Efficacy of Hounsfield Unit of CT in Prediction of the Chemical Composition of Urinary 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 < 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.

Download Full-text

Stone composition of renal stone formers from different global regions

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.3.307 ◽

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.

Download Full-text

Kidney Stone Composition in Various Country Around the World

10.21203/rs.3.rs-286555/v1 ◽

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.

Download Full-text

Using Computed Tomography to Predict in Vivo Stone Chemical Composition

Urologia Journal ◽

10.1177/039156030907600213 ◽

2009 ◽

Vol 76 (2) ◽

pp. 107-111

Author(s):

D. Tiscione ◽

L. Ruggera ◽

P. Beltrami ◽

M.A. Cerruto ◽

A. Cielo ◽

...

Keyword(s):

Computed Tomography ◽

Uric Acid ◽

Chemical Composition ◽

Calcium Oxalate ◽

Colorimetric Method ◽

Hounsfield Unit ◽

Urinary Stones ◽

Helical Computed Tomography ◽

Significant Difference

Objectives Several authors hypothesized the usefulness of the non-contrast helical computed tomography (NCHCT) with the determination of stone Hounsfield Unit (HU) values in order to predict urinary stone compositions. Preoperative knowledge of stone composition might be interesting in pre-operative decision-making process. The aim of this study was to evaluate the possible correlation between stone chemical composition and correspondent stone HU value in an in-vivo experience. Methods Forty patients with urinary stones were preoperatively studied with abdominal NCHCT, where stone HU values were reported. Stone chemical composition was obtained in each patient, using the colorimetric method. The HU value of each stone was compared with the correspondent chemical analysis. Results The median HU values of calcium oxalate (n=10), mixed calcium oxalate and phosphate (n=19), calcium phosphate (n=2), uric acid (n=6) and mixed uric acid and calcium oxalate (n=3) stones were 1060 HU [interquartile range (IQR) 743.75–1222.5]; 900 HU (IQR 588.5–1108.5); 774 HU (range 720–828); 371 HU (IQR 361.25–436.25) and 532 HU (range 476–626), respectively. Conclusions Our results confirmed a statistically significant difference of the HU values between calcium and pure uric acid calculi, suggesting a correlation between stone chemical composition and CT-density. Hounsfield unit

Download Full-text

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194974 ◽

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.

Download Full-text

Application of uCT-scan and infrared spectroscopy for determination of urinary stone components

Journal of Aceh Physics Society ◽

10.24815/jacps.v10i4.19114 ◽

2021 ◽

Vol 10 (4) ◽

pp. 88-93

Author(s):

Vepy Asyana ◽

Leni Aziyus Fitri ◽

Freddy Haryanto ◽

Taufik Ridwan ◽

Nanda Fitri Ayu Muningrat

Keyword(s):

Uric Acid ◽

Infrared Spectroscopy ◽

Calcium Oxalate ◽

Mineral Content ◽

Hounsfield Unit ◽

Urinary Stone ◽

Urinary Stones ◽

Ftir Characterization ◽

High Prevalence

Abstrak. Batu kemih merupakan salah satu penyakit dengan tingkat prevalensi yang cukup tinggi di Indonesia. Pengetahuan komposisi pada kandungan batu kemih dapat membantu tenaga medis dalam melakukan justifikasi penanganan tindakan lanjut pada pasien dengan tepat.Tujuan penelitian iniadalah menentukan kandungan mineral yang terdapat pada batu kemih menggunakan metode analisa spektrum inframerah dan nilai hounsfield unit (HU) yang terdapat pada citra yang dihasilkan dari modality mCT-Scan. Hasil karakterisasi fourier transform infrared spectroscopy (FTIR) memperlihatkan kandungan mineral batu kemih terdiri dari batu kemih calcium oxlate monohydrate, uric acid, batu campuran calcium oxalate dengan phosphate dan batu campuran cystine dengan phosphate sedangkan hasil dari scanning mCT memperlihatkan adanya kandungan mineral batu kemih campuran seperti batu campuran calcium oxalate dan cystine, batu campuran calcium oxalate, struvite, dan cystine, dan batu campuran calciumoxalate dan uric acid.Dari hasil penelitian ini dapat disimpulkan bahwa kedua modaliti tersebut mampu memperlihatkan kandungan mineral batu kemih dengan baik. Hal ini terlihat adanya spektrum serapan karakteristik dari FTIR setiap sampel berbeda-beda dan dari hasil citra mCT-Scan memperlihatkan nilai HU yang bervariasi sehingga mengindikasikan kandungan mineral pada sampel batu kemih yang diamati juga memiliki jenis yang berbeda-beda. Abstract. Urinary stones are a disease with a high prevalence rate in Indonesia. Knowledge of the composition of the urinary stone is an essential part to determine suitable treatments for patients. The aim of this research is to determine the mineral contained in urinary stones using the infrared spectrum and the value of HU (hounsfield unit) from the image mCT-Scan. The results of FTIR characterization showed that the mineral content of urinary stones consisted of calcium oxlate monohydrate, uric acid, calcium oxalate and phosphate mixed stones and cystine-phosphate mixed stones. mCT-Scan results showed the mineral content of urinary stones such as calcium oxalate and cystine mixed stone, calcium oxalate, struvite, and cystine mixed stones, and calcium oxalate and uric acid mixed stones. This show that the two modalities are be able to determine the mineral content of urinary stones. It can be seen that the characteristic absorption spectrum of the FTIR for each sample is different and from the mCT-Scan image results, the HU value varies so that it indicates the mineral content of the observed urine stone sample are different.

