Calcium Oxalate Dihydrate Stones Research Articles

The Vitamin D Metabolite Diagnostic Ratio Associates With Phenotypic Traits of Idiopathic Hypercalciuria

IntroductionUnderlying mechanisms for hypercalciuria remain unknown in most cases, hence the designation “idiopathic”. We hypothesized that the Vitamin D-inactivating enzyme CYP24A1 contributes to the pathogenesis of hypercalciuria in kidney stone formers. MethodsWe conducted association analyses between CYP24A1 activity, estimated by the Vitamin D metabolite diagnostic ratio (25(OH) Vitamin D3/total 24,25 (OH)2 Vitamin D ratio; VMDR), and the phenotype of participants in two observational cohorts of kidney stone formers, the Swiss Kidney Stone Cohort and the Bern Kidney Stone Registry. Circulating 25(OH)- and 24,25 (OH)2 Vitamin D were quantified using a validated LC-MS/MS assay. Results974 participants were included in the analysis. We found a positive association of VMDR (and hence negative association of CYP24A1 activity) with total (β 0.009 mmol/L; 95% CI 0.002, 0.016; p = 0.02) and ionized plasma calcium (β 0.005 mmol/L; 95% CI 0.002, 0.008; p < 0.01), absolute and fractional excretion of urinary calcium (β 0.054 mmol/24h; 95% CI 0.010, 0.097; p = 0.02 and β 0.046 %; 95% CI 0.018, 0.074; p < 0.01, respectively). Further, VMDR was associated with an increased likelihood of forming calcium oxalate dihydrate stones (Odds ratio 1.64; 95% CI 1.22, 2.35; p < 0.01) and reduced bone mineral density at the femoral neck (β -0.005 g/cm2; 95% CI -0.010, -0.001; p = 0.04). The described associations became stronger when the analysis was confined to idiopathic calcium stone formers. ConclusionOur study reveals that CYP24A1 activity, estimated by VMDR, is associated with clinical traits previously linked to idiopathic hypercalciuria.

Pediatric age-related distribution of calcium oxalate monohydrate and calcium oxalate dihydrate in urinary tract stones: metabolic, gender and ethnic correlates.

Previous studies of pediatric urolithiasis have suggested possible associations between the relative proportions of calcium oxalate dihydrate (COD) and calcium oxalate monohydrate (COM) stones with age, gender, and ethnicity. This study aimed to investigate the composition and distribution of calcium oxalate stones according to these clinical factors and the metabolic correlates of the different subtypes in pediatric stone formers. We retrospectively reviewed the database of all first-time stone formers between 2014 and 2019. Infrared spectrometry was used to determine stone composition. Stones were categorized by their highest relative component and reported as a percentage of occurrences in the cohort as a whole and by patient gender, age (divided into three age groups: 1-5, 6-12, 13-18 years), and ethnicity. Clinical and metabolic correlates were analyzed. Of 2,479 consecutive stones submitted to our chemical stone lab, 220 first-time pediatric stone formers were identified. COD stones were the predominant subtype in the youngest group, and COM stones in the oldest group (OR 0.39, 95% CI:0.18-0.86, p=0.036). In the intermediate-age group (6-12 years), COM stones were more prevalent in Arab boys and COD stones in girls of either ethnicity. COD stones were associated with hypercalciuria (p< 0.0001), and COM stones with hyperoxaluria (p=0.0024). Hypercalciuria and hypocitraturia were the most prevalent abnormalities at ages 1-5 and 13-18, respectively. Analysis of calcium oxalate stone subtypes and their metabolic correlates in stone formers has significant clinical relevance, specifically in children. In the present study, COD stones and hypercalciuria were more common in younger children, and COM stones and hypocitraturia in adolescents. These findings suggest unique, complex interactions driving stone formations in children that may guide a more practical, limited, and cost-effective approach to metabolic evaluations, choice of treatment, and preventive measures, particularly in first-time calcium oxalate pediatric stone-formers.

