Spectrum of chemical analysis of 150 consecutive upper urinary tract stones with critical analysis in respect of demographic and geographical distribution

Waliul Islam, Fazal Naser, Mahmood Hasan, Mohammed Mizanur Rahman, Mizanur Rahman, Shohrab Hossain


Background: The aim of the study was to evaluate the chemical composition of urinary stones and pattern of changes according to the patient's demographic and geographical distribution.

Methods: 150 patients of upper tract urolithiasis were prospectively selected during the study period. Chemical composition was analyzed by FTIR spectroscopy. A subgroup study based on the patient's age, sex and geographical origin was done. For subgroup analysis patients were divided into two age groups; group A (5-18 years, 14 patients) and group B (>18 years, 136 patients). The geographical origin of the patients was recorded according to the administrative division.

Results: Male were predominant in all age groups with ratio of 2.49:1. Most of the patients were from Rangpur (28.67%) and Mymensingh (20.67) division. Mixed composition stones were much more common than pure one (75.99% vs 24.01%). Overall, combination of calcium oxalate monohydrate with dehydrate was the most common composition (56.67%). Calcium oxalate was the predominant chemical composition in 82% of stones, followed by struvite in 9.33%, apatite in 4.67%, uric acid in 3.33% and cystine in 0.67%. The proportion of calcium oxalate stone was increasing while that of struvite, uric acid, and cystine stone was decreasing with age. But stone composition did not show any significant difference on geographical distribution.

Conclusions: Calcium oxalate is the most common composition of urinary stones in all age groups. Mixed stones are more common than pure ones. The incidence of calcium oxalate stone increases while that of struvite, uric acid, and cystine stone decreases with age.


Chemical composition, Renal stone, Demographical variation

Full Text:



Fisang C, Anding R, Muller SC, Latz S, Laube N. Urolithiasis- an interdisciplinary diagnostic, therapeutic and secondary preventive challenge. Dtsch Arztebl Int. 2015;112:83-91.

Lopez M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol. 2010;25(1):49-59.

Saigal CS, Joyce G, Timilsina AR, Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005;68(4):1808-14.

Rahman MM, Zhang C, Swe KT, Rahman MS, Islam MR, Kamrujjaman M, et al. Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis. PLoS One. 2020;15(1):227565.

Moe OW. Kidney stones: pathophysiology and medical management. Lancet. 2006;367(9507):333-44.

Turk C, Neisius A, Petrik C, Seitz C, Skolarikos A. EAU guidelines on urolithiasis. UroSource. 2021;13:4.

Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu CCJ, Matlaga BR, Monga M, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-24.

Singh I. Renal geology (quantitative renal stone analysis) by 'Fourier transform infrared spectroscopy'. Int Urol Nephrol. 2008;40(3):595-602.

Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child. 2003;88(11):962-5.

Basiri A, Taheri M, Taheri F. What is the state of the stone analysis techniques in urolithiasis? Urol J. 2012;9(2):445-54.

Ansari MS, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M, et al. Spectrum of stone composition: structural analysis of 1050 upper urinary tract calculi from northern India. Int J Urol. 2005;12(1):12-6.

Jindal T, Mandal SN, Sonar P, Kamal MR, Ghosh N, Karmakar D. Analysis of urinary stone composition in Eastern India by X-ray diffraction crystallography. Adv Biomed Res. 2014;3:203.

Bangash K, Shigri F, Jamal A, Anwar K. Spectrum of renal stones composition; chemical analysis of renal stones. Int J Pathol. 2011;9:63-6.

Alaya A, Nouri A, Belgith M, Saad H, Jouini R, Najjar MF. Changes in urinary stone composition in the Tunisian population: A retrospective study of 1,301 cases. Ann Lab Med. 2012;32:177-83.

Daudon M, Donsimoni R, Hennequin C, Fellahi S, Le MG, Paris M, et al. Sex- and age-related composition of 10 617 calculi analyzed by infrared spectroscopy. Urol Res. 1995;23(5):319-26.

Herring LC. Observations on the analysis of ten thousand urinary calculi. J Urol. 1962;88:545-62.

Mandel NS, Mandel CS. Urinary tract stone disease in united veteran population: II. Geographic analysis of variations in composition. J Urol. 1989;142:1516-21.

Rao MV, Agarwal JS, Taneja OP. Studies in urolithiasis: II. X-ray diffraction analysis of calculi from Delhi region. Indian J Med Res. 1976;64(1):102-7.

Ahlawat R, Goel MC, Elhence A. Upper urinary tract stone analysis using X-ray diffraction: results from a tertiary referral centre in northern India. Natl Med J India. 1996;9(1):10-12.

Masai M, Ito H, Kotake T. Effect of dietary intake on urinary oxalate excretion in calcium renal stone formers. Br J Urol. 1995;76(6):692-6.

Massey LK. Dietary influences on urinary oxalate and risk of kidney stones. Front Biosci. 2003;8:584-94.

Gabrielsen JS, Laciak RJ, Frank EL, Fadden M, Bates CS, Oottamasathien S, Hamilton BD, et al. Pediatric urinary stone composition in the United States. J Urol. 2012;187(6):2182-7.

Costa BA, Ramis M, Montesinos V, Grases F, Conte A, Piza P, Pieras E, et al. Type of renal calculi: variation with age and sex. World J Urol. 2007;25(4):415-21.

Daudon M, Dore JC, Jungers P, Lacour B. Changes in stone composition according to age and gender of patients: a multivariate epidemiological approach. Urol Res. 2004;32(3):241-7.

Stapleton FB, Linshaw MA, Hassanein K, Gruskin AB. Uric acid excretion in normal children. J Pediatr. 1978;92(6):911-4.

Grant C, Guzman G, Stainback RP, Amdur RL, Mufarrij P. Variation in Kidney Stone Composition Within the United States. J Endourol. 2018;32(10):973-7.