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.

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.

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.

scholarly journals Il calcolo urinario. Proposta di un nuovo metodo di determinazione: dati preliminari

2020 ◽  
Vol 32 (1) ◽  
pp. 81-89
Author(s):  
Gianni Cangiano ◽  
Grazie Buccino ◽  
Annachiara Latte ◽  
Marianna Bencivenga ◽  
Giovanna Capolongo ◽  
...  
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Clinical Chemistry ◽  
Carbonate Apatite ◽  
Laboratory Procedure ◽  
Magnesium Ammonium ◽  
Molecular Ratios ◽  
Ammonium Urate

Introduzione: La visualizzazione soggettiva delle reazioni utilizzate per l’identificazione e la quantificazione delle sostanze presenti nel calcolo urinario presentano notevoli problemi. Metodi: Viene descritta una nuova procedura per la determinazione del calcolo urinario. La rilevazione dei carbonati e le concentrazioni di calcio, fosforo, magnesio, ammonio, acido urico (dosaggi quantitativi su analizzatore COBAS 6000 ditta Roche) ed ossalato e cistina (determinazioni adattate su Viva E ditta Siemens) si inseriscono in un foglio Excel per ottenere i possibili principali calcoli urinari (calcio ossalato, acido urico, urato di ammonio, cistina, struvite, brushite, apatite, carbonato apatite) e più in generale “calcio fosfato”. Le determinazioni di chimica clinica sono simili a quelle utilizzate effettuate per lo studio metabolico sulle urine delle 24h in cui il dosaggio fotometrico della cistina all’acido fosfotungstico, non essendo commercializzato, è stato costruito ed adattato su analizzatore Viva E. Particolarmente utile risulta l’uso del rapido metodo quantitativo al ferro-solfosalicilico, non commercializzato e costruito nel nostro laboratorio, per la determinazione dell’ossalato nel calcolo. Risultati: Il software proposto converte le concentrazioni degli analiti in mmoli/dL e, partendo dalla struvite, definisce successivamente l’eventuale presenza di calcio ossalato, urato di ammonio ed i diversi calcio fosfato, determinati a seconda del rapporto Ca/P. La conversione finale in concentrazione delle diverse componenti presenti nel calcolo, assieme ad un eventuale residuo inorganico, da la presentazione dei dati in percentuale. Conclusioni: I dati ottenuti, specie se riferiti a concrezioni formate da più componenti, evidenziano buoni risultati se confrontati con la tecnica di riferimento FTIR suggerendo una metodica di laboratorio pratica, rapida ed affidabile.   A new laboratory procedure is described for the determination of urinary calculus. The detection of carbonates (production of carbon dioxide with the use of concentrated sulfuric acid) and the concentrations of calcium, phosphorus, magnesium, ammonium, uric acid (quantitative dosages carried out on COBAS 6000 analyzer of the Roche company) and oxalate and cystine (determinations adapted by us on the Siemens Viva E instrument) they are inserted in an Excel sheet created by us in order to obtain the main possible urinary calculations (calcium oxalate, uric acid, ammonium urate, cystine, struvite, brushite, apatite, carbonate apatite and more generally "calcium phosphate." The clinical chemistry determinations are similar to those used for the metabolic study carried out on the urine of 24 hours in which the photometric dosage of cystine with phosphotungstic acid, not being marketed, was built by us and adapted on Viva E analyzer. The use of the rapid quantitative method, with non-commercial sulfosalicylic acid, is particularly useful zato and then built in our laboratory, for the determination of oxalate in the calculation. The software proposed by us converts all the concentrations of the above mentioned analytes to mmoles / dL and, starting from struvite (molecular ratios: 1P - 1Mg - 1NH4), the possible presence of calcium oxalate is subsequently defined (molecular ratios: 1Ca - 1Ox ), that of ammonium urate and the different calcium phosphate (brushite, apatite / carbonate apatite and "calcium phosphate"), the latter determined according to the Ca / P ratio (brushite: <1.155; 1.155≥ "calcium phosphate" <1 , 45; apatite ≥1.45). The final conversion into concentration of the various components present in the calculation, together with any inorganic residue, determines the presentation of the data as a percentage. The data obtained, especially if referring to concretions formed by several components, show good results when compared with the FTIR reference technique.  

scholarly journals Short-Term Tolvaptan Increases Water Intake and Effectively Decreases Urinary Calcium Oxalate, Calcium Phosphate and Uric Acid Supersaturations

2016 ◽  
Vol 195 (5) ◽  
pp. 1476-1481 ◽  
Author(s):  
Wisit Cheungpasitporn ◽  
Stephen B. Erickson ◽  
Andrew D. Rule ◽  
Felicity Enders ◽  
John C. Lieske
Keyword(s):  
Uric Acid ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Water Intake ◽  
Urinary Calcium ◽  
Short Term

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.