MP05-18 FLUID TEMPERATURE EFFECT ON SUPERPULSE THULIUM FIBER LASER STONE ABLATION

You have accessJournal of UrologyCME1 Apr 2023MP05-18 FLUID TEMPERATURE EFFECT ON SUPERPULSE THULIUM FIBER LASER STONE ABLATION Kalon L. Morgan, Andrei D. Cumpanas, Nittesh Katta, Rohit Bhatt, Antonio R. H. Gorgen, Allen Rojhani, Paul Piedras, Seyed Amiryaghoub Lavasani, Zachary E. Tano, Sohrab N. Ali, Pengbo Jiang, Roshan M. Patel, Thomas Milner, Jaime Landman, and Ralph V. Clayman Kalon L. MorganKalon L. Morgan More articles by this author , Andrei D. CumpanasAndrei D. Cumpanas More articles by this author , Nittesh KattaNittesh Katta More articles by this author , Rohit BhattRohit Bhatt More articles by this author , Antonio R. H. GorgenAntonio R. H. Gorgen More articles by this author , Allen RojhaniAllen Rojhani More articles by this author , Paul PiedrasPaul Piedras More articles by this author , Seyed Amiryaghoub LavasaniSeyed Amiryaghoub Lavasani More articles by this author , Zachary E. TanoZachary E. Tano More articles by this author , Sohrab N. AliSohrab N. Ali More articles by this author , Pengbo JiangPengbo Jiang More articles by this author , Roshan M. PatelRoshan M. Patel More articles by this author , Thomas MilnerThomas Milner More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The absorption coefficient measures the energy lost to the medium through which a laser beam passes. Prior mid-infrared laser studies have shown that as the temperature of the medium increases, there is less loss of energy into the medium. Accordingly, we evaluated the impact of irrigation temperature on the amount of stone ablation when using the superpulse Thulium fiber laser (sTFL). METHODS: Optical coherence tomography (OCT), a non-invasive, high-resolution imaging technique, was used to generate a detailed surface image during single pulse sTFL lithotripsy (0.5 J, 1.0 Hz, 1.25 ms) of 12 samples of each of the following stone compositions: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), and uric acid (UA). Stones were immersed in either room temperature (20°C) or body temperature (37°C) 0.9% saline. With the tip of a 200 µm laser fiber in contact with the stone, a single pulse was applied at two separate sites on each stone. OCT determined the volume of stone removed per each laser pulse. Data were evaluated using an unpaired t-test (Figure 1) (Table 1). RESULTS: Regardless of stone composition, the mean volume of stone ablated during sTFL at 37°C was significantly greater than at room temperature. The single pulse of the sTFL ablated 12.4%, 24.4% and 28.6% more stone at 37°C irrigation for COM stones (p=0.034), COD stones (p=0.014) and UA stones (p=0.007), respectively (Table 1). CONCLUSIONS: sTFL efficiency in ablating COM, COD, and UA stones is enhanced when using irrigation warmed to 37°C. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e51 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kalon L. Morgan More articles by this author Andrei D. Cumpanas More articles by this author Nittesh Katta More articles by this author Rohit Bhatt More articles by this author Antonio R. H. Gorgen More articles by this author Allen Rojhani More articles by this author Paul Piedras More articles by this author Seyed Amiryaghoub Lavasani More articles by this author Zachary E. Tano More articles by this author Sohrab N. Ali More articles by this author Pengbo Jiang More articles by this author Roshan M. Patel More articles by this author Thomas Milner More articles by this author Jaime Landman More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...

Incidence and risk factors for urolithiasis recurrence after endourological management of kidney stones: A retrospective single-centre study.

