Factors affecting the precipitation of calcium phosphate in vitro

Myositis Ossificans of the Psoas Major Muscle After XLIF With Preoperative Administration of Romosozumab: A Case Report

CASE

A 62-year-old woman receiving romosozumab for 3 months underwent extreme lateral interbody fusion (XLIF) for lumbar degenerative spondylolisthesis. From 1 week after surgery, she experienced gradually increasing pain from the right groin to the front of the thigh. Examination revealed ossifying myositis in bilateral psoas major muscles. Etidronate treatment was initiated, improving pain after 4 days. Computed tomography showed lesion disappearance by 3 months after surgery.

CONCLUSION

We report a rare case of myositis ossificans in bilateral psoas major muscles following XLIF surgery, possibly influenced by intraoperative manipulation and romosozumab treatment. Etidronate administration may be effective, as with heterotopic ossification.

Bioinspired calcium phosphate mineralization on Net-Shape-Nonwoven chitosan scaffolds stimulates human bone marrow stromal cell differentiation

Chitosan fibers were processed using the Net-Shape-Nonwoven (NSN) technique in order to create porous scaffolds which were functionalized in two bioinspired ways: collagen type I coating and unique mineralization with organically modified hydroxyapatite (ormoHAP). While collagen is common to enhance cell attachment on surfaces, the electric-field assisted migration and deposition of ormoHAP on the surface of the NSN-scaffolds is a novel technique which enables sub-micrometer sized mineralization while maintaining the original pore structure. Microscopy revealed fast attachment and morphological adaptation of the cells on both, the pure and the functionalized NSN-scaffolds. Remarkably, the cell number of osteogenically induced hBMSC on ormoHAP-modified NSN-scaffolds increased 3.5-5 fold compared to pure NSN-scaffolds. Osteogenic differentiation of hBMSC/osteoblasts was highest on collagen-functionalized NSN-scaffolds. RT-PCR studies revealed gene expression of ALP, BSP II, and osteocalcin to be high for all NSN-scaffolds. Overall, the NSN-scaffold functionalization with collagen and ormoHAP improved attachment, proliferation, and differentiation of hBMSC and therefore revealed the remarkable potential of their application for the tissue engineering of bone.

Do "inhibitors of crystallisation" play any role in the prevention of kidney stones? A critique

A critical examination of data in the literature and in as yet unpublished laboratory records on the possible role of so-called inhibitors of crystallisation in preventing the formation of calcium-containing kidney stones leads to the following conclusions. So-called inhibitors of spontaneous "self-nucleation" are unlikely to play any role in the initiation of the crystallisation of CaOx or CaP in urine because excessive urinary supersaturation of urine with respect to these salts dominates the onset of "self-nucleation" within the normal time frame of the transit of tubular fluid through the nephron (3-4 min). Inhibitors of the crystal growth of CaOx crystals may or may not play a significant role in the prevention of CaOx stone-formation since once again excessive supersaturation of urine can overwhelm any potential effect of the inhibitors on the growth process. However, they may play a role as inhibitors of crystal growth at lower levels of metastable supersaturation when the balance between supersaturation and inhibitors is more equal. Inhibitors of CaOx crystal aggregation may play a significant role in the prevention of stones, since they do not appear to be strongly affected by excessive supersaturation, either in vitro or in vivo. Inhibitors of CaOx crystal binding to renal tubular epithelium may exist but further studies are necessary to elucidate their importance in reducing the risk of initiating stones in the renal tubules. Inhibitors of CaOx crystal binding to Randall's Plaques and Randall's Plugs may exist but further studies are necessary to elucidate their importance in reducing the risk of initiating stones on renal papillae. There may be an alternative explanation other than a deficiency in the excretion of inhibitors for the observations that there is a difference between CaOx crystal size and degree of aggregation in the fresh, warm urines of normal subjects compared those in urine from patients with recurrent CaOx stones. This difference may depend more on the site of "self-nucleation" of CaOx crystals in the renal tubule rather than on a deficiency in the excretion of so-called inhibitors of crystallisation by patients with CaOx stones. The claim that administration of potassium citrate, potassium magnesium citrate or magnesium hydroxide reduces the rate of stone recurrence may be due to the effect of these forms of medication on the supersaturation of urine with respect to CaOx and CaP rather than to any increase in "inhibitory activity" attributed to these forms of treatment. In summary, there is a competition between supersaturation and so-called inhibitors of crystallisation which ultimately determines the pattern of crystalluria in stone-formers and normals. If the supersaturation of urine with respect to CaOx reaches or exceeds the 3-4 min formation product of that salt, then it dominates the crystallisation process both in terms of "self-nucleation" and crystal growth but appears to have little or no effect on the degree of aggregation of the crystals produced. At supersaturation levels of urine with respect to CaOx well below the 3-4 min formation product of that salt, the influence of inhibitors increases and some may affect not only the degree of aggregation but also the crystal growth of any pre-formed crystals of CaOx at these lower levels of metastability.

