scholarly journals Prevention of Calcium Nephrolithiasis: The Influence of Diuresis on Calcium Oxalate Crystallization in Urine

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Johannes M. Baumann ◽  
Roberto Casella
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Stone Disease ◽  
Ion Concentration ◽  
Critical Parameters ◽  
Initial Development ◽  
Stone Formers ◽  
High Supersaturation ◽  
Recurrent Stone ◽  
Using Data

A high fluid intake is still the most evidence-based measure for the prevention of idiopathic stone disease. The recommendation of current guidelines on urolithiasis to increase diuresis to 2–2.5 L/day is mainly based on a single clinical study. The present paper shows the influence of diuresis on calcium oxalate (CaOx) crystallization and especially aggregation (AGN) which can explain the initial development of Ca stones on papillary calcifications as well as stone growth in the renal pelvic system. Diuresis determines the urinary transit time (UT) through the kidney and together with the afflux of Ca and Ox the state of urinary saturation with respect to CaOx being the most frequent stone mineral. High supersaturation inducing crystallization during UT and a high urinary ion concentration interfering with the inhibition of crystal AGN by urinary macromolecules seem to be critical parameters for stone formation. Using data from the literature the influence of diuresis on these parameters is evaluated for short-term recurrent stone formers (RSF), idiopathic stone patients, and healthy controls, the latter two collectives with and without excessive oxalate ingestion. This investigation suggests that a diuresis of 2 L/day may protect from stone formation even after dietary Ox excesses and in RSF. However, in RSF with a continuously high Ca and Ox afflux into urine a permanent high diuresis is required which is difficult to sustain over 24 hours.

Calcium Oxalate Crystalluria and Inhibitors of Crystallization in Recurrent Renal Stone-Formers

1972 ◽  
Vol 43 (4) ◽  
pp. 499-506 ◽  
Author(s):  
W. G. Robertson ◽  
M. Peacock
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Sodium Oxalate ◽  
Calcium Oxalate Crystals ◽  
Oxalate Crystals ◽  
Stone Formers ◽  
Large Particles ◽  
Recurrent Stone ◽  
Recurrent Stone Formers

1. The particle size distributions of calcium oxalate crystals were measured at 37°C in fresh urine from recurrent, idiopathic stone-formers and their controls under the same conditions of dietary and fluid intake. The crystals excreted by the controls were small and belonged to a unimodal distribution, whereas those excreted by the stone-formers belonged to a distribution which contained a second peak of much larger particles. The proportion of large crystals in the urines of the stone-formers was significantly higher than in the urines of the controls. 2. The difference in the proportion of large particles passed by the two groups was accentuated by adding a small quantity of sodium oxalate to their diets. Whereas the controls continued to excrete only small crystals of calcium oxalate, the stone-formers passed most of their crystals as large particles. 3. Further investigations showed that the urines of the controls contained a potent inhibitor of the growth and aggregation of calcium oxalate crystals in vitro and that the inhibitor was deficient in the urines of the recurrent stone-formers. 4. It is suggested that the inhibitor in normal urine may allow calcium oxalate to be passed harmlessly in the form of small particles, whereas the lower inhibitory activity in the urines of the recurrent stone-formers is insufficient to prevent the growth of the primary crystals into the large aggregates seen in these urines. By blocking the formation of abnormally large crystals and aggregates the inhibitor may therefore play an important role in preventing crystalluria leading to stone formation.

Evaluation of stone formers

2017 ◽  
Author(s):  
Muhammad Waqas Iqbal ◽  
Ghalib Jibara ◽  
Michael E. Lipkin ◽  
Glenn M. Preminger
Keyword(s):  
Stone Formation ◽  
Stone Disease ◽  
Metabolic Evaluation ◽  
Recurrence Rates ◽  
Preventative Measures ◽  
Stone Formers ◽  
Increased Risk ◽  
High Incidence ◽  
Recurrent Stone ◽  
Environmental Temperatures

Urolithiasis is among the most common urologic disorders with high incidence and recurrence rates. High environmental temperatures, prevalence of the Western diet, obesity, age, gender, and race are among the common risk factors associated with this disease. The primary goal of evaluating these patients is to provide a simple, economic, and effective workup, which yields information that is directly applicable to providing relevant medical preventative measures. The management of urolithiasis requires a relevant history, targeted physical exam, appropriate chemistry, urinary and stone analyses results, radiological imaging to accurately identify number, location, and size of stones, as well as a metabolic evaluation. All stone formers whether single or recurrent should have a basic evaluation to identify any factors that may predispose to recurrent stone formation. Comprehensive metabolic evaluations are offered to patients at increased risk of recurrence or morbidity from stone disease, or have difficult to treat stones.