Almost half of the patients have hadrecurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences. Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups. During this period 265 patients were treated for upper urinary tract stone. A total of 190 patients were included in the study. The median age and median BMI of the patients were 57.5 years and 25.2kg/m2, respectively. A biochemical analysis of the stones was performed in 117 (61.5%) patients. The most common types of stones were calcium oxalate monohydrate stones (n=44, 23.2%), mixed stones (n=39, 20.5%) including mixed calcium oxalate (n=10; 8.5%), calcium oxalate dihydrate stones (n=13, 6.8%) and uric acid stones (n=11, 5.8%). At the end of a median follow-up of 32 months (range, 13-61 monthes), 49 patients (25.8%) had a recurrent stone. In univariate analysis, the risk factors for recurrence were BMI greater than 25kg/m2 (HR: 2; P<0.05), diabetes (HR: 3.73; P<0.008) and smoking (HR: 3.1; P<0.039). However age (HR: 0.96: P<0.003) and high blood pressure (HR: 0.37; P<0.027) were protective factors. In multivariate analysis, diabetes, smoking, hypertension, and age are still risk factors for recurrence. Stone recurrence is common after the management of urinary stones. In this study25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

MP26-10 CLINICAL AND METABOLIC FACTORS AFFECTING RELATIVE PROPORTION OF CALCIUM OXALATE MONOHYDRATE AND DIHYDRATE IN PURE CALCIUM OXALATE STONES

You have accessJournal of UrologyCME1 May 2022MP26-10 CLINICAL AND METABOLIC FACTORS AFFECTING RELATIVE PROPORTION OF CALCIUM OXALATE MONOHYDRATE AND DIHYDRATE IN PURE CALCIUM OXALATE STONES Mohammad Hout, Vedant Acharya, Madhumita Parmar, Ruben Blachman Braun, Jonathan Katz, Robert Marcovich, and Hemendra Shah Mohammad HoutMohammad Hout More articles by this author , Vedant AcharyaVedant Acharya More articles by this author , Madhumita ParmarMadhumita Parmar More articles by this author , Ruben Blachman BraunRuben Blachman Braun More articles by this author , Jonathan KatzJonathan Katz More articles by this author , Robert MarcovichRobert Marcovich More articles by this author , and Hemendra ShahHemendra Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Calcium oxalate stone are the commonest variety of urinary calculi. Patients contain varying amount of its sub-types- calcium oxalate monohydrate and dihydrate. Few studies from past demonstrate varying metabolic defects in patients with both sub-types. The aim of present study was to study influence of various clinical and metabolic factors on relative proportion of calcium oxalate monohydrate and dihydrate in pure calcium oxalate stones. METHODS: We retrospectively examined stone analysis report of all patients who underwent endourological procedure for stone removal at our center from Jan 2017 to December 2019. Stones made of pure calcium oxalate with varying proportion of its subtypes were identified. Patient with combination of calcium oxalate with other components were excluded from study. Chart review was performed of all this patient to identify those who had 24-hour urinary stone risk profile done within 3 month of stone analysis and prior to start of medical management of stone. Statistical analysis was performed using SPSS 24. Correlational analysis between stone composition and clinical and metabolic variables was performed with the Spearman test. RESULTS: Of 120 calcium oxalate stones, 66 contained > 60% monohydrate and 8 contained > 60% dihydrate. The mean age in patients with dihydrate stone was 39.6 + 17 and monohydrate was 55.3 + 14.6. (P=0.002). Correlation analysis suggested that age, BMI and urinary Ph. Calcium oxalate saturation, brushite saturation and uric acid saturation were found to have significant co-relation with percentage of calcium oxalate dihydrate or calcium oxalate monohydrate stone composition (Figures 1 and 2). CONCLUSIONS: Calcium oxalate dihydrate stones former are younger and have lower BMI than those with monohydrate stones. Similarly as urinary Ph become more alkaline, the relative proportion of dihydrate increases. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e442 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Hout More articles by this author Vedant Acharya More articles by this author Madhumita Parmar More articles by this author Ruben Blachman Braun More articles by this author Jonathan Katz More articles by this author Robert Marcovich More articles by this author Hemendra Shah More articles by this author Expand All Advertisement PDF DownloadLoading ...