Kidney stones

Kidney stones are mineral deposits in the renal calyces and pelvis that are found free or attached to the renal papillae. They contain crystalline and organic components and are formed when the urine becomes supersaturated with respect to a mineral. Calcium oxalate is the main constituent of most stones, many of which form on a foundation of calcium phosphate called Randall's plaques, which are present on the renal papillary surface. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone episode. Obesity, diabetes, hypertension and metabolic syndrome are considered risk factors for stone formation, which, in turn, can lead to hypertension, chronic kidney disease and end-stage renal disease. Management of symptomatic kidney stones has evolved from open surgical lithotomy to minimally invasive endourological treatments leading to a reduction in patient morbidity, improved stone-free rates and better quality of life. Prevention of recurrence requires behavioural and nutritional interventions, as well as pharmacological treatments that are specific for the type of stone. There is a great need for recurrence prevention that requires a better understanding of the mechanisms involved in stone formation to facilitate the development of more-effective drugs.

Thermal effect on thermoluminescence response of hydroxyapatite

This paper presents the experimental results of the thermoluminescence (TL) induced by gamma radiation in synthetic hydroxyapatite (HAp) obtained by the precipitation method, using Ca(NO3)2·4H2O and (NH4)2HPO4 and calcined at different temperatures. The structural and morphological characterization was carried out by X-ray diffraction (XRD) and scanning electron microscopy (SEM) techniques. TL response as a function of gamma radiation dose was in a wide range, where intensity was enhanced in the sample annealed at 900°C, which tricalcium diphosphate (TCP) phase appear. Fading of the TL was also studied.

Role of mineralization inhibitors in the regulation of hard tissue biomineralization: relevance to initial enamel formation and maturation

Vertebrate mineralized tissues, i.e., enamel, dentin, cementum, and bone, have unique hierarchical structures and chemical compositions. Although these tissues are similarly comprised of a crystalline calcium apatite mineral phase and a protein component, they differ with respect to crystal size and shape, level and distribution of trace mineral ions, the nature of the proteins present, and their relative proportions of mineral and protein components. Despite apparent differences, mineralized tissues are similarly derived by highly concerted extracellular processes involving matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organization of forming mineral crystals. Nature, however, provides multiple ways to control the onset, rate, location, and organization of mineral deposits in developing mineralized tissues. Although our knowledge is quite limited in some of these areas, recent evidence suggests that hard tissue formation is, in part, controlled through the regulation of specific molecules that inhibit the mineralization process. This paper addresses the role of mineralization inhibitors in the regulation of biological mineralization with emphasis on the relevance of current findings to the process of amelogenesis. Mineralization inhibitors can also serve to maintain driving forces for calcium phosphate precipitation and prevent unwanted mineralization. Recent evidence shows that native phosphorylated amelogenins have the capacity to prevent mineralization through the stabilization of an amorphous calcium phosphate precursor phase, as observed in vitro and in developing teeth. Based on present findings, the authors propose that the transformation of initially formed amorphous mineral deposits to enamel crystals is an active process associated with the enzymatic processing of amelogenins. Such processing may serve to control both initial enamel crystal formation and subsequent maturation.

Marked improvement of calcinosis in adult dermatomyositis with etidronate therapy

We report a 26-year-old woman with severe calcinosis associated with dermatomyositis. Although calcinosis of the skin or muscles is unusual in adults with dermatomyositis, this patient developed subcutaneous calcinosis with tenderness on the arms, axillary areas, shoulder areas, chest, abdomen, pelvis, and limbs. The calcinosis steadily increased and spread until joint motions were severely limited. Radiographic examination showed extensive soft-tissue calcification with a reticular pattern and severe osteoporosis. The patient was treated with oral etidronate (800 mg/day for 3 months every 6 months) to prevent calcification of the lesions. Three months later, the patient showed a dramatic improvement in symptoms with softening of the calcinosis, reduced pain, and marked increase in joint mobility. Radiographic examination showed marked decreases in the size of the calcified lesions compared to pre-treatment findings, and this effect persisted with a constant progressive efficacy for 3 years. The 3-year course of etidronate therapy also resulted in marked improvement of the severe osteoporosis and the patient was able to return to work and enjoy a normal life. We propose etidronate as a beneficial and effective therapy for calcinosis with osteoporosis.

