This study investigated whether incorporation of proteins into calcium oxalate urinary crystals is different in the black and white populations in South Africa and whether such differences could provide insight into the former group's remarkably low stone incidence. CaOx monohydrate (COM) and dihydrate (COD) crystals were precipitated from each group's urine after adjustment of the calcium concentrations to 0.5 and 12mmol/l, respectively. Crystals were characterised by X-ray powder diffraction and scanning electron microscopy. Intracrystalline proteins were analysed by SDS-PAGE and immunodetected for urinary prothrombin fragment 1 (UPTF1) and osteopontin. Crystals precipitated from the black and white groups' control urines comprised mainly COM and COD, respectively. In both race groups UPTF1 was the major protein included in pure COM crystals while in pure COD it was osteopontin, but in the black group osteopontin was also included in COM. The black group's urine crystals incorporated significantly more intracrystalline protein. Selective inclusion of UPTF1 and osteopontin may be due to the unique crystal structure of COM and COD and the proteins' conformation at the different calcium concentrations at which these hydrates precipitate. The greater amount of intracrystalline inhibitory protein in the black group may be a factor in their low stone incidence. (C) 2003 Elsevier B.V. All rights reserved.