Clinical characteristics of surgically managed patients with asymptomatic renal stones: Comparison of patients with symptomatic renal stones.

This study aimed to compare the characteristics of asymptomatic and symptomatic nephrolithiasis in patients who underwent surgical treatment for kidney stones. Between 2015 and 2019, 245 patients who underwent percutaneous nephrolithotomy or retrograde intrarenal surgery for kidney stones were included. The patients were divided into asymptomatic (n=124) and symptomatic (n=121) groups. All patients underwent blood and urine tests, preoperative non-contrast computed tomography, and postoperative stone composition analysis. We retrospectively analyzed and compared the characteristics of the patients and stones, operation time, stone-free rate, and postoperative complications between the two groups. In the asymptomatic group, mean body mass index (BMI) was significantly higher (25.7±3.8 kg/m² vs. 24.3±2.8 kg/m², p=0.002) and urine pH was significantly lower (5.6±0.9 vs. 5.9±0.9, p=0.013). The ratio of calcium oxalate dihydrate stones was significantly higher in the symptomatic group (5.3% vs. 15.5%, p=0.023). No significant differences were observed in stone characteristics, postoperative outcomes, or complications. In the multivariate logistic regression analysis for predicting variables for asymptomatic renal stones, BMI (odds ratio [OR], 1.144; 95% confidence interval [CI], 1.038-1.260; p=0.007), and urine pH (OR, 0.608; 95% CI, 0.407-0.910; p=0.016) were independent predictive variables for asymptomatic renal stones. This study demonstrated that thorough medical check-ups are needed for the early detection of renal stones in individuals with a high BMI or low urine pH.

Correlations between stones composition, dietary and comorbidities context of the lithiasic patient.

The incidence of nephrolithiasis is in full expansion, its etiology being frequently associated with lifestyle changes. The objective of this retrospective study, carried out between April and December 2019, was to identify the correlations of the known lithogenic factors with the chemical structure of the calculi in the patients from the North-Eastern region of Romania. The results obtained after the data analysis of our LAMPA questionnaire (L – liquids, A – antecedents, M – medication, P – associated pathologies, A – aliments) made in evidence a statistically relevant relationship between the heredocollateral history of lithiasis and calcium oxalate dihydrate (COD) calculi, hypertension and calcium oxalate monohydrate (COM) stones, uric lithiasis and diabetes, COD, and obesity, between predominantly uric lithiasis and meat or meat-derived products consumption, between frequent potato consumption and COD stones and the frequently consume of dairy products and predominantly COM calculi. The authors concluded that the use of a complex questionnaire, like LAMPA, together with Fourier-transform infrared (FTIR) spectroscopic and morphological analysis are essential steps for developing an efficient metaphylaxis.

MO119COMPUTER-DERIVED SOFTWARE IN CLINICAL PRACTICE: RESULTS FROM A SHORT-TERM FOLLOW-UP ACCORDING TO KIDNEY STONE COMPOSITION IN KIDNEY STONE FORMERS

