The effects of fractioned human urine on urease-induced crystallisation in vitro

Citrate and urease-induced crystallization in synthetic and human urine

The effects of citrate on the different phases of urease-induced crystallization were studied using Coulter counter techniques and optical microscopy. Citrate increased urine pH and markedly delayed the initiation of the crystallization (nucleation) in both human and synthetic urine. In synthetic urine, particle aggregation and especially particle growth were delayed and inhibited by citrate. In human urine, aggregation was distinctly inhibited by citrate. It appears that the susceptibility of urine to form crystals in the presence of urease activity is influenced by its citrate concentration.

In vitro investigations into the formation and dissolution of infection-induced catheter encrustations

Encrustations are the most frequent complications occurring with indwelling catheters and urine drainage systems. The conditions for bacterial infections, using synthetic urine and controlled contamination by Proteus vulgaris, were standardised by using an in vitro model. Crystal deposits on catheters were analysed by infra-red spectroscopy and scanning electron microscopy. The main components of deposits in all investigations were struvite (MgNH4PO4.6H2O) 60-70% and carbonate apatite (Ca10(PO4,CO3)6 (OH,CO3)2) 30-40%. Investigations as to the quality and quantity of encrustations confirmed the analysis. Irrigation treatment was carried out with physiological saline solution and citric acid solution (Suby G) to study and quantify the dissolution of crystal deposits. Regular irrigation with citric solution resulted in a 70% dissolution of encrustations and ensured free flow as ascertained by measuring flow rates.

Prophylaxis of infection-induced kidney stone formation

Lowering supersaturation with respect to struvite and carbonate apatite is the most important prophylactic measure in patients with infection-induced kidney stone disease. This is best achieved by combining culture-specific antibiotics with urinary acidification. Urinary infection with non-urease-producing Escherichia coli, probably promoting struvite particle formation, must be eradicated. Possible measures for improving urothelial anti-adherence properties or reducing bacterial adherence are discussed.

How variations in the composition of urine influence urease-induced crystallization

To Study how the composition of urine influences urease-induced crystallization, human urine samples were incubated with urease and the subsequent precipitation measured. Beside the pH increase, the urinary content of magnesium and calcium had profound effects on the precipitation of magnesium ammonium phosphate and calcium phosphate, respectively. Urine phosphate, ammonium and osmolarity had no direct effects on the precipitation. Among the urine components with potential inhibitory properties, only albumin was found to be correlated with such an effect. This inhibitory activity was especially influential in urines with high calcium and magnesium levels. These findings suggest that the composition of urine could also influence the formation of stones consisting of magnesium ammonium phosphate and calcium phosphate.