Genetic basis of renal cellular dysfunction and the formation of kidney stones

Nephrolithiasis is a result of formation and retention of crystals within the kidneys. The driving force behind crystal formation is urinary supersaturation with respect to the stone-forming salts, which means that crystals form when the concentrations of participating ions are higher than the thermodynamic solubility for that salt. Levels of supersaturation are kept low and under control by proper functioning of a variety of cells including those that line the renal tubules. It is our hypothesis that crystal deposition, i.e., formation and retention in the kidneys, is a result of impaired cellular function, which may be intrinsic and inherent or triggered by external stimuli and challenges. Cellular impairment or dysfunction affects the supersaturation, by influencing the excretion of participating ions such as calcium, oxalate and citrate and causing hypercalciuria, hyperoxaluria or hypocitraturia. The production and excretion of macromolecular promoters and inhibitors of crystallization is also dependent upon proper functioning of the renal epithelial cells. Insufficient or ineffective crystallization modulators such as osteopontin, Tamm-Horsfall protein, bikunin, etc. are most likely produced by the impaired cells.

The nucleation and growth of calcium phosphate by amelogenin

The nucleation processes involved in calcium phosphate formation in tooth enamel are not well understood but are believed to involve proteins in the extracellular matrix. The ability of one enamel protein, amelogenin, to promote the nucleation and growth of calcium phosphate was studied in an in vitro system involving metastable supersaturated solutions. It was found that recombinant amelogenin (rM179 and rp(H)M180) promoted the nucleation of calcium phosphate compared to solutions without protein. The amount of calcium phosphate increased with increasing supersaturation of the solutions and increasing protein concentrations up to 6.5 μg/mL. At higher protein concentrations, the amount of calcium phosphate decreased. The kinetics of nucleation was studied in situ and in real time using a quartz crystal microbalance (QCM) and showed that the protein reduced the induction time for nucleation compared to solutions without protein. This work shows a nucleation role for amelogenin in vitro which may be promoted by the association of amelogenin into nanosphere templates, exposing charged functionality at the surface.

Proteoglycans from the vertebral cartilage of the clearnose skate, Raja eglanteria: Inhibition of hydroxyapatite formation

Studies were undertaken to examine the importance of organic proteoglycan matrices in the calcification of elasmobranch vertebral cartilage. Proteoglycans were extracted from the vertebral cartilage of the clearnose skate, Raja eglanteria Bosc, with a 3M guanidine hydrochloride/10% EDTA solution. Proteoglycan solutions (12 μg ml(-1)) were effective inhibitors of hydroxyapatite formation in vitro from high concentration calcium phosphate solutions. Inhibition of crystal formation appears to occur through the restriction of phase transformation from a calcium phosphate precursor to hydroxyapatite crystals. The concentration and/or degradation of proteoglycans in elasmobranch vertebral cartilage may have a physiological role in the production of alternating mineral-rich and mineral-poor growth zones, currently used in ageing studies.

A new method for the study of the formation and transformation of calcium phosphate precipitates: effects of several chemical agents and Chinese folk medicines

A simple method of assaying the formation of amorphous calcium phosphate and its transformation to hydroxyapatite using a conventional pH meter and recorder is described. Its validity was confirmed by direct assay of calcium consumption with atomic absorption spectrophotometry. The method was used to study substances which influence the formation of amorphous calcium phosphate and its transformation to hydroxyapatite, such as albumin, casein, chondroitin sulphate, phospholipid, ATP, Mg2+, Sr2+, pyrophosphate and several Chinese folk medicines.

