| Abstract|| |
Ramadan fasting for Muslims means abstinence from eating, drinking, and smoking from sunrise to sunset. There are concerns whether the occurrence of renal colic increases during the month of Ramadan. In view of the importance of fasting among Muslims, the occurrence of renal colic during Ramadan fasting has been compared during the following periods: two weeks before commencement of Ramadan (stage-1), during the first two weeks (stage-2), the last two weeks (stage-3), and, two weeks after Ramadan (stage-4). This was a prospective observational study, which was carried out in patients with symptoms of renal colic who were referred to the emergency wards in two major hospitals in Iran. During the study period, 610 subjects were admitted with renal colic during the four periods of study; there were 441 males (72.3%) and 169 females (27.7%). The number of patients with renal colic was highest during the first two weeks of Ramadan in comparison with the other periods (stage-1: 157, stage-2: 195, stage-3: 139, stage-4: 119, P < 0.05]. Results from this study show that the number of admissions due to renal colic was high during the first two weeks of Ramadan. However, the number of admissions decreased during the last two weeks of Ramadan and this trend continued after Ramadan.
|How to cite this article:|
Abdolreza N, Omalbanin A, Mahdieh TS, Mohammad Ali MR, Reza MA, Maryam S, Mohsen N. Comparison of the number of patients admitted with renal colic during various stages of peri-ramadan month. Saudi J Kidney Dis Transpl 2011;22:1199-202
|How to cite this URL:|
Abdolreza N, Omalbanin A, Mahdieh TS, Mohammad Ali MR, Reza MA, Maryam S, Mohsen N. Comparison of the number of patients admitted with renal colic during various stages of peri-ramadan month. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2021 May 18];22:1199-202. Available from: https://www.sjkdt.org/text.asp?2011/22/6/1199/87232
| Introduction|| |
Ramadan is a month during which Muslims abstain from eating, drinking, and smoking from dawn to sunset. Ramadan is the ninth month of the Islamic lunar calendar, which advances 11 days each year and, therefore, can occur during any season of the year.  Thus, the duration for which a person fasts may vary from six to 18 h a day, depending on the season and geographical location. 
The magnitude of renal colic is large worldwide. The lifetime risk of developing an acute attack of renal colic is estimated to be 1%-10%.  It is caused by acute partial or complete ureteric obstruction due to a calculus, in the vast majority of cases. In approximately 5% of patients, renal colic may be caused by abnormalities of the urinary tract unrelated to a stone disease, such as pyelonephritis and pelviureteric junction obstruction.  A proportion of up to 10% of patients with renal colic may have extrinsic ureteric obstruction, caused by a variety of conditions, including intestinal, gynecologic, retroperitoneal, and vascular lesions.  The hallmark symptom of renal colic is a severe sharp, stabbing pain in the flank area and lower back on the same side as the location of the underlying kidney stone. Renal colic often comes in waves of very intense pain that can be accompanied by sweating, pallor, nausea and vomiting.
Episodes of renal colic can last from hours to days. Its worldwide occurrence is estimated to be 1%-5% in developed countries and 0.5%-1% in developing countries. ,,, The highest incidence of renal stone disease has been reported during the months of July, August, and September, when presumably dehydration due to perspiration is common and the urine contains high concentration of lithogenic substances.  One of the common questions for patients with a history of renal stone disease is whether it is safe for them to fast during Ramadan, as Islamic Theology does not allow fasting if it is harmful to the body. Yet, studies on the effects of Ramadan fasting on incidence of renal colic are scarce, and have given variable and inconclusive results.
This study was conducted to compare the number of patients who presented with symptoms of renal colic in two main hospitals in the city of Mashad, Iran.
The study period was divided in to four parts: two weeks before Ramadan (stage-1), during the first two weeks (stage-2) and second two weeks of Ramadan (stage-3), and two weeks after the month of Ramadan (stage-4).
| Subjects and Methods|| |
This was a prospective observational study, which was carried out in patients with renal colic admitted in accident and emergency as well as urology departments in two major teaching Hospitals in Mashad, Iran, namely the Imam Reza and Ghaem hospitals, between August and October 2008.
The temperature was recorded every day during the study. This study was approved by the Research Ethics Committee of Mashad University of Medical Sciences (approval number 87224). The study was divided into four intervals: two weeks prior to Ramadan (stage-1), during the first two weeks (stage-2) and last two weeks of Ramadan (stage-3) and two weeks after Ramadan (stage-4). The inclusion criteria were any patients who had been fasting and were admitted to the accident and emergency department with symptoms of renal colic. Diagnosis of renal colic was based on physician's clinical judgment. Statistical analyses were conducted using SPSS statistical software (version 15.0, SPSS Inc., Chicago, IL, USA). Statistical significance was considered at P < 0.05 for all tests. Repeated measure of ANOVA was performed to analyze the occurrence of renal colic in different intervals.