Abnormal Erythrocyte and Renal Frusemide-Sensitive Sodium Transport in Idiopathic Calcium Nephrolithiasis

1994 ◽  
Vol 86 (3) ◽  
pp. 239-243 ◽  
Author(s):  
Bruno Baggio ◽  
Giovanni Gambaro ◽  
Francesco Marchini ◽  
Massimo Vincenti ◽  
Giulio Ceolotto ◽  
...  
Keyword(s):  
Calcium Oxalate ◽  
Renal Stone ◽  
Stone Formation ◽  
Fractional Excretion ◽  
Cation Transport ◽  
Anion Transport ◽  
Kinetic Properties ◽  
Distal Nephron ◽  
Stone Formers ◽  
Na Efflux

1. Anomalous transmembrane anion transport has been observed in erythrocytes of patients with idiopathic calcium nephrolithiasis. 2. To verify whether cation transport is also abnormal, we investigated the frusemide-sensitive Na+ efflux from Na+-loaded erythrocytes and the natriuretic response to acute intravenous frusemide administration in calcium oxalate renal stone formers. 3. Frusemide administration induced a statistically significant smaller increase in the fractional excretion of Na+ in patients than in control subjects. Abnormal kinetic properties of erythrocyte Na+-K+-2Cl− co-transport were observed in approximately 60% of stone formers. The Km for Na+ of Na+-K+-2Cl− co-transport correlated with urinary Ca2+ excretion. 4. The abnormal kinetic properties of Na+-K+-2Cl− co-transport may be relevant for stone formation, hampering renal Ca2+ reabsorption in the distal nephron and determining critical physicochemical conditions for calcium/oxalate crystallization.

scholarly journals In Vivo Entombment of Bacteria and Fungi during Calcium Oxalate, Brushite and Struvite Urolithiasis

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0006942020
Author(s):  
Jessica J. Saw ◽  
Mayandi Sivaguru ◽  
Elena M. Wilson ◽  
Yiran Dong ◽  
Robert A. Sanford ◽  
...  
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Human Kidney ◽  
Rrna Gene ◽  
Bacterial Cells ◽  
Stone Formers ◽  
Bacteria And Fungi ◽  
Struvite Stones

Background: Human kidney stones form via repeated events of mineral precipitation, partial dissolution and reprecipitation, which are directly analogous to similar processes in other natural and man-made environments where resident microbiomes strongly influence biomineralization. High-resolution microscopy and high-fidelity metagenomic (microscopy-to-omics) analyses, applicable to all forms of biomineralization, have been applied to assemble definitive evidence of in vivo microbiome entombment during urolithiasis. Methods: Stone fragments were collected from a randomly chosen cohort of 20 patients using standard percutaneous nephrolithotomy (PCNL). Fourier transform infrared (FTIR) spectroscopy indicated that 18 of these patients were calcium oxalate (CaOx) stone formers, while one patient each formed brushite and struvite stones. This apportionment is consistent with global stone mineralogy distributions. Stone fragments from 7 of these 20 patients (5 CaOx, 1 brushite and 1 struvite) were thin sectioned and analyzed using brightfield (BF), polarization (POL), confocal, superresolution autofluorescence (SRAF) and Raman techniques. DNA from remaining fragments, grouped according to each of the 20 patients, were analyzed with amplicon sequencing of 16S rRNA gene sequences (V1-V3, V3-V5) and internal transcribed spacer (ITS1, ITS2) regions. Results: Bulk entombed DNA was sequenced from stone fragments in 11 of the 18 CaOx patients, as well as the brushite and struvite patients. These analyses confirmed the presence of an entombed low-diversity community of bacteria and fungi, including Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria, and Aspergillus niger. Bacterial cells ~1  µm in diameter were also optically observed to be entombed and well-preserved in amorphous hydroxyapatite spherules and fans of needle-like crystals of brushite and struvite. Conclusions: These results indicate a microbiome is entombed during in vivo CaOx stone formation. Similar processes are implied for brushite and struvite stones. This evidence lays the groundwork for future in vitro and in vivo experimentation to determine how the microbiome may actively and/or passively influence kidney stone biomineralization.