Abstract Background and Aims Urinary supersaturation (SS) contributes to stone formation, and its assessment in stone formers may be helpful in clinical practice. Several computer programs are available for SS calculation, including EQUIL2, JESS and Lithorisk1. The aim of this study was to evaluate changes in SS in 24-hour urine in patients with known stone composition before and after about three months of regular treatment. Method Patients who submitted their stone/s for composition analysis and had provided an adequate 24-hour urine collection (creatinine 15-20 mg/kg/24-hour) before and around 90 days under regular treatment were included. Stone composition was defined using morphoconstitutional and infrared spectroscopy. The treatment was initiated in accordance with specific guidelines, and included dietary advices and medications2. SS for calcium oxalate (CaOx), calcium phosphate (CaP) and uric acid (UA) using EQUIL2, JESS and Lithorisk were calculated at baseline and after about 90 days on treatment. Continuous variables were reported as means (SD) while categorical variables were reported as frequencies and percentages. Baseline and follow-up SS urine values were compared using the Wilcoxon signed-rank test. 3D graphs were plotted using mean SS values of CaOx, CaP and UA obtained from each program before and after treatment, dividing the stones into 4 groups1: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), calcium phosphate (CaP), and uric acid (UA). Ethical Committee approval was obtained. Results 105 patients (61 men, 58%) were followed and provided 24h urine collection. Of these, 101 (96%) were recurrent patients. The mean (SD) follow-up was 94 (14) days. 48 (46%) of all calculi were made of CaOx, either COM or COD, 36 (34%) of UA, and 21 (20%) of CaP. A significant reduction in SS values during treatment was observed in patients with COM (p&amp;lt;0.05) , COD (p&amp;lt;0.001), and UA stones (p&amp;lt;0.001) with all programs. The reduction in SS values over time in patients with CaP stones was not significant (Table 1). Figure 1 shows 3D plots with SS before and after treatment into 4 groups of stone formers. Conclusion EQUIL2, JESS and Lithorisk are suitable software currently used for clinical and research purposes. SS values calculated by EQUIL2, JESS and Lithorisk during follow-up showed a significant reduction among COM, COD and UA stone formers. CaP stone formers did not show significant changes in SS over time.

Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2)

Introduction and objectivesTo assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. Materials and methodsA series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. ResultsA total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1–12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. ConclusionsObservation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

Identificación endoscópica de la composición de los cálculos urinarios: un estudio del Southeastern Group for Lithiasis Research (SEGUR 2)

Introduction and objectivesTo assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. Materials and methodsA series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. ResultsA total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. ConclusionsObservation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.

Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24\u2009h urine analysis

BackgroundOur purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis.MethodsThis prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall’s plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher’s exact test and Student’s t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant.ResultsThe most common injury was tubular calcification (78%), followed by Randall’s plaque (58%), and papillary crater (39%). There was no significant relationship of Randall’s plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall’s plaque with hypocitraturia (p = 0.005).ConclusionsThere are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall’s plaque.

Genetic and Clinical Analyses of 13 Chinese Families With Cystine Urolithiasis and Identification of 15 Novel Pathogenic Variants in SLC3A1 and SLC7A9.

BackgroundCystinuria is a rare genetic disorder characterized by defective renal reabsorption of cystine, ornithine, arginine, and lysine. The increased urinary excretion of cystine results in the development of cystine urolithiasis (CU). The mutated SLC3A1 and SLC7A9 genes are the cause of CU, a global disorder. Its frequency and mutation spectrum vary between different populations. In Asia, the data for CU are limited.MethodUrinary stones were collected from patients of a single center over a five-year period and analyzed via Fourier transform infrared spectroscopy. Genomic DNA was isolated from 13 patients with CU and their parents and from 26 controls affected by calcium oxalate dihydrate stones. The coding regions and the exon–intron boundaries of SLC3A1 and SLC7A9 were subjected to PCR amplification and then sequenced via traditional Sanger sequencing. Genetic variants were functionally annotated using the InterVar, ClinVar, gnom AD, and HGMD databases.ResultsFrom the 232 samples of urinary stones, we identified 13 patients with CU (10 males and 3 females). The onset age was from 7 months to 9 years. The CU stones varied from 0.26 cm3 to 18.67 cm3. Sanger sequencing detected a total of 14 SLC3A1 (nine were novel) and 10 SLC7A9 (six were novel) rare variants from the 13 CU families. All variants, including 15 novel variants, were pathogenic, disease-causing, or damaging.ConclusionAll 13 pediatric CU families harbored SLC3A1 or/and SLC7A9 rare variants. A total of 15 novel pathogenic variants in SLC3A1 and SLC7A9 were identified. This study expanded the known mutational spectrum of CU in the Chinese population.

