Skip to main content
SpringerLink
Log in

Changes in stone composition according to age and gender of patients: a multivariate epidemiological approach

  • Original Paper
  • Published:
Urological Research Aims and scope Submit manuscript

Abstract

Urinary stone incidence and composition have changed markedly over the past half-century in industrialized countries, in parallel with profound changes in living standards and dietary habits, with a dramatic increase in the incidence of calcium oxalate stones. However, studies evaluating the influence of age and gender on the distribution of the various types of urinary calculi are scarce. We report the results of a study based on 27,980 calculi (from 19,442 males and 8,538 females) analyzed by infrared spectroscopy between 1976 and 2001. The relationships between age and sex and stone composition were investigated using a multivariate approach, based on correspondence factor analysis (CFA). We found a male predominance for calcium oxalate and uric acid, a female preponderance for calcium phosphate and struvite stones, and an increasing prevalence of uric acid stones with age in both genders. CFA was able to reconstruct in blind the age curve from stone composition. The first two axes of the multidimensional classification, which correspond to age, included 86.9% of the total variance, indicating that age was the main factor involved in stone type. Superimposition of age classes and stone components showed a strong relationship between age and whewellite, weddellite, brushite, carbapatite, octacalcium phosphate and uric acid, while other substances (whitlockite, amorphous carbonated calcium phosphate, struvite, proteins, mucopolysaccharides, triglycerides or ammonium urate) appeared weakly related to age. In addition, CFA suggests the role of common lithogenic factors between weddellite, carbapatite and brushite, which clustered in the same area, whereas the various crystalline forms of phosphate stones segregated into two different clusters, suggesting distinct pathogenic factors. In conclusion, this study provides a picture of the present epidemiology of urinary stones in France. CFA helped to confirm: (1) an etiopathogenic distinction between weddellite and whewellite, (2) etiopathogenic associations between chemical compounds, which were only suspected on a clinical basis, and (3) suggested yet unrecognized associations, especially with respect to the heterogeneous group of phosphate stones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Abate N, Chandalia M, Cabo-Chan AVJr, Moe OW, Sakhaee K (2004) The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int 65: 386

    Google Scholar 

  2. Agarwal BN, Cabebe FG (1980) Renal acidification in elderly subjects. Nephron 26: 291

    Google Scholar 

  3. Asper R (1984) Epidemiology and socioeconomic aspects of urolithiasis. Urol Res 12: 1

    Google Scholar 

  4. Asplin JR, Lingeman J, Kahnoski R, Mardis H, Parks JH, Coe FL (1998) Metabolic urinary correlates of calcium oxalate dihydrate in renal stones. J Urol 159: 664

    Google Scholar 

  5. Benzécri JP (1993) Correspondence analysis handbook. Marcel Dekker, New York

  6. Berg W, Lange P, Bothor C, Rössler D (1979) Submicroscopic investigations on calcium oxalate stone genesis. Eur Urol 5: 136

    Google Scholar 

  7. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A (1996) Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 155: 839

    Google Scholar 

  8. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk of kidney stones in women. Ann Intern Med 126: 497

    Google Scholar 

  9. Curhan CG, Willett WC, Speizer FE, Stampfer MJ (2001) Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int 59: 2290

    Google Scholar 

  10. Daudon M, Bader CA, Jungers P (1993) Urinary calculi: review of classification methods and correlations with etiology. Scanning Microsc 7: 1081

    Google Scholar 

  11. Daudon M, Donsimoni R, Hennequin C, Fellahi S, Le Moël G, Paris M, Troupel S, Lacour B (1995) Sex- and age-related composition of 10617 calculi analyzed by infrared spectroscopy. Urol Res 23: 319

    Google Scholar 

  12. Daudon M, Estépa L, Hennequin C, Lacour B, Jungers P (1996) Evolution of urinary stone composition between 1980 and 1994 in France. In: Tiselius HG (ed) Renal stones. Aspects on their formation, removal and prevention. Akademitryck AB, Edsbruk, p 128

  13. Daudon M, Labrunie M, Hennequin C, Lacour B, Jungers P (1997) Relative influence of calcium and oxalate urine concentration on the risk of calcium oxalate crystallization. In: Jungers P, Daudon M (eds). Renal stone disease. Crystallization process, pathophysiology, metabolic disorders and prevention. Elsevier, Paris, p 72

  14. Daudon M, Réveillaud RJ (1984) Whewellite et weddellite: vers des étiopathogénies différentes. Intérêt du typage morphologique des calculs. Néphrologie 5: 195

  15. Dick WH, Lingeman JE, Preminger GM, Smith LH, Wilson DM, Shirrel WL (1990) Laxative abuse as a cause for ammonium urate renal calculi. J Urol 143: 244

    Google Scholar 

  16. Domrongkitchaiporn S, Ongphiphadhanakul B, Stitchantrakul W, Piaseu N, Chansirikam S, Puavilai G, Rajatanavin R (2000) Risk of calcium oxalate nephrolithiasis after calcium or combined calcium and calcitriol supplementation in postmenopausal women. Osteoporos Int 11: 486

