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Published: Kem. Ind. 51 (7-8) (2002) 329–336
Paper reference number: KUI-31/2001
Paper type: Review

Analysis of Urinary Calculi – Correlation with Age Distribution, Sex and Residence of Patients

M. Tonković


R. Asper made an interesting epidemiologic study about the occurrence of urolithiasis comparing the resultsfrom 54 countries concerning 340 000 urinary stone analyses.1 He concluded that the distributionof urolithiasis in a low socio-economic level population is defined by: highest frequency in childhood,more than 40 % bladder stone, less than 20 % female patients, less than 40 % calcium oxalate stones andmore than 30 % uric acid/urate stones. In a high socio-economic level population these characteristicsare: highest frequency among adults, less than 10 % bladder stones, the percent of female patients increasesto more than 25 %, there are more than 60 % calcium oxalates stones and less than 20 % uricacid/urate stones. The former Yugoslavia was classified as a country of medium socio-economic level. Urolithiasis is nowadays a relative common disease and the knowledge about the composition of urinarycalculi is important for the further treatment of patients and the recommendation of the adequate diet.The results of urinary calculi analyzed by infrared spectroscopy during the last ten years in Rudjer Boskovic Institute are presented. The data showed the changes in male/female ratios during the war years. In Fig.1 two peaks are marked: in the years 1992 and 1995, when the war operations in Croatiawere the most intensive and the number of male patients increased. Complete results of analyses of 3 282 calculi (1 979 from men and 1 303 calculi from women) are given in Table 1. The chi-square test was used for statistical treatment of results. The most frequent and the most frequent main constituent inboth sexes were calcium oxalates; for males the oxalates were found in 74.18 % calculi, for females in 74.60 % with no significant statistical difference between sexes. The mixture of Ca-oxalate monohydrateand Ca-oxalate dihydrate was the most frequent for males and females, while the mixture of Ca-oxalatesand Ca-phosphates was more frequent in female patients. Calcium oxalate dihydrate was more frequentin males as shown by the sex ratio of 2.7 (p < 0.01). Stones connected with the urinary tract infectionwere more frequent in female patients (NM/NF _ 1 : 2, p < 0.01 for apatite and NM/NF _ 1 : 2, p <0.01 for struvite) while uric acids were far more frequent in males (NM/NF _ 5 : 1, p < 0.01). Accordingto the recommendation of some authors the stones were classified in four groups. Figure 2 shows the distributionof these groups in the period 1990-1998 and 2000. All calculi containing Ca-oxalates, brushiteand Ca-oxalates in the mixture with Ca-phosphates were classified as calcium calculi; the calculi containinguric acids and mixtures with uric acids were classified as urate calculi; the infection calculi were thecalculi containing struvite and carbonate apatite; the cystine calculi contained cystine and mixtures withcystine. The incidence of these groups were more or less constant during the years; war conditions didnot change the composition of stones. Figure 3 shows the overall distribution of stone groups and figure 4sex ratios for these groups. During 2000. we collected some more data: the residence and age of patients.The patients were classified in three groups: the capital of Croatia - Zagreb, Adriatic coast and therest of country (continental part). The stones were classified in four groups as described earlier and thedistribution is shown in figure 5. The total number of analysed stones was 393, from males 231 and 162from females, NM/NF _ 3 : 2. Majority of the patients was from continental part - 48.09 % with NM/NF _1 : 1, from Zagreb 35.88 % with NM/NF _ 5 : 3 and from Adriatic coast 16.03 % with NM/NF _ 5 : 2 (p< 0.05).There is a statistical significant difference between these three parts of Croatia related to NM/NFratio. The most frequent constituents were calcium oxalates in all three regions, but the incidence ofurate calculi is greater in the Adriatic part of Croatia. This phenomenon was already noticed anddescribed.11,14-17,20 In Figure 6 the age distribution of 287 patients (172 men and 115 women) is shownand in Figure 7, the sex ratio for these groups. It is worth noticing that urolithiasis affects all age groups,but it affects most fit for work population. The data were compared with those from industrialised countries (Table 2) and some significant differenceswere not found. Considering Aspers findings about close relationship between urolithiasis and thesocio-economic state of population, Croatia could be considered as a country where living conditions(health care, water supplies, hygienic conditions, dietary habits etc.) are not considerably different fromthose in developed European countries.

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urinary Calculi, infrared analysis, sex-related composition, residence-related composition