Tamm-Horsfall glycoprotein: role in inhibition and promotion of renal calcium oxalate stone formation studied with Fourier-transform infrared spectroscopy

1994 ◽  
Vol 40 (9) ◽  
pp. 1739-1743 ◽  
Author(s):  
R Knörle ◽  
P Schnierle ◽  
A Koch ◽  
N P Buchholz ◽  
F Hering ◽  
...  
Keyword(s):  
Fourier Transform ◽  
Infrared Spectroscopy ◽  
Sialic Acid ◽  
Calcium Oxalate ◽  
Fourier Transform Infrared Spectroscopy ◽  
Acid Content ◽  
Stone Formation ◽  
Fourier Transform Infrared ◽  
Sialic Acid Content ◽  
Stone Formers

Abstract Tamm-Horsfall glycoprotein (THP) from healthy probands inhibits the precipitation of calcium oxalate, whereas THP from individuals who repeatedly develop calcium oxalate stones has no effect or even promotes precipitation. Using Fourier-transform infrared spectroscopy, we found a structural differentiation between these functionally different THPs: a decisive difference in sialic acid content. Quantitative analysis for sialic acid showed the same results. THP from healthy probands had a high sialic acid content (51 +/- 9 g/kg), whereas THP from recurrent stone formers had a decreased sialic acid content (21 +/- 4 g/kg). This explains the dual role of THP in the precipitation of calcium oxalate and the formation of renal stones and shows the importance of glycosylation in the function of this glycoprotein.

The Effect of Ethane-1-Hydroxy-1,1-Diphosphonate (EHDP) on Calcium Oxalate Crystalluria in Recurrent Renal Stone-Formers

1974 ◽  
Vol 47 (1) ◽  
pp. 13-22 ◽  
Author(s):  
W. G. Robertson ◽  
M. Peacock ◽  
R. W. Marshall ◽  
F. Knowles
Keyword(s):  
Calcium Oxalate ◽  
Stone Formation ◽  
Basal Diet ◽  
Sodium Oxalate ◽  
Calcium Oxalate Crystals ◽  
Calcium Oxalate Dihydrate ◽  
Calcium Oxalate Stone ◽  
Oxalate Crystals ◽  
Stone Formers

1. The volume, size and type of calcium oxalate crystals excreted in the urine of a group of patients with recurrent ‘idiopathic’ stones were studied on a controlled basal diet, after an oral supplement of sodium oxalate and after oral administration of ethane-1-hydroxy-1,1-diphosphonate (EHDP) for 4 weeks. 2. Before administration of EHDP the stone-formers passed the large crystals and aggregates of calcium oxalate dihydrate characteristic of recurrent calcium oxalate stone-formers. For the same level of urine saturation and crystalluria EHDP caused a significant reduction in the proportion of large crystals and aggregates excreted. Studies by light-microscopy confirmed that EHDP caused a striking change in the size and habit of calcium oxalate crystals in some but not all of the urine samples examined. 3. The decrease in average crystal size during the administration of EHDP was attributed to the observed increase in the ability of urine to inhibit the growth and aggregation of calcium oxalate crystals as measured by a growth system in vitro. 4. The possible use of EHDP as a therapeutic agent in the treatment of calcium oxalate stone-formation is discussed.

