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