Efficacy of Hounsfield Unit of CT in Prediction of the Chemical Composition of Urinary Stones

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Salah Mahmoud Ahmed Shehata ◽  
Mohamed Rafik El-Halaby ◽  
Ahmed Mohamed Saafan
Keyword(s):  
Uric Acid ◽  
Chemical Composition ◽  
Calcium Phosphate ◽  
Calcium Oxalate ◽  
Chemical Structure ◽  
Urinary Calculi ◽  
Hounsfield Unit ◽  
Urinary Stones ◽  
The Mean ◽  
Struvite Stones

Abstract Objectives to make a reliable correlation between the chemical composition of the urinary calculi and its Hounsfield unit on CT scan, upon which we can depend on it for prediction of the type of the urinary calculi. The prediction of the chemical structure of the stone would help us to reach a more efficient therapeutic and prophylactic plan. Methods A retrospective study was performed by interpretation of the preoperative CT scans for patients who were presented by urinary stones. Identification of the chemical structure of the calculi was implemented using Fourier Transform Infrared Spectroscopy (FT-IR spectroscopy). The laboratory report revealed multiple types of stones either of pure or mixed composition. Afterwards, a comparison was done between Hounsfield units of the stones and the chemical structure. Results The chemical structure of the urinary stones revealed four pure types of stones (Uric acid, Calcium Oxalate, Struvite and Cystine) and two types of mixed stones (mixed calcium oxalate+ Uric, and mixed calcium oxalate+ calcium phosphate). Uric acid stone had a mean Hounsfield Unit (HU) density of428 ± 81, which was quite less than the other stones, followed by struvite stones with density ranging about 714 ± 38. Mixed calcium oxalate stones could be differentiated from other types of stones like uric acid, pure calcium oxalate and struvite stones by the Hounsfield unit of Computed Tomography (the mean Hounsfield Unit was 886 ± 139 and 1427 ± 152 for mixed calcium oxalate + uric stone and mixed calcium oxalate + calcium phosphate stones respectively). Moreover, pure calcium oxalate stones were easily differentiated from all other stones using the mean Hounsfield density as it was 1158 ± 83. It was challenging only when it was compared to cystine stones, as they were quiet similar to HU value (997 ± 14). The variation of Hounsfield values among the previously mentioned stones, was statistically significant (p &lt; 0.001). Conclusion The study proved that the Hounsfield Unit of CT scanning is a convenient measure to predict the chemical structure of urinary calculi.

The Influence of Disodium Ethane-1-Hydroxy-1,1-Diphosphonate (Ehdp) on the Development of Experimentally Induced Urinary Stones in Rats

1972 ◽  
Vol 42 (2) ◽  
pp. 197-207 ◽  
Author(s):  
D. Fraser ◽  
R. G. G. Russell ◽  
Ortrun Pohler ◽  
W. G. Robertson ◽  
H. Fleisch
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Ammonium Phosphate ◽  
Urinary Stones ◽  
Hydrogen Phosphate ◽  
Magnesium Ammonium Phosphate ◽  
Magnesium Ammonium ◽  
The Difference ◽  
Calcium Oxalate Calculi

1. Bladder stones composed of calcium hydrogen phosphate dihydrate, calcium oxalate mono- and di-hydrate and magnesium ammonium phosphate hexahydrate (struvite) were successfully induced in rats by various dietary manipulations and by implanting zinc pellets in the bladder. 2. The effect of a diphosphonate, disodium ethane-1-hydroxy-1,1-diphosphonate (EHDP), given in the drinking water at concentrations of 0·0025, 0·05 and 0·5% (w/v), on the size and composition of these stones was examined. 3. All the concentrations of EHDP decreased the weight of the calcium oxalate calculi. In contrast, only the highest concentration of EHDP inhibited calcium hydrogen phosphate stone formation and the magnesium ammonium phosphate stones were unaffected. 4. The difference between the effects on calcium oxalate and magnesium ammonium phosphate stones is consistent with the finding that EHDP inhibited the precipitation of calcium oxalate from solution in vitro but had only a slight effect on magnesium ammonium phosphate precipitation. 5. It is suggested that EHDP might be of use in the prevention of some types of urinary stones in man.

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