Inhibition of the amorphous calcium phosphate phase transformation reaction by polyphosphates and metal ions

The induction time for amorphous calcium phosphate (ACP) phase transformation was monitored at pH 7.4 and T = 25 degrees C with [Ca2+]o = [PO4]o = 4.0 X 10(-3) M, as a function of added crystal growth inhibitors Mg2+, Sr2+, Zn2+, pyrophosphate (PP), and tripolyphosphate (TPP). Metal ions increase the induction time for the initiation of the phase change reaction in the order Zn2+ less than Sr2+ less than Mg2+. For polyphosphates it was observed that both PP and TPP are potent inhibitors with TPP more effective than PP as expected. The combination of Mg2+ or Sr2+ and PP or TPP leads to a synergistic delay in the onset of the phase conversion. The greatest inhibition was observed for Mg2+ and TPP. Reaction solutions containing 2.0 X 10(-4) M Mg2+ and 4.0 X 10(-5) M TPP resulted in a 90% increase in the induction time over what would be anticipated from an additive effect from these species.

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

Previous studies have shown human urine to have an inhibitory action on urease-induced crystallisation. Centrifugation and 0.45 microns filtration of the urine did not reduce this activity. This eliminates larger urine particles as being the cause of the inhibitory activity. Both the retenate and the filtrate after ultrafiltration of urine with a 100.000 mol weight cut-off influenced the urease-induced crystallisation of magnesium ammonium phosphate and calcium phosphate. The results indicate that the inhibitory action is exerted by more than one urinary component.

The effects of 1% pyrophosphate and 0.02% sodium fluoride on artificial caries lesions in vivo

We evaluated the potential of a pyrophosphate-fluoride solution to affect the remineralizing-demineralizing equilibrium, i.e., caries-inhibiting/-promoting effects on enamel in vivo. Fifteen subjects carried dentin blocks and enamel thin sections with artificial caries lesions in removable partial dentures for periods of two weeks, during which time they rinsed twice daily in a double-blind, randomized cross-over design with solutions containing (a) 90 ppm F, (b) 90 ppm F and 1% pyrophosphate, or (c) no active agents (placebo). A severe cariogenic challenge provided to the lesions by plaque under a stainless steel mesh cover resulted in the placebo-treated lesions losing 70.2% +/- 72.1% mineral. The pyrophosphate rinse with fluoride held the mineral loss to only 28.1 +/- 52.8%, while the fluoride rinse without pyrophosphate held the loss to 24.2 +/- 50.1%. The differences between the fluoride and placebo results were significant (p less than 0.01), but the difference between the two fluoride groups was not. A large amount of fluoride was deposited in the dentin lesions. In the surface layer, the concentration was increased from 1000 ppm F to more than 2300 ppm F by both fluoride treatments. The concentration of fluoride in both groups of fluoride-treated lesions further increased to more than 3500 ppm F in the approximate center of the lesion before declining in deeper layers toward the level found in the placebo-treated group. The findings from both mineral change and fluoride uptake phases of this study show that in the presence of 90 ppm F, 1% pyrophosphate did not promote demineralization of artificial caries lesions.

The inhibitory effect of human urine on urease-induced crystallization in vitro

To study whether human urine contains inhibitors against urease-induced crystallization, Jackbean urease and human urine, in amounts small enough (0.5 to 10 per cent) not to influence the ion concentration, buffering capacity or pH, were added to synthetic urine. The ammonia production and alkalinization that followed were independent of the amounts of human urine added. The addition of human urine gave a dose-related decrease in the amount of calcium phosphate and struvite precipitated on glass rods immersed in the synthetic urine, however. Addition of only 0.5 per cent human urine gave a reproducible decrease and when 10 per cent human urine was added to the synthetic urine the precipitation of calcium phosphate was reduced by 50 per cent and that of struvite by 75 per cent. The results thus indicate that human urine contains components with the ability to reduce the urease-induced crystallization.

Solubility study of the initial formation of calcium orthophosphates from aqueous solutions at pH 5-10

In unsaturated stock solutions with various concentrations of calcium and phosphate and pH of 4-5, supersaturation with respect to brushite, hydroxy- and fluorapatite, octacalcium phosphate and amorphous tricalcium phosphate was established at 20 degrees C by increasing pH in two series of portions, one containing low concentrations of fluoride, one fluoride-free. The precipitate as identified by X-ray diffraction was compared to the ion-activity products in the liquid. Brushite and amorphous tricalcium phosphate were formed at low supersaturation with respect to the salt in question; apatite formation required a high degree of supersaturation. Octacalcium phosphate was not observed presumably due to moderate supersaturations with respect to this salt. Fluoride had no effect on brushite and tricalcium-phosphate formation; only apatite was influenced slightly through a fluorapatite precipitation. The salts were often formed in mutual competition.