Download Full-text

Gender and Age Characteristics of the Mineral Composition of Urinary Stones in Patients with Urolithiasis

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.06.124 ◽

2020 ◽

Vol 5 (6) ◽

pp. 124-128

Author(s):

S. M. Kolupayev ◽

◽

E. P. Bereznyak ◽

Keyword(s):

Uric Acid ◽

Calcium Phosphate ◽

Calcium Oxalate ◽

Mineral Composition ◽

Age Distribution ◽

Urinary Stones ◽

Gender And Age ◽

Type 3 ◽

Age Range

The paper presents the results of studying the features of the mineral composition of urinary stones obtained after spontaneous passage, as well as the use of minimally invasive surgical techniques. Material and methods. The study involved 61 patient with urolithiasis, depending who were examined depending on the sex and age of the patients. Infrared spectroscopy in the spectral range of 4000-400 cm-1 was used as a method for assessing the mineral composition of the stone. The next stage of the study consisted of analyzing the occurrence of stones of various mineral types in groups of patients with different gender and age characteristics. Results and discussion. Infrared spectroscopy identified a wide range of chemical compounds in urinary stones, in which calcium oxalate in the form of monohydrate (vevelite) or dihydrate (vedelite), calcium phosphate in the form of hydroxylapatite and uric acid were most often identified. Calcium carbonate, aragonite, struvite, ammonium urate, and cystine were detected in single samples. 45 patients (73.77%) had a mixed composition of the stone, consisting of two or more mineral components. Depending on the prevailing component, which is more than 50% vol. the sample, urinary stones were classified into 3 mineral types: type 1 – calcium oxalate calculi, the prevailing component of which is calcium oxalate in the form of monohydrate (vevellite) or dihydrate (veddelite); Type 2 – calcium phosphate, in which more than 50% vol. represented by apatite, hydroxylapatite or fluorapatite; Type 3 – stones, the dominant substance of which is uric acid or uric acid dihydrate. Most of the urinary stone samples were represented by type 1 stones, which were significantly more often detected in males. The study of gender dependence in the prevalence of stones of types 2 and 3, corresponding to these minerals, was not identified. Type 1 urinary stones were observed in all age categories, with a predominance in patients aged 30-39 years (41.38%). The age distribution of stones of type 2 had similar characteristics, while the maximum number of patients with this type of stone was noted in the age range of 40-49 years (40%), followed by a decrease in this indicator in older age groups. The minimum number of cases of type 3 stone formation was registered among patients aged 30-39 years (8.33%). In the following age periods, the quantitative presence of this type of stones increased with a maximum value in the age range of 50-59 years (41.67%). Conclusion. The mineral composition of urinary stones has features, depending on the sex and age of patients. The formation of oxalate-calcium urinary stones is most characteristic of men, the peak incidence occurs at the age of 40-49 years. Gender features of the distribution of stones, the dominant components of which are calcium phosphate and uric acid were not detected. The frequency of detection of uric acid stones increases with age, the inverse relationship is characteristic of the age distribution of phosphate-calcium stones

Download Full-text

Spectrum of chemical analysis of 150 consecutive upper urinary tract stones with critical analysis in respect of demographic and geographical distribution

International Surgery Journal ◽

10.18203/2349-2902.isj20211942 ◽

2021 ◽

Author(s):

Waliul Islam ◽

Fazal Naser ◽

Mahmood Hasan ◽

Mohammed Mizanur Rahman ◽

Mizanur Rahman ◽

...