    Google Scholar 

  17. Ford ES, Giles WH, Dietz WH (2002) Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287: 356

    Google Scholar 

  18. Gault MH, Chafe L (2000) Relationship of frequency, age and sex, stone weight and composition in 15,624 stones: comparison of results for 1980 to 1983 and 1995 to 1998. J Urol 164: 302

    Google Scholar 

  19. Gault MH, Parfrey PS, Robertson W (1988) Idiopathic calcium phosphate nephrolithiasis. Nephron 48: 265

    Google Scholar 

  20. Greenacre MJ (1993) Correspondence analysis in practice. Academic Press, New York

  21. Halloran BP, Lonergan ET, Portale AA (1996) Aging and renal responsiveness to parathyroid hormone in healthy men. J Clin Endocrinol Metab 81: 2192

    Google Scholar 

  22. Ito H, Kotabe T, Nomura K, Masai M (1995) Clinical and biochemical features of uric acid nephrolithiasis. Eur Urol 27: 324

    Google Scholar 

  23. Joly D, Rieu P, Méjean A, Gagnadoux MF, Daudon M, Jungers P (1999) Treatment of cystinuria. Pediatr Nephrol 13: 945

    Google Scholar 

  24. Kamel KS, Cheema-Dhadli S, Halperin ML (2002) Studies on the pathophysiology of the low urine pH in patients with uric acid stones. Kidney Int 61: 988

    Google Scholar 

  25. Koide T, Itatani H, Yoshioka T, Ito H, Namiki M, Nakano E, Okuyama A, Takemoto M, Sonoda T (1982) Clinical manifestations of calcium oxalate monohydrate and dihydrate urolithiasis. J Urol 127: 1067

    Google Scholar 

  26. Koide T, Oka T, Takaha M, Sonoda T (1986) Urinary tract stone disease in modern Japan. Stone incidence, composition and possible causes in Osaka district. Eur Urol 12: 403

    Google Scholar 

  27. Kotowicz MA, Melton LJIII, Cedel SL, O’Fallon WM, Riggs BL (1990) Effect of age on variables relating to calcium and phosphorus metabolism in women. J Bone Miner Res 5: 345

    Google Scholar 

  28. Leusmann DB, Blaschke R, Schmandt W (1990) Results of 5035 stone analysis: a contribution to epidemiology of stone disease. Scand J Urol Nephrol 24: 205

    Google Scholar 

  29. Maurice-Estepa L, Levillain P, Lacour B, Daudon M (1999) Crystalline phase differentiation in urinary calcium phosphate and magnesium phosphate calculi. Scand J Urol Nephrol 33: 299

    Google Scholar 

  30. Pak CYC, Sakhaee K, Peterson RD, Poindexter JR, Frawley WH (2001) Biochemical profile of idiopathic uric acid nephrolithiasis. Kidney Int 60: 757

    Google Scholar 

  31. Pierratos AE, Khalaff H, Cheng PT, Psihramis K, Jewett MAS (1994) Clinical and biochemical differences in patients with pure calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones. J Urol 151: 571

    Google Scholar 

  32. Robertson WG (2001) The changing pattern of urolithiasis in the UK and its causes. In: Kok DJ, Romijn HC, Verhagen PCMS, Verkoelen CF (eds). Eurolithiasis. Shaker, Maastricht, p 9

  33. Robertson WG (2003) Stones in the tropics. Semin Nephrol 23: 77

    Google Scholar 

  34. Robertson WG, Peacock M, Heyburn PJ (1980) Clinical and metabolic aspects of urinary stone disease in Leeds. Scand J Urol 53 [Suppl]: 199

  35. Sakhaee K, Adams-Huet B, Moe OW, Pak CYC (2002) Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Kidney Int 62: 971

    Google Scholar 

  36. Schubert G, Brien G (1981) Crystallographic investigations of urinary calcium oxalate calculi. Int Urol Nephrol 13: 249

    Google Scholar 

  37. Stamatelou KK, Francis ME, Jones CA, Nyberg LMJr, Curhan GC (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63: 1817

    Google Scholar 

  38. Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E (2000) Increase in the prevalence of symptomatic upper urinary tract stones during the past ten years. Eur Urol 37: 23

    Google Scholar 

  39. Yoshida O, Okada Y (1990) Epidemiology of urolithiasis in Japan: a chronological and geographical study. Urol Int 45: 104

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hôpital Necker, Service de Biochimie A, Paris, France

    Michel Daudon & Bernard Lacour

  2. Muséum National d’Histoire Naturelle, URA 401 CNRS, Paris, France

    Jean-Christophe Doré

  3. Hôpital Necker, Département de Néphrologie, Paris, France

    Paul Jungers

Authors
  1. Michel Daudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Christophe Doré
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Jungers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernard Lacour
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Daudon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daudon, M., Doré, JC., Jungers, P. et al. Changes in stone composition according to age and gender of patients: a multivariate epidemiological approach. Urol Res 32, 241–247 (2004). https://doi.org/10.1007/s00240-004-0421-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-004-0421-y

Keywords

Search

Navigation