Roles of lipids and proteins in the Ca2+-PO4-induced aggregation of cytoskeleton-free erythrocyte vesicle membranes

The roles of lipids and proteins in Ca2+-PO4-induced membrane aggregation were investigated. Cytoskeleton-free vesicles derived from intact human and rabbit erythrocytes (HEves and REves, respectively) were employed as a model system. The HEves and REves have a simplified membrane protein composition [band 3 proteins and glycoproteins PAS-1, -2, and -3 (HEves)] and normal lipid composition. Optimal experimental conditions for pH, [PO4], and [CaCl2] were determined for quantitatively examining the dynamics and extent of HEves and REves aggregation, measured turbidimetrically. The aggregation process was found to be quite sensitive to small changes in pH and [PO4] and much less sensitive to [CaCl2]. The roles of membrane proteins in vesicle aggregation were examined by selectively modifying the proteins enzymatically. The roles of lipids were studied by using sonicated lipid vesicles [small unilamellar vesicles (SUVs)] made from Dodge ghost lipid extracts. Enzymatic treatment with trypsin, chymotrypsin, or Pronase had no effect on either the rates or the extent of vesicle aggregation (2-min incubation period). Neuraminidase treatment reduced both factors by approximately 20%. SUVs aggregated with Ca2+-PO4 in a way which depended on the PO4/lipid ratio. Together the results suggest the following: (1) PO4 is associated with the vesicle surface, involving the membrane lipids; (2) the vesicle + PO4 incubation time component of the PO4 effect is eliminated by enzymatically modifying the vesicle membrane proteins; (3) qualitative, rather than quantitative, properties of sialic acid containing molecules affect vesicle aggregation; and (4) with the exception of the incubation time effect, membrane proteins seem neither to promote nor to inhibit Ca2+-PO4-induced HEves or REves aggregation.

Effectiveness of phosphocitrate and N-sulpho-2-amino tricarballylate, a new analogue of phosphocitrate, in blocking hydroxyapatite induced crystal growth and calcium accumulation by matrix vesicles

Phosphocitrate and its analogue N-sulpho-2-amino tricarballylate were compared with ethane-1-hydroxy-1,1-diphosphonate for inhibition of calcium phosphate crystallization in hydroxyapatite induced crystal growth and 45Ca uptake by matrix vesicles. Phosphocitrate (1 microM) was the most potent inhibitor followed by ethane-1-hydroxy-1,1-diphosphonate and N-sulpho-2-amino tricarballylate, the latter requiring a high concentration (100 microM) to be equally effective as an inhibitor.

The dynamics of calcium phosphate precipitation studied with a new polyacrylamide steady state matrix-model: influence of pyrophosphate collagen and chondroitin sulfate

A novel steady-state gel-matrix model system is described which facilitates the quantitative kinetic study of the influence of media and matrix composition on a precipitation process. The potentialities of the system are illustrated in experiments in which the precipitation of calcium phosphate in a polyacrylamide film is studied as a function of the calcium and phosphate concentration in the solutions flowing along opposite sides of the film. Addition of pyrophosphate to the reactant solutions was found to diminish the (calcium) x (phosphate) millimolar product at which precipitation starts, indicating a positive effect on nucleation. The slope of the curve was found to decrease, which points to a negative influence of pyrophosphate on the crystal growth process. Incorporation of collagen in the matrix did not change the curve, but incorporation of chondroitin sulfate decreased the formation product since the intercept of the curve was reduced. The usefulness of the system compared with test-tube and non-steady state gel experiments for calcium phosphate precipitation studies and its significance for the study of in vitro and in vivo precipitation processes in general, are discussed.

