<b>Correlation of Renal Calculi with Non-Alcoholic Fatty Liver Disease on Ultrasonography</b>

Background: Non-alcoholic fatty liver disease (NAFLD) and renal calculi are increasingly prevalent conditions that share common metabolic risk factors such as obesity, insulin resistance, and dietary changes. While their coexistence has been reported, limited evidence exists regarding their correlation when assessed by ultrasonography, particularly in South Asian populations where ultrasound is the primary diagnostic modality. Objective: To evaluate the correlation between renal calculi and NAFLD using ultrasonography in patients presenting with abdominal pain at a tertiary hospital in Lahore, Pakistan. Methods: A cross-sectional study was conducted among 115 patients aged ≥18 years undergoing abdominal ultrasonography. Participants with prior hepatic or renal surgery, alcohol consumption, chronic liver or kidney disease, or hepatic mass lesions were excluded. Standardized sonographic protocols were used to assess hepatic steatosis and renal calculi. Fatty liver was graded from 0 to 3 based on echogenicity relative to the renal cortex. Data were analyzed using SPSS 24.0 with chi-square tests to assess associations between calculi characteristics and fatty liver grades. Statistical significance was defined as p < 0.05. Results: NAFLD was identified in 61.7% of participants, with Grade 1 as the most frequent stage (34.8%). Renal calculi were distributed as right-sided in 33.9%, left-sided in 35.7%, and bilateral in 30.4%. No statistically significant correlation was observed between fatty liver grade and the presence, number, or laterality of calculi (p > 0.05). Conclusion: Although NAFLD and renal calculi commonly coexist, ultrasonography-based findings suggest that renal stones are not independently associated with hepatic steatosis. Larger, multicenter studies are required to clarify shared metabolic pathways.