| Results|| |
Six hundred ten patients with a mean age of 37.6 years (range 15-85 years) with symptoms of renal colic were enrolled into the study. There were 441 males (72.3%) and 169 females (27.7%). The results showed that during the first two weeks of Ramadan (stage-2), renal colic admissions were significantly high. [Table 1] shows the number of admissions due to renal colic during the four stages of the study in each hospital. The results indicated an obvious increase in the number of admissions in stage-2 in comparison with stage-1; also, the frequency was low in stage-3 and stage-4 as well [Figure 1]. Both hospitals showed similar trends in the number of admissions due to renal colic [Table 1]. The mean room temperatures were 27.7°C (min: 19.4°C, max: 35.9°C) in stage-1, 24.8°C (min: 17.1°C, max: 32.4°C) in stage-2, 23.5°C (min: 18.4°C, max: 28.6°C) in stage-3, and 21.2°C (min: 13.1°C, max: 29.2°C) in stage-4 of the study.
|Figure 1: Correlation of the number of hospital admissions with the various stages of Ramadan in the study patients.|
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|Table 1: Number of admissions with renal colic to the emergency department.|
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| Discussion|| |
The results of this study show that admissions due to renal colic were higher during the first two weeks of Ramadan. These results are compatible with that of a previous study, which revealed a higher occurrence of renal colic during the month of Ramadan.  Also, there was a significant reduction in the number of admissions due to renal colic in the second two weeks of Ramadan. It appears that the occurrence of renal colic increases at the beginning of Ramadan fasting. It is possible that a sudden change in dietary habits leads to this increase in occurrence of renal colic. ,,,,, Data from this study showed that during Ramadan month, the number of renal colic admissions gradually decreased. It is possible that patients with renal colic symptoms might discontinue fasting after experiencing renal colic symptoms.
Environmental factors such as temperature of about 27°C and humidity below 45% have shown to increase the incidence of renal colic.  However, in the current research, the first and second stages were in summer with similar temperature and humidity, the fourth stage was in the beginning of autumn with a reduction in temperature and increase in weather humidity.
In conclusion, this study showed a significant increase in the incidence of renal colic during the month of Ramadan. However, environmental factors, age, gender, and dietary habits during the month of Ramadan may have an important role, other than fasting alone.
| Acknowledgment|| |
The authors thank Mashad University of Medical Sciences for their grant that made this study possible.
| References|| |
|1.||Husain R, Duncan MT, Cheah SH, Chng SL. Effects of fasting in Ramadan on tropical Asiatic Moslems. Br J Nutr 1987;58(1):41-8. |
|2.||Ziaee V, Razaei M, Ahmadinejad Z, et al.The changes of metabolic profile and weight during Ramadan fasting. J Singapore Med 2006;47(5):409-14. |
|3.||Labrecque M, Dostaler L, Rousselle R, Nguyen T, Poirier S. Efficacy of nonsteroidal anti-inflammatory drugs in the treatment of acute renal colic. Arch Intern Med 1994;154:1381-7. |
|4.||Dalrymple NC, Verga M, Anderson KR, et al. The value of unenhanced helical compute-rized tomography in the management of acute flank pain. J Urol 1998;159:735-40. |
|5.||Menon M, Koul H. Clinical review 32: Calcium oxalate nephrolithiasis. J Clin Endo-crinol Metab 1992:74:703-7. |
|6.||Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol 2000; 13:45-50. |
|7.||Kim H, Jo MK, Kwak C, et al. prevalence and epidemiologic characteristics of urolithiasis in Seoul, Korea. Urology 2002;59(4):517-21. |
|8.||Lee YH, Huang WC, Tsai JY, et al. Epidemiological studies on the prevalence of upper urinary calculi in Taiwan. Urol Int 2002; 68(3):172-7. |
|9.||Elomaa I, Karonen SL, Kairento AL, Pelkonen R. Seasonal variation of urinary calcium and oxalate excretion, serum 25 (OH) D3 and albumin level in relation to renal stone formation. Scand J Urol Nephrol 1982;16:156-61. |
|10.||Basiri A, Moghaddam SM, Khoddam R, Nejad ST, Hakimi A. Monthly variations of urinary stone colic in Iran and its relationship to the Fasting month of Ramadan. J Pak Med Assoc 2004;54(1):6-8. |
|11.||Boscolo-Berto R, Dal Moro F, Abate A, Arandjelovic G, Tosato F, Bassi PF. Do weather conditions influence the onset of renal colic? A novel approach to analysis. Urol Int 2008;80:19-25. |
|12.||Chauhan V, Eskin B, allegra JR, Cochrane D. Effect of season, age, and gender on renal colic incidence. Am J Emerg Med 2004;22(7): 560-3. |
|13.||Al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pack Med Assoc 1997;47:281-4. |
|14.||Blacklock NJ. The pattern of urolithiasis in the Royal Navy. In: Hodgkinson A, Nordin BE, Eds. Renal Stone Research Symposium, J & A Churchill Ltd, London 1969;33-47. |
|15.||Pierce LW, Bloom B. Observations on urolithiasis among American troops in a desert area. J Urol 1945;54:466. |
Department of Nutrition, Faculty of Medicine, Biochemistry and Nutrition, Endoscopic & Minimally Invasive Surgery, and Cancer Research Centers, Mashad Medical School, Paradise Daneshgah, Azadi Square, Mashad