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

ObjectiveThere 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.MethodsA 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.ResultsAmong 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%).ConclusionsThere was a relatively high rate of uric acid stones in patients from the eastern Shandong region of China.

Prevalence and chemical composition of uroliths in fattening pigs in Belgium

The present study investigated the prevalence of uroliths in fattening pigs and assessed the composition of these urinary tract concrements. In total, 2,432 urinary bladders were sampled in the slaughterhouse and checked for abnormal content. Urinary samples were analysed microscopically, and samples of the urinary bladder wall were tested for histological signs of inflammation. The composition of the concrements was examined by infrared spectrophotometry. Macroscopic and microscopic abnormalities were detected in 8.4% and 52.8% of the samples respectively. Magnesium ammonium phosphate (struvite), calcium oxalate dihydrate (COD), calcium carbonate (calcite), calcium oxalate monohydrate (COM) and amorphous crystals were detected. Analysis of stones showed COD in all samples in different proportions. The calcium content of examined stones was always considerable (up to 34%), in contrast to the magnesium content which represented max 1.9%. Struvite was found in one third of the samples, but was never part of stones and grit. COD crystals were the second most common microscopic crystal. These COD crystals and some COD stones had a rectangular shape, and therefore, they can be harmful to the bladder mucosa. In conclusion, uroliths are present in a large proportion of male fattening pigs, and consequently, urinary concrements pose a life-threatening risk for urethra obstruction in male pigs. Further research is warranted to identify potential risk factors for urolithiasis and microscopic crystals.

MP90-09 THE METABOLIC SYNDROME AND ITS IMPACT ON CALCIUM OXALATE STONE TYPE

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2017MP90-09 THE METABOLIC SYNDROME AND ITS IMPACT ON CALCIUM OXALATE STONE TYPE Egor Parkhomenko, Kathleen Kan, Timothy Tran, Julie Thai, Kyle Blum, and Mantu Gupta Egor ParkhomenkoEgor Parkhomenko More articles by this author , Kathleen KanKathleen Kan More articles by this author , Timothy TranTimothy Tran More articles by this author , Julie ThaiJulie Thai More articles by this author , Kyle BlumKyle Blum More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2828AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The metabolic syndrome plays an important role in lithogenesis of calcium oxalate stones, but to our knowledge no study has clinically correlated metabolic factors that influence stone subtype. It has been indicated that calcium oxalate monohydrate (COM) stones are more likely of tubular origin as secondary deposits onto calcium apatite whereas calcium oxalate dihydrate (COD) stones are more likely to form in solution. We sought to perform a comprehensive analysis of metabolic and clinical factors in patients who make predominantly one type of calcium oxalate stone. METHODS From our prospectively maintained database of 1049 kidney stone formers between 01/2014 - 06/2016, we identified 95 patients with comprehensive medical records including stone analysis who had predominantly (≥80%) COM (75 pts) or COD (20 pts) composition. Another 27 patients had mixed COM and COD stones (<80% of one subtype). Clinical, demographic and laboratory parameters were compared between (>80%) COM or COD stones. RESULTS There were no differences in age, gender or BMI between the COM and COD patients. COM patients were more likely to be hypertensive (46.7% vs. 15% p=0.01) and this difference was more pronounced in males (60% vs. 16.7%, p=0.007). Male COM patients were also more likely to be diabetic (22% vs. 0%, p=0.102). There were no differences in hyperlipidemia, coronary artery disease, gastrointestinal disease, and serum markers of uric acid, calcium, creatinine or HbA1c. COM patients were more likely to have hypocitraturia compared to COD patients (49.3% vs. 25%, p = 0.05). Male COM patients had significantly higher urinary oxalate levels (48 vs. 37 mg/d, p=0.05) compared to male COD formers. COD females showed a trend towards higher calcium levels vs. COM females (213 vs. 140 mg/d, p=0.13). The calcium/oxalate ratio in COD formers was significantly higher compared to COM formers (6.46 vs. 4.84, p < 0.05). No differences were observed for urine uric acid levels, supersaturation of uric acid, CaOx supersaturation, magnesium, and pH. CONCLUSIONS Our study suggests that HTN and DM, two components of the metabolic syndrome, are more closely linked to COM stones compared to COD stones. Patients with higher urine oxalate and lower urine citrate levels tend to form COM stones, while those with a higher urine calcium/oxalate ratio tend to form COD stones. This suggests that the two stone subtypes are clinically and metabolically different and thus may have different etiology. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1213 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Egor Parkhomenko More articles by this author Kathleen Kan More articles by this author Timothy Tran More articles by this author Julie Thai More articles by this author Kyle Blum More articles by this author Mantu Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Proteomic Analysis after Sequential Extraction of Matrix Proteins in Urinary Stones Composed of Calcium Oxalate Monohydrate and Calcium Oxalate Dihydrate.

