Effect of changes in epidemiological factors on the composition and racial distribution of renal calculi

One thousand and two calculi, which occurred in both black and white patients during a 15-year period, have been analysed by the X-ray diffraction technique. Calcium oxalate calculi were the most common irrespective of race. Whewellite calculi were equally distributed in both race groups, while weddelite stones appeared to be much less common amongst blacks; the opposite applied for struvite and the rare ammonium acid urate stones. The other calculi were approximately equally distributed between the two race groups. A statistically significant rising trend in the prevalence of renal stones in blacks, accompanied by changes in the ratios of the major stone forming constituents, have been a prominent feature of this survey. However, the aforementioned remained unchanged in white patients. Contrary to previous impressions, total urates exceed phosphates in whites as a major stone forming constituent. The composition of upper urinary tract stones in blacks, during the 3-year period 1981 to 1983, was very similar to the composition previously reported for the Sudanese. The profile of renal stones in blacks over the last 3 years, however, is now becoming substantially different from that of the other previously reported surveys and may be approaching that of their white compatriots. A change in the dietary patterns in blacks is occurring which is also reflected in an increasing incidence of ischaemic heart disease and which may also be responsible for the observed changes in renal stones.