The Relation between the Concentration of Calcium Salts in the Urine and Renal Stone Composition in Patients with Calcium-Containing Renal Stones

1972 ◽  
Vol 43 (3) ◽  
pp. 433-441 ◽  
Author(s):  
R. W. Marshall ◽  
M. Cochran ◽  
W. G. Robertson ◽  
A. Hodgkinson ◽  
B. E. C. Nordin
Keyword(s):  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Renal Stones ◽  
Urine Ph ◽  
Stone Composition ◽  
Calcium Oxalate Stones ◽  
Urine Oxalate ◽  
The Difference ◽  
Normal Urine ◽  
Normal Men

1. Diurnal variations in urine calcium oxalate and calcium phosphate activity products were observed in normal men and patients with recurrent calcium oxalate or mixed oxalate—phosphate renal stones. 2. Maximum and minimum calcium oxalate products were higher in the patients than in the controls, the difference being most marked in the patients with calcium oxalate stones. 3. Maximum and minimum calcium phosphate products expressed as octocalcium phosphate [(Ca8H2(PO4)6], brushite or hydroxyapatite, were significantly higher than normal in the patients with mixed stones but not in the patients with calcium oxalate stones. 4. The raised calcium oxalate products in the patients were due mainly to increased concentrations of Ca2+ ions; these, in turn, were due mainly to an increased rate of excretion of calcium. Raised calcium phosphate products were due mainly to hypercalciuria, combined with abnormally high urine pH values. 5. Patients with recurrent calcium stones appear to fall into two types: (1) patients with calcium oxalate stones associated with hypercalciuria, a normal or raised urine oxalate and a normal urine pH; (2) patients with mixed oxalate—phosphate stones associated with hypercalciuria, a normal or raised urine oxalate and a raised urine pH. 6. The implications of these findings in regard to treatment are discussed.

scholarly journals Clinical Significance of Phosphate in Calcium Oxalate Renal Stones

1992 ◽  
Vol 29 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Sten Öhman ◽  
Lasse Larsson ◽  
Hans-Göran Tiselius
Keyword(s):  
Calcium Oxalate ◽  
Calcium Phosphates ◽  
Renal Stones ◽  
Calcium Excretion ◽  
Stone Composition ◽  
Oxalate Excretion ◽  
Calcium Oxalate Stones ◽  
Calculated Risk ◽  
Calcium Magnesium ◽  
Primary Precipitation

We analysed calcium, magnesium, oxalate, citrate, urate and creatinine in urine and calculated risk factors in patients who had formed stones composed of calcium oxalate, and calcium phosphate, alone or as a mixture. Patients producing pure calcium oxalate stones (< 0·1% phosphate) had a higher oxalate, and lower calcium excretion than stone-free subjects and patients forming other stone types. In contrast, patients producing calcium oxalate stones containing phosphate, even in trace amounts (> 0·1%) had no increase in oxalate excretion, but a higher calcium excretion than stone-free subjects. We could not correlate any computed variable (e.g. AP(CaOx) index) to stone composition. We conclude that pure CaOx stones may be the result of a high oxalate excretion, and that other calcium containing stones may have another and probably more complex aetiology, including primary precipitation of calcium phosphates.

scholarly journals Association of Urine Findings with Metabolic Syndrome Traits in a Population of Patients with Nephrolithiasis

2021 ◽  
Author(s):  
Virginia L Hood ◽  
Kevan M Sternberg ◽  
Desiree de Waal ◽  
John R Asplin ◽  
Carley Mulligan ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Uric Acid ◽  
Calcium Oxalate ◽  
Protein Intake ◽  
Dietary Factors ◽  
Acid Excretion ◽  
Urine Ph ◽  
Stone Composition ◽  
Calcium Oxalate Stones ◽  
Net Acid Excretion