In this study, we performed proteomic analysis following sequential protein extraction on calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) urinary stones to determine the specific matrix proteins according to the crystal components of the stones. After X-ray and IR analysis of 13 urinary stones, matrix proteins were sequentially extracted with KCl, formic acid, guanidine-HCl, and EDTA, before SDS-electrophoresis followed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). The electrophoretic patterns of the extracted proteins differed from that of COM and COD stones. LC-MS/MS identified 65 proteins, of which many were cellular plasma proteins, and were frequently detected regardless of the crystal components. However, 6 proteins (protein Z, protein S, prothrombin, osteopontin, fatty acid binding protein 5, and ubiquitin) were detected in the final EDTA fractions of COM stones. These proteins are involved in the coagulation process or osteometabolism, and thus the roles they play are of particular interest.

Factors Associated With the Lower Prevalence of Nephrolithiasis in Children Compared With Adults

To determine the reasons behind the lower prevalence of kidney stones in children by assessing urinary lithogenic parameters in healthy children, healthy adults, and 3 groups of stone-former patients. The study subjects included 75 healthy adults, 105 healthy children, 62 patients with previous calcium oxalate monohydrate papillary stones, 120 patients with previous calcium oxalate monohydrate unattached stones, and 248 patients with previous calcium oxalate dihydrate stones. Twenty-four-hour urine samples were collected, and the urinary lithogenic parameters were measured. Calcium, magnesium, and phosphorous concentration differed significantly between healthy children and adults. Except citrate, all solute/creatinine ratios differed between healthy children and adults. However, these differences were much more important in the cases of calcium and magnesium. The calcium/creatinine ratio was 2-fold lower, whereas the magnesium/creatinine ratio was 2-fold higher, in healthy children than that in healthy adults (P <.001 each). The calcium/creatinine ratio was higher and the citrate/creatinine ratio lower in calcium oxalate dihydrate stone formers than that in healthy adults. Ratios of calcium and magnesium to creatinine, as well as morphoanatomic factors and lifestyle habits, may explain the lower prevalence of nephrolithiasis in children than those in adults.

Differentiation of Calcium Oxalate Monohydrate and Calcium Oxalate Dihydrate Stones Using Quantitative Morphological Information from Micro-Computerized and Clinical Computerized Tomography

We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images. A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 μm. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index. On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively. On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy.