Keyword(s):

Uric Acid ◽

Chemical Composition ◽

Calcium Oxalate ◽

Geographical Origin ◽

Age Groups ◽

Urinary Stones ◽

Mixed Composition ◽

Calcium Oxalate Stone ◽

Significant Difference ◽

Cystine Stone

Background: The aim of the study was to evaluate the chemical composition of urinary stones and pattern of changes according to the patient's demographic and geographical distribution.Methods: 150 patients of upper tract urolithiasis were prospectively selected during the study period. Chemical composition was analyzed by FTIR spectroscopy. A subgroup study based on the patient's age, sex and geographical origin was done. For subgroup analysis patients were divided into two age groups; group A (5-18 years, 14 patients) and group B (>18 years, 136 patients). The geographical origin of the patients was recorded according to the administrative division.Results: Male were predominant in all age groups with ratio of 2.49:1. Most of the patients were from Rangpur (28.67%) and Mymensingh (20.67) division. Mixed composition stones were much more common than pure one (75.99% vs 24.01%). Overall, combination of calcium oxalate monohydrate with dehydrate was the most common composition (56.67%). Calcium oxalate was the predominant chemical composition in 82% of stones, followed by struvite in 9.33%, apatite in 4.67%, uric acid in 3.33% and cystine in 0.67%. The proportion of calcium oxalate stone was increasing while that of struvite, uric acid, and cystine stone was decreasing with age. But stone composition did not show any significant difference on geographical distribution.Conclusions: Calcium oxalate is the most common composition of urinary stones in all age groups. Mixed stones are more common than pure ones. The incidence of calcium oxalate stone increases while that of struvite, uric acid, and cystine stone decreases with age.

Download Full-text

Urinary stone composition analysis of 3684 patients in the eastern Shandong region of China

Journal of International Medical Research ◽

10.1177/0300060519887266 ◽

2019 ◽

Vol 48 (3) ◽

pp. 030006051988726

Author(s):

Xuebao Zhang ◽

Jiajia Ma ◽

Ning Wang ◽

Chunhua Lin

Keyword(s):

Uric Acid ◽

Calcium Oxalate ◽

Urinary Calculi ◽

High Rate ◽

Urinary Stones ◽

Composition Analysis ◽

Carbonate Apatite ◽

Stone Composition ◽

Calcium Oxalate Dihydrate ◽

Uric Acid Stones

Objective There has not been a study that analyzed the composition of urinary stones from patients in the eastern Shandong region of China. Thus, we explored the composition of urinary stones in the eastern Shandong region of China and discuss the clinical significance of the findings. Methods A total of 3684 urinary calculi from the eastern Shandong region were collected in our study. Compositions of the stones were analyzed using an Automatic Infrared Spectrum Analysis System (type LIIR-20). The results were verified through manual analysis of the spectrograms, which was accompanied by polarizing microscopy and chemical analysis if necessary. Results Among the 3684 specimens, there were 1767 single-component stones and 1917 mixed-component stones. According to the main components of the stones, the stones were divided into the following types: calcium oxalate monohydrate stones (1779, 48.3%), anhydrous uric acid stones (1105, 30.0%), carbonate apatite stones (590, 16.0%), ammonium magnesium phosphate hexahydrate stones (143, 3.9%), calcium oxalate dihydrate stones (36, 1.0%), and cystine stones (31, 0.8%). Conclusions There was a relatively high rate of uric acid stones in patients from the eastern Shandong region of China.

Download Full-text

Urine stones of different chemical composition occurrence depending on the level of uricuria

Urologicheskie vedomosti ◽

10.17816/uroved102107-113 ◽

2020 ◽

Vol 10 (2) ◽

pp. 107-113

Author(s):

Michail Y. Prosiannikov ◽

Nikolay V Anokhin ◽

Sergey A. Golovanov ◽

Olga V Konstantinova ◽

Andrey V. Sivkov ◽

...

Keyword(s):

Uric Acid ◽

Chemical Composition ◽

Calcium Oxalate ◽

Biochemical Analysis ◽

Urinary Stone ◽

Urinary Stones ◽

Acid Excretion ◽

Uric Acid Excretion ◽

Calcium Oxalate Stones ◽

Urinary Acid

Introduction. According to modern concepts one of the key links in the pathogenesis of urolithiasis is metabolic lithogenic disturbances. The study of the complex effect of many factors on the metabolism of urolithiasis patient is the basis of modern scientific research. We studied the frequency of various chemical urinary stones occurrence depending on various levels of uricuria. Materials and methods. Data from of 708 urolithiasis patients (303 men and 405 women) were analized. The results of blood and urine biochemical analysis and chemical composition of urinary stone were studied. The degree of uricuria was ranked by 10 intervals: from 0.4 to 14.8 mmol/day to assess the occurrence of different stones at various levels of uricuria. Results. The incidence of calculi consisting of uric acid also increases with increasing levels of uric acid in the urine. An increase in the level of uricuria above 3.11 mmol/day is observed to increase calcium-oxalate stones occurrence. Decrease in the prevalence of carbonatapatite and struvite stones observed at an increase of urine uric acid excretion. At high levels of uric acid excretion, we found uric acid and calcium oxalate stones most often. Conclusion. Control over the level of urinary acid excretion in urine is important in case of calcium-oxalate and uric acid urolithiasis.

Download Full-text