Background and objectives: The odds of nephrolithiasis increase with more metabolic syndrome (met-s) traits. We evaluated associations of metabolic and dietary factors from urine studies and stone composition with met-s traits in a large cohort of stone-forming patients. Design, setting, participants & measurements: Patients >18 years, who were evaluated for stones with 24 h urine collections, July 2009-December 2018, had records reviewed retrospectively. Patient factors, laboratory values and diagnoses were identified within 6 months of urine collection and stone composition within 1 year. Four groups with 0, 1, 2, > 3 met-s traits (hypertension, obesity, dyslipidemia, diabetes) were evaluated. Trends across groups were tested using linear contrasts in analysis of variance and analysis of covariance. Results: 1473 patients met inclusion criteria (835 with stone composition). Met-s groups were 0=684, 1=425, 2=211, 3 and 4 =153. There were no differences among groups for urine volume, calcium or ammonium (NH4) excretion. There was a significant trend (p<0.001) for more met-s traits being associated with decreasing urine pH, increasing age, calculated dietary protein, urine uric acid, oxalate, citrate, titratable acid (TAP), net acid excretion (eNAE) and uric acid supersaturation. The ratio of ammonium to net acid excretion did not differ among the groups. After adjustment for protein intake, the fall in urine pH remained strong, while the upward trend in TAP excretion was attenuated and NH4 decreased. Calcium oxalate stones were most common, but there was a trend for more uric acid (p<0.001) and fewer calcium phosphate (p=0.09) and calcium oxalate stones (p=0.01) with more met-s traits. Conclusions: Stone forming patients with met-s have a defined pattern of metabolic and dietary risk factors that contribute to an increased risk of stone formation including higher acid excretion, largely the result of higher protein intake, and lower urine pH.

scholarly journals Association of Urine Findings with Metabolic Syndrome Traits in a Population of Patients with Nephrolithiasis

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002292021
Author(s):  
Virginia L. Hood ◽  
Kevan M. Sternberg ◽  
Desiree de Waal ◽  
John R. Asplin ◽  
Carley Mulligan ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Uric Acid ◽  
Calcium Oxalate ◽  
Protein Intake ◽  
Dietary Factors ◽  
Acid Excretion ◽  
Urine Ph ◽  
Stone Composition ◽  
Calcium Oxalate Stones ◽  
Net Acid Excretion

Background: The odds of nephrolithiasis increase with more metabolic syndrome (met-s) traits. We evaluated associations of metabolic and dietary factors from urine studies and stone composition with met-s traits in a large cohort of stone-forming patients. Methods: Patients >18 years, who were evaluated for stones with 24 h urine collections, July 2009-December 2018, had records reviewed retrospectively. Patient factors, laboratory values and diagnoses were identified within 6 months of urine collection and stone composition within 1 year. Four groups with 0, 1, 2, > 3 met-s traits (hypertension, obesity, dyslipidemia, diabetes) were evaluated. Trends across groups were tested using linear contrasts in analysis of variance and analysis of covariance. Results: 1473 patients met inclusion criteria (835 with stone composition). Met-s groups were 0=684, 1=425, 2=211, 3 and 4 =153. There were no differences among groups for urine volume, calcium or ammonium excretion. There was a significant trend (p<0.001) for more met-s traits being associated with decreasing urine pH, increasing age, calculated dietary protein, urine uric acid, oxalate, citrate, titratable acid phosphate, net acid excretion and uric acid supersaturation. The ratio of ammonium to net acid excretion did not differ among the groups. After adjustment for protein intake, the fall in urine pH remained strong, while the upward trend in acid excretion was lost. Calcium oxalate stones were most common, but there was a trend for more uric acid (p<0.001) and fewer calcium phosphate (p=0.09) and calcium oxalate stones (p=0.01) with more met-s traits. Conclusions: Stone forming patients with met-s have a defined pattern of metabolic and dietary risk factors that contribute to an increased risk of stone formation including higher acid excretion, largely the result of greater protein intake, and lower urine pH.

scholarly journals Urinary stone composition analysis and clinical characterization of 1520 patients in central China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daling Zhang ◽  
Songchao Li ◽  
Zhengguo Zhang ◽  
Ningyang Li ◽  
Xiang Yuan ◽  
...  
Keyword(s):  
Calcium Oxalate ◽  
Urinary Stone ◽  
Geographic Region ◽  
Central China ◽  
Urinary Stones ◽  
Composition Analysis ◽  
Stone Composition ◽  
Calcium Oxalate Stones ◽  
Significant Difference ◽  
Lower Urinary

AbstractA total of 1520 patients with urinary stones from central China were collected and analysed by Fourier transform infrared spectroscopy between October 1, 2016 and December 31, 2019. For all patients, age, sex, comorbidities, stone location, laboratory examination and geographic region were collected. The most common stone component was calcium oxalate (77.5%), followed by calcium phosphate (8.7%), infection stone (7.6%), uric acid (UA) stone (5.3%)and cystine (0.9%). The males had more calcium oxalate stones (p < 0.001), while infection stone and cystine stones occurred more frequently in females (p < 0.001). The prevalence peak occurred at 41–60 years in both men and women. UA stones occurred frequently in patients with lower urinary pH (p < 0.001), while neutral urine or alkaline urine (p < 0.001) and urinary infection (p < 0.001) were more likely to be associated with infection stone stones. Patients with high levels of serum creatinine were more likely to develop UA stones (p < 0.001). The proportion of UA stones in diabetics was higher (p < 0.001), and the incidence of hypertension was higher in patients with UA stones (p < 0.001). Compared to the other types, more calcium oxalate stones were detected in the kidneys and ureters (p < 0.001), whereas struvite stones were more frequently observed in the lower urinary tract (p = 0.001). There was no significant difference in stone composition across the Qinling-Huaihe line in central China except UA stones, which were more frequently observed in patients south of the line (p < 0.001).