Imaging-Based Assessment of the Mineral Composition of Urinary Stones: An In Vitro Study of the Combination of Hounsfield Unit Measurement in Noncontrast Helical Computerized Tomography and the Twinkling Artifact in Color Doppler Ultrasound

We evaluated the value of combining noncontrast helical computerized tomography (NCHCT) and color Doppler ultrasound in the assessment of the composition of urinary stones. In vitro, we studied 120 stones of known composition, that separate into the five main types: 18 calcium oxalate monohydrate (COM) stones, 41 calcium oxalate dihydrate (COD) stones, 24 uric acid stones, 25 calcium phosphate stones and 12 cystine calculi. Stones were characterized in terms of their Hounsfield density (HU) in NCHCT and the presence of a twinkling artifact (TA) in color Doppler ultrasound. There were statistically significant HU differences between calcium and non-calcium stones (p < 0.001), calcium oxalate stones and calcium phosphate stones (p < 0.001) and uric acid stones and cystine calculi (p < 0.001) but not between COM and COD stones (p = 0.786). Hence, the HU was a predictive factor of the composition of all types of stones, other than for COM and COD stones within the calcium oxalate class (p > 0.05). We found that the TA does not enable differentiation between calcium and non-calcium stones (p > 0.999), calcium oxalate stones and calcium phosphate stones (p = 0.15), or uric acid stones and cystine calculi (p = 0.079). However, it did reveal a significant difference between COM and COD stones (p = 0.002). The absence of a TA is a predictive factor for the presence of COM stones (p = 0.008). Hence, the association of NCHCT and Doppler enables the accurate classification of the five types of stones in vitro.

Application of LIIR Automatic Analysis System of Infrared Spectroscopy in the determination of urinary stone composition

Objective To determine the value of applying LIIR Automatic Analysis System of Infrared Spectroscopy in analyzing urinary stone composition. Methods 1450 samples of urinary stones were collected from 1032 male and 418 female patients. The age of patients ranged from 6 months to 88 years. The mean ages were 41.7±15.3 and 42.0±15.6 years for male and female pa- tients, respectively. Of 1450 stones, 875 cases were located in kidney （60.34%）, 504 cases in ureter （34.76%） and 71 cases in bladder （4.90%）. All stones were analyzed by LIIR Automatic Analysis System of Infrared Spectroscopy （Tianjin）. Analysis results were reevaluated by the artificial analysis of spectrogram, i{ necessary, with polarization microscope, chemical analysis, and X ray diffraction. Results Calcium oxalate monohydrate stones were found in 714 cases （49. 24%）, carbonate apatite stones in 444 cases （30.62%）, anhydrous uric acid stones in 93 cases （6.41%）, calcium oxalate dihydrate stones in 92 cases （6. 34%）, ammonium magnesium phosphate hexahydrate stones in 28 cases （1. 93%）, cystine stones in 23 cases （1.59%）, ammonium urate stones in 20 cases （1.38%）, uric acid dihydrate stones in 16 cases （1.10%）, brushite stones in 12 cases （0. 83%）, sodium urate monohydrate stones in 2 cases （0. 14%）, calcium carbonate stones in 1 cases （0.07%）, and other stone types in 5 cases （0.34%）. Most urinary stones were composed of 2 or more compositions, and purestones were only observed in 397 cases （27.38%）. Most of the mixed stones contained calcium and non-calcium mixed stone was rarely observed. In addition, 15 stones were found in infants who had consumed melamine-contaminated milk powder. These stones were composed of uric acid dihydrate and ammonium urate. The results of reevaluation by artificial analysis showed the following among pure and mixed stones, false detection occurred in 6 cases （0.41%）, of which the composition was ammonium urate or carbonate apatite determined by automatic system but the true composition was an hydrous uric acid. False negative detection occurred in 9 cases （0.62%）, of which the composition was ammonium magnesium phosphate hexahydrate or carbonate apatite in 7 cases, but in other 2 cases the composition could not be determined by artificial analysis. The false negative detection of compo- nents with relatively low content occurred in 6 cases and 10 cases in stones with 2 components and 3 components, respectively. The undetected composition in these cases was ammonium magnesium phosphate hexahydrate or carbonate apatite. Conclusion Automatic Analysis System of Infrared Spectroscopy has many advantages in accuracy, automation and is quick in analyzing the composition of urinary stones, and is worthy of promotion in clinical use. Key words: Urinary calculi; Spectrophotometry, infrared; Calcium oxalate; Apatites