Urine protein markers distinguish stone-forming from non-stone-forming relatives of calcium stone formers

2006 ◽  
Vol 291 (3) ◽  
pp. F530-F536 ◽  
Author(s):  
Kristin J. Bergsland ◽  
Jennifer K. Kelly ◽  
Brian J. Coe ◽  
Fredric L. Coe
Keyword(s):  
Discriminant Analysis ◽  
Stone Formation ◽  
Stone Disease ◽  
Small Subset ◽  
Protein Markers ◽  
Urine Protein ◽  
Multivariate Discriminant Analysis ◽  
Stone Formers ◽  
Calgranulin B ◽  
Multivariate Discriminant

We have investigated urine protein inhibitors of calcium oxalate crystallization to determine whether variations in these proteins are associated with kidney stone disease and whether protein measurements improve the identification of stone formers compared with conventional risk factors (RF). Using Western blotting, we studied variations in the electrophoretic mobility patterns and relative abundances of crystallization-inhibitory proteins in urine from 50 stone-forming (SF) and 50 non-stone-forming (NS) first-degree relatives of calcium SF patients, matched by gender and age. Standard urine chemistry stone risk measurements were also made. Multivariate discriminant analysis was used to test the association of these proteins with nephrolithiasis. Differences in form and abundance of several urine proteins including inter-α-trypsin inhibitor (ITI), prothrombin fragment 1 (PF1), CD59, and calgranulin B (calB) were found to be associated with stone formation. By multivariate discriminant analysis, measurements of forms of PF1, ITI, and calB in men and ITI and CD59 in women, classified 84% of men and 76% of women correctly by stone status. In contrast, standard urine chemistry RF identified only 70% of men correctly and failed to distinguish female SF from NS. Thus a small subset of protein measurements distinguished SF from NS far better than conventional RF in a population of relatives of calcium SF, illustrating the significant association of these proteins with stone disease. Variations in these proteins may serve as markers of stone disease activity or vulnerability to recurrence and may provide new insights into mechanisms of stone formation.

Hypertension Influences Recurrent Stone Formation in Nonobese Stone Formers

Urology ◽  
2011 ◽  
Vol 77 (5) ◽  
pp. 1059-1063 ◽  
Author(s):  
Yong-June Kim ◽  
Moon Seon Park ◽  
Won-Tae Kim ◽  
Seok-Joong Yun ◽  
Wun-Jae Kim ◽  
...  
Keyword(s):  
Stone Formation ◽  
Stone Formers ◽  
Recurrent Stone

scholarly journals Body size and risk of kidney stones.

1998 ◽  
Vol 9 (9) ◽  
pp. 1645-1652
Author(s):  
G C Curhan ◽  
W C Willett ◽  
E B Rimm ◽  
F E Speizer ◽  
M J Stampfer
Keyword(s):  
Body Mass Index ◽  
Body Size ◽  
Calcium Oxalate ◽  
Body Mass ◽  
Kidney Stones ◽  
Stone Formation ◽  
Stone Disease ◽  
Kidney Stone Formation ◽  
Risk Of Stone Formation

A variety of factors influence the formation of calcium oxalate kidney stones, including gender, diet, and urinary excretion of calcium, oxalate, and uric acid. Several of these factors may be related to body size. Because men on average have a larger body size and a threefold higher lifetime risk of stone formation than women, body size may be an important risk factor for calcium oxalate stone formation. The association between body size (height, weight, and body mass index) and the risk of kidney stone formation was studied in two large cohorts: the Nurses' Health Study (NHS; n = 89,376 women) and the Health Professionals Follow-up Study (HPFS; n = 51,529 men). Information on body size, kidney stone formation, and other exposures of interest was obtained by mailed questionnaires. A total of 1078 incident cases of kidney stones in NHS during 14 yr of follow-up and a total of 956 cases in HPFS during 8 yr of follow-up were confirmed. In both cohorts, the prevalence of a stone disease history and the incidence of stone disease were directly associated with weight and body mass index. However, the magnitude of the associations was consistently greater among women. Specifically, the age-adjusted prevalence odds ratio for women with body mass index > or = 32 kg/m2 compared with 21 to 22.9 kg/m2 was 1.76 (95% confidence interval, 1.50 to 2.07), but 1.38 (95% confidence interval, 1.16 to 1.65) for the same comparison in men. For incident stone formation, the multivariate relative risks for the similar comparisons were 1.89 (1.51 to 2.36) for women and 1.19 (0.83 to 1.70) in men. Height was inversely associated with the prevalence of stone disease but was not associated with incident stone formation. These results suggest that body size is associated with the risk of stone formation and that the magnitude of risk varies by gender. Additional studies are necessary to determine whether a reduction in body weight decreases the risk of stone formation, particularly in women.

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