Urolithiasis in the early bronze age of the North Caucasus: a paleopathological case study and insights into ancient lifeways

Abstract

The study presents the first comprehensive, multidisciplinary analysis of a calcified concretion from a mature male (40–49 years) burial at the Ipatovo-5 site, associated with the “Steppe Maikop” horizon (final third of the 4th millennium BCE, c. 3300–3000 BCE) in the North Caucasus. An extensive analytical protocol was applied to determine the precise mineral composition and elucidate the origin of the concretion. The results conclusively identify the specimen as an urolith of infectious origin. Its defining mineralogical signature - a matrix of carbapatite/hydroxyapatite with whitlockite - is a clinical hallmark of bacterial infection. The complete absence of metabolic phases (calcium oxalate, uric acid) confirms an infectious, rather than dietary, etiology as the primary lithogenic factor. The data do not permit a definitive distinction between two equally plausible anatomical origins: a renal stone resulting from upper urinary tract infection (e.g., chronic pyelonephritis) or a prostatic calculus formed in situ due to chronic bacterial prostatitis. This urolith serves as direct physical evidence of chronic urogenital ill-health, which would have significantly impacted the individual’s quality of life. The research contributes to the understudied paleopathology of urolithiasis in prehistory and showcases the power of an integrated analytical approach in bioarchaeology.