The chemical composition of 256 urinary calculi on the Witwatersrand has been determined in 3 population groups. 'Calcium stones' comprised 53,1% of the total and most of the remainder were triple phosphate. The distribution of these stones in the different population groups was similar. Urinary calculi are rare in the Bantu.S. Afr. Med. J., 47, 128 (1973

Pantanowitz, D

Politzer, WM

Pollen, JJ

van Blerk, PJP

English

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S.A. MEDICAL JOURNAL 27 January 1973Urinary Calculi *D. PANTANOWITZ, J. 1. POLLEN, W. M. POLITZER AND P. J. P. VAN BLERK, Division of Urologyand School of Pathology, University of the Witwatersrand and Johannesburg Hospital, JohannesburgSUMMARYThe chemical composition of 256 urinary calculi on theWitwatersrand has been determined in 3 populationgroups. 'Calcium stones' comprised 53,1% of the totaland most of the remainder were triple phosphate. The dis-tribution of these stones in the different population groupswas similar. Urinary calculi are rare in the Bantu.S. Air. Med. J., 47, 128 (1973).The purpose of this study was to determine and comparethe chemical types of urinary calculi, as they occurin the Witwatersrand area. Stones from the White, Bantuand Coloured population groups were analysed.In the White group there were 113 (51,6%) 'calciumstones', comprising 7 calcium oxalate, 99 mixed, and7 calcium phosphate stones. There were 90 (41,1 %) triplephosphate, 9 (4,1 %) uric acid, 2 (0,9%) cystine, and5 (2,3 %) fibrin stones.In the Bantu group there were 7 (43,8 %) mixed, 8(50%) triple phosphate and 1 (6,2%) uric acid stones.In the Coloured group there were 16 (76,2%) 'calciumstones' comprising 2 calcium oxalate, and 14 mixed.There were 5 (23,8 %) triple phosphate stones.DISCUSSIONMATERIALRESULTSTABLE I. DISTRIBUTION OF URINARY CALCULI IN THREEPOPULATION GROUPSREFERENCESQualitative analysis showed that 53,1 % (136) of all thestones were 'calcium stones', i.e. calcium oxalate, mixedor calcium phosphate, whereas triple phosphate stonescomprised the majority of the remainder. This may becompared with other Western series where Herring'found 73,1 % and Nordin' 79,5% calcium oxalate stones.Most of the stones (85,6%) were received from theWhite group. Only 6,2 % came from the Bantu and 8,2 %from the Coloured group. Considering the populationdistribution on the Witwatersrand, where there areapproximately one and a half times as many Bantu asWhites, the incidence of calculous disease is far lessin the former than in the latter. This is in keeping withthe known low incidence of urinary calculi in the Bantu!"The Coloured population sample on the Witwatersrandis too small to draw any conclusion about the incidenceof stones in this group.There appears to be no significant difference in theproportion of 'calcium stones' and triple phosphate stonesin the 3 population groups.In general, the smaller calcium stones contained thehighest proportion of oxalate, while the larger onescontained increasing proportions of magnesium ammoniumphosphate. Four of the uric acid and one of the cystinestones also contained magnesium ammonium phosphate.It is suggested that magnesium ammonium phosphateis laid down secondary to stasis or infection caused bythe primary stone.I. Varley, H. (1967): Practical Clinical Biochemistry. 4th ed., p. 717.London: William Heinemann Medical Books.2. Herring, L. C. (1962): J. Ural. (Baltimore), 88, 545.3. Nordin, B. E. C. (1969): Ftfth Symposium on Advanced Medicine.p. 236. London: Pitman.4. Modlin, M. (1967): Ann. Roy. Coil. Surg., 40, 155.5. Idem (1968): Brit. J. Clin. Pract., 22, 531.6. Lopis, S. and Kaplan, S. A. (1948): Clin. Proc., 7, 103.7. Wise, R. O. and Kark, A. E. (1961): S. Afr. Med. J., 35, 47.21 100219 100 16 100TotalIn the 2-year period from May 1970 to April 1972, 256·calculi from various hospitals on the Witwatersrandwere submitted to the South African Institute for MedicalResearch for chemical analysis. The stones consideredwere renal or ureteric, either surgically removed, orpassed spontaneously. Calculi occurring elsewhere inthe urinary tract were not included in this series.The method used to determine the chemicalcomposition of the calculi was that described by Vadey.'Of the 256 stones analysed, 219 were from the White,16 from the Bantu and 21 from Coloured populationgroups (Table I).Whites B~.ntu ColouredTypes No. % No. % No. %Calcium oxalate 7 3,2 2 9,5Calcium oxalate + magne-sium ammonium phosphate(mixed) 99 45,2 7 43,8 14 66,7Calcium phosphate 7 3,2Magnesium ammonium phos-phate; calcium phosphate(triple phosphate) 90 41,1 8 50 5 23,8Uric acid 9 4,1 1 6,2Cystine 2 0,9Fibrin 5 2,3,.. Date received: 1 August 1972.

Urinary Calculi

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Urinary Calculi

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