Should Idiopathic Calcium-Phosphate Stones be Separated from Calcium-Oxalate Stones?

Urolithiasis ◽  
1989 ◽  
pp. 563-565
Author(s):  
M. H. Gault ◽  
B. Barrett ◽  
P. Parfrey ◽  
W. Robertson ◽  
M. Paul ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Calcium Oxalate Stones

scholarly journals Stone composition of renal stone formers from different global regions

2021 ◽  
Vol 93 (3) ◽  
pp. 307-312
Author(s):  
Adam Hali´nski ◽  
Kamran Hassan Bhatti ◽  
Luca Boeri ◽  
Jonathan Cloutier ◽  
Kaloyan Davidoff ◽  
...  
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Urinary Stones ◽  
Ureteral Stones ◽  
Stone Analysis ◽  
Stone Composition ◽  
Stone Formers ◽  
Cystine Stones ◽  
Struvite Stones

Objective: To study urinary stone composition patterns in different populations around the world. Materials and methods: Data were collected by reviewing charts of 1204 adult patients of 10 countries with renal or ureteral stones (> 18 years) in whom a stone analysis was done and available. Any method of stone analysis was accepted, but the methodology had to be registered. Results: In total, we observed 710 (59%) patients with calcium oxalate, 31 (1%) with calcium phosphate, 161 (13%) with mixed calcium oxalate/calcium phosphate, 15 (1%) with carbapatite, 110 (9%) with uric acid, 7 (< 1%) with urate (ammonium or sodium), 100 (9%) with mixed with uric acid/ calcium oxalate, 56 (5%) with struvite and 14 (1%) with cystine stones. Calciumcontaining stones were the most common in all countries ranging from 43 to 91%. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones in most countries except Egypt and India. The rate of uric acid containing stones ranged from 4 to 34%, being higher in Egypt, India, Pakistan, Iraq, Poland and Bulgaria. Struvite stones occurred in less than 5% in all countries except India (23%) and Pakistan (16%). Cystine stones occurred in 1% of cases. Conclusions: The frequency of different types of urinary stones varies from country to country. Calcium-containing stones are prevalent in all countries. The frequency of uric acid containing stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase in the frequency of uric acid containing stones in association with high obesity rates. Struvite stones are decreasing in most countries due to improved health conditions.

Disorders of renal calcium handling, urinary stones, and nephrocalcinosis

2020 ◽  
pp. 5093-5103
Author(s):  
Christopher Pugh ◽  
Elaine M. Worcester ◽  
Andrew P. Evan ◽  
Fredric L. Coe
Keyword(s):  
Uric Acid ◽  
Urinary Tract ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Renal Colic ◽  
Ammonium Phosphate ◽  
Renal Stones ◽  
Magnesium Ammonium ◽  
Cystine Stones ◽  
Stone Passage

Renal stones are common, with a prevalence of 5 to 10% worldwide. Acute stone passage almost always produces the severe pain of renal colic, but stones are often asymptomatic and discovered incidentally on imaging. Prevalence of both symptomatic and asymptomatic disease appears to be rising, although the relative contributions of increasing use of more sensitive imaging modalities and real changes relating to diet and lifestyle are debated. The initial evaluation of patients with renal colic optimally includes noncontrast CT to accurately visualize the size and location of stones in the urinary tract. Initial management of stones less than 5 mm in diameter in patients without anatomical abnormalities of the urinary tract is to provide adequate analgesia coupled with α‎-blockade, followed by watchful waiting to allow time for stone passage. The presence of urinary tract infection, inability to take oral fluids, or obstruction of a single functioning kidney requires hospitalization and active management. Once the acute episode of stone passage or removal is over, thought should be given to diagnosis of the underlying causes and steps taken towards prevention. Since stone analysis is the cornerstone of diagnosis, the patient should be encouraged to collect any stones passed and retain them for analysis. Most stones (66–76%) are formed of calcium oxalate: other types include calcium phosphate (12–17%), uric acid (7–11%), struvite (magnesium ammonium phosphate, 2–3%), and cystine (1–2%). They form because urine becomes supersaturated with respect to the solute, and treatment to lower its concentration can prevent recurrence. This chapter describes the aetiology, pathogenesis, diagnosis and treatment of calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones, cystine stones, and nephrocalcinosis.

