Stone composition as a function of age and sex

Abstract

Background and objectives: Kidney stones are heterogeneous but often grouped together. The potential effects of patient demographics and calendar month (season) on stone composition are not widely appreciated.

Design, setting, participants, & measurements: The first stone submitted by patients for analysis to the Mayo Clinic Metals Laboratory during 2010 was studied (n=43,545). Stones were classified in the following order: any struvite, any cystine, any uric acid, any brushite, majority (≥50%) calcium oxalate, or majority (≥50%) hydroxyapatite.

Results: Calcium oxalate (67%) was the most common followed by hydroxyapatite (16%), uric acid (8%), struvite (3%), brushite (0.9%), and cystine (0.35%). Men accounted for more stone submissions (58%) than women. However, women submitted more stones than men between the ages of 10-19 (63%) and 20-29 (62%) years. Women submitted the majority of hydroxyapatite (65%) and struvite (65%) stones, whereas men submitted the majority of calcium oxalate (64%) and uric acid (72%) stones (P<0.001). Although calcium oxalate stones were the most common type of stone overall, hydroxyapatite stones were the second most common before age 55 years, whereas uric acid stones were the second most common after age 55 years. More calcium oxalate and uric acid stones were submitted in the summer months (July and August; P<0.001), whereas the season did not influence other stone types.

Conclusions: It is well known that calcium oxalate stones are the most common stone type. However, age and sex have a marked influence on the type of stone formed. The higher number of stones submitted by women compared with men between the ages of 10 and 29 years old and the change in composition among the elderly favoring uric acid have not been widely appreciated. These data also suggest increases in stone risk during the summer, although this is restricted to calcium oxalate and uric acid stones.

Keywords: calcium oxalate; calcium phosphate; infrared spectroscopy; struvite; uric acid.

Figure 1.

Association of sex with stone type.

Figure 2.

Association of age with stone type.

Figure 3.

Combined association of age and sex with stone type. (A) Men and (B) women are depicted separately.

Figure 4.

Association of calendar month with stone numbers submitted. Submissions by month are depicted for four major stone types: (A) calcium oxalate, (B) uric acid, (C) struvite, and (D) apatite. *P<0.001 for evidence of seasonality for a given stone type using a chi-squared test with 11 degrees of freedom.