Effect of human salivary proteins on the precipitation kinetics of calcium phosphate

Inhibition of calcium phosphate precipitation in saliva, and prevention of the formation of mineral accretions on tooth surfaces, has been ascribed to the existence of inhibiting salivary macromolecules. Marked reductions in the crystal growth rate of hydroxyapatite (HA) seeds were measured in supersaturated solutions containing either of two proline-rich proteins, PRP1 or PRP3, or statherin; the three macromolecules were isolated from human parotid saliva. The reductions were also observed when the HA seeds were pretreated with solutions of the macromolecules before adding them to the supersaturated calcium phosphate solution. This effect was very similar in the case of the two PRPs and it was directly related to the extent of adsorption site coverage of these proteins on the HA seeds. The effect of statherin was larger than anticipated from its adsorption behavior. However, comparison on the basis of number of moles adsorbed per unit area of HA shows that the PRP are more effective inhibitors than statherin. The macromolecule concentrations used were considerably lower than those in the salivary secretions, therefore these macromolecules could readily prevent mineral accretion on tooth surfaces through their adsorption onto the enamel surface.

A new dynamic model system for the study of capture reactions for diffusable compounds in cytochemistry. II. Effect of the composition of the incubation medium on the trapping of phosphate ions in acid phosphatase cytochemistry

A model system developed for the study of the dynamics of capture reactions for diffusable compounds in cytochemistry served as a basis for the experiments reported in the present paper. The model was used to study the effect of the composition of the cytochemical medium on the trapping of phosphate ions by lead (II) ions in acid phosphatase cytochemistry. In this system a phosphate-containing solution and a lead-containing solution (cytochemical medium) are pumped along opposite sides of a polyacrylamide film. The phosphate concentration at which measurable precipitation starts in the film (critical phosphate concentration) was taken as a measure of the trapping efficiency of the cytochemical medium. The addition of beta-glycerophosphate and cytidine-5'-monophosphate to a buffered lead-containing solution resulted in a higher critical phosphate. The addition of chloride ions and acetone, as well as decreasing the molarity of the acetate buffer of the cytochemical medium, were found to lower the critical phosphate concentration, whereas the addition of fluoride ions, glucose, and sucrose had no effect. From the effect of variations in the composition of the cytochemical medium on the trapping efficiency and the turnover number of acid phosphatase in the medium, it was possible to predict which cytochemical medium would be the most suitable for the demonstration of acid phosphatase activity in guinea-pig peritoneal exudate cells. The results were in accordance with the localization of acid phosphatase activity: the higher the trapping efficiency and the turnover number, the higher the amount of precipitate and the number of positive enzymatic sites. In this way an improved cytochemical medium for acid phosphatase was developed.

Inhibitors and promoters of stone formation

The understanding of the formation of urinary stones centers around three main mechanisms: the urinary concentration of stone-forming ions, the role of promoters, and the role of inhibitors of crystal formation and crystal aggregation. With respect to the promoting activity, lately emphasis has shifted from the role of the organic matrix to that of one salt inducing by epitaxy the precipitation of another salt. Among the inhibitors, it has become necessary to distinguish between those affecting crystal formation and those affecting crystal aggregation. For measuring the inhibitory activity, the various techniques and their relevance have been reviewed. It has been found that the main inhibitors for calcium phosphate and calcium oxalate precipitation are citrate, pyrophosphate, and perhaps magnesium. Those for calcium phosphate and calcium oxalate aggregation are glycosaminoglycans, pyrophosphate, and citrate. Among the synthetic inhibitors, the diphosphonates are the most powerful for both processes. The role and the therapeutic implications of these various concepts have been discussed.

A reappraisal of the Coulter Counter technique for measuring calcium oxalate crystal size

A modification of the technique for measuring crystal size using a Coulter Counter is described. The method differs from that previously published in that counts are taken at equal size increments rather than at constant threshold settings. This ensures that equal emphasis is placed on all particles, regardless of size, thereby preventing the contribution of the larger particles being artificially magnified in relation to the smaller particles as has previously been the case. A mixture of latex particles of three known sizes is used to demonstrate the improvement in resolution and accuracy afforded by the modified technique.

Effect of diphosphonate on crystallization of calcium oxalate in vitro

Reliable techniques for the calculation of activity product (state of saturation), formation product (limit of metastability) and crystal growth of calcium oxalate were devised. The activity product at saturation was 2.53 times 10 minus 9 M2, and was independent of duration of incubation, solid-to-solution ratio, pH, calcium concentration or ionic strength. These tehcniques were utilized to assess the effect of disodium ethane-1-hydroxy-1, 1-diphosphonate (EHDP) on crystallization of calcium oxalate in an aqueous salt solution in vitro. EHDP increased the formation product of calcium oxalate, indicating an inhibition of nucleation of calcium oxalate. Further, it inhibited the crystal growth of calcium oxalate.