## Composition of Ureteric Calculi in India **Key Point:** Calcium oxalate stones are the most common type of ureteric calculi, accounting for 70–80% of all urinary stones in India and worldwide. ### Epidemiology of Stone Composition in India | Stone Type | Composition | Frequency in India | Risk Factors | |------------|-------------|-------------------|---------------| | **Calcium oxalate (most common)** | CaC₂O₄ | 70–80% | High dietary oxalate, dehydration, hypercalciuria | | Uric acid | C₅H₄N₄O₃ | 5–10% | Low urine pH, gout, high purine diet | | Magnesium ammonium phosphate (struvite) | MgNH₄PO₄·6H₂O | 10–15% | Recurrent UTI, alkaline urine, female predominance | | Calcium phosphate | CaPO₄ | 5% | Alkaline urine, renal tubular acidosis | ### Why Calcium Oxalate Predominates in India? 1. **Dietary factors:** High intake of oxalate-rich foods (spinach, beets, nuts, tea, chocolate). 2. **Climate:** Hot, dry climate in much of India leads to concentrated urine and dehydration. 3. **Hypercalciuria:** Common in Indian populations due to genetic predisposition and high dietary calcium. 4. **Low urine citrate:** Citrate is a natural inhibitor of stone formation; deficiency increases stone risk. 5. **Recurrent dehydration:** Seasonal variation and inadequate fluid intake promote crystallization. **Clinical Pearl:** Calcium oxalate stones are **radiopaque** (visible on plain X-ray), unlike uric acid stones (radiolucent). This distinction is crucial for initial imaging triage. **High-Yield:** The **"Calcium Oxalate Triad"** in India: - High dietary oxalate + dehydration + genetic predisposition → 70–80% of stones **Mnemonic:** **"COX"** — **C**alcium **O**xalate is most common in India and worldwide (eXtremely common).
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