Renal calcinosis and stone formation in mice lacking osteopontin, Tamm-Horsfall protein, or both

2007 ◽  
Vol 293 (6) ◽  
pp. F1935-F1943 ◽  
Author(s):  
Lan Mo ◽  
Lucy Liaw ◽  
Andrew P. Evan ◽  
Andre J. Sommer ◽  
John C. Lieske ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Stone Formation ◽  
Calcium Oxalate Monohydrate ◽  
Wild Type ◽  
Mineral Salts ◽  
Calcium Oxalate Crystallization ◽  
Whole Urine ◽  
Normal Urine

Although often supersaturated with mineral salts such as calcium phosphate and calcium oxalate, normal urine possesses an innate ability to keep them from forming harmful crystals. This inhibitory activity has been attributed to the presence of urinary macromolecules, although controversies abound regarding their role, or lack thereof, in preventing renal mineralization. Here, we show that 10% of the mice lacking osteopontin (OPN) and 14.3% of the mice lacking Tamm-Horsfall protein (THP) spontaneously form interstitial deposits of calcium phosphate within the renal papillae, events never seen in wild-type mice. Lack of both proteins causes renal crystallization in 39.3% of the double-null mice. Urinalysis revealed elevated concentrations of urine phosphorus and brushite (calcium phosphate) supersaturation in THP-null and OPN/THP-double null mice, suggesting that impaired phosphorus handling may be linked to interstitial papillary calcinosis in THP- but not in OPN-null mice. In contrast, experimentally induced hyperoxaluria provokes widespread intratubular calcium oxalate crystallization and stone formation in OPN/THP-double null mice, while completely sparing the wild-type controls. Whole urine from OPN-, THP-, or double-null mice all possessed a dramatically reduced ability to inhibit the adhesion of calcium oxalate monohydrate crystals to renal epithelial cells. These data establish OPN and THP as powerful and functionally synergistic inhibitors of calcium phosphate and calcium oxalate crystallization in vivo and suggest that defects in either molecule may contribute to renal calcinosis and stone formation, an exceedingly common condition that afflicts up to 12% males and 5% females.

scholarly journals Spectrum of pediatric urinary stone composition in North Western India: analysis at tertiary care center

2019 ◽  
Vol 7 (11) ◽  
pp. 4102
Author(s):  
Rama Kishan Saran ◽  
Pawan Katti ◽  
Kiran Mirdha ◽  
Sanya Saran ◽  
Rajendra Prasad Takhar
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Pediatric Patients ◽  
Dietary Habits ◽  
Urinary Stone ◽  
Urinary Stones ◽  
Stone Composition ◽  
Epidemiological Characteristics ◽  
North Western

Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.

scholarly journals Kidney Stone Composition in Various Country Around the World

2021 ◽  
Author(s):  
Adam Halinski ◽  
Elenko Popov ◽  
Kamran Hassan Bhattikam ◽  
Luca Boeri ◽  
Jonathan Cloutier ◽  
...  
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Urinary Stones ◽  
Stone Composition ◽  
Calcium Stones ◽  
Uric Acid Stones ◽  
The World ◽  
Cystine Stones ◽  
Struvite Stones

Abstract To compare urinary stone composition patterns in different populations around the world in relation to the structure of their population, dietary habits, and climate. 1204 adult patients with urolithiasis and stone analysis was included . International websites were searched to obtain data. We observed 710(59%) patients with calcium oxalate, 31(1%) calcium phosphate, 161(13%) mixed calcium oxalate/calcium phosphate, 15(1%) carbapatite, 110(9%) uric acid, 7(<1%) urate, 100(9%) mixed uric acid/ calcium oxalate, 56(5%) struvite and 14(1%) cystine stones. Calcium stones were the most common in all countries (up to 91%) with the highest rates in Canada and China. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones except Egypt and India. The rate of uric acid stones, being higher in Egypt, India, Pakistan, Iraq, Poland, and Bulgaria. Struvite stones occurred in less than 5% except India (23%) and Pakistan (16%). Cystine stones occurred in 1%. The frequency of different types of urinary stones varies from country to country. Calcium stones are prevalent in all countries. Uric acid stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase it. Struvite stones are decreasing in most countries.

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