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Talati VM, Soares RMO, Khambati A, Nadler RB, Perry KT. Trends in urinary calculi composition from 2005 to 2015: a single tertiary center study. Urolithiasis 2019; 48:305-311. [PMID: 31372690 DOI: 10.1007/s00240-019-01151-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
The goal of this study was to investigate recent changes in stone composition and patient demographics to identify factors influencing stone formation for the purpose of reducing the incidence of urolithiasis and preventing stone recurrence. This retrospective analysis includes patients who underwent percutaneous nephrolithotripsy or ureteroscopy at our institution from 2005 to 2015. Northwestern Medicine Enterprise Data Warehouse was used to retrieve demographic information and stone composition analyses. The composition of mixed stones containing uric acid (UA) and calcium oxalate monohydrate (COM) was analyzed further. Chi-squared tests were used for categorical variables and logistic regression was used to assess trends. From 2005 to 2015, 5268 stones were treated. COM was predominant in 42.2% and only 16.6% were pure. The male/female ratio decreased significantly from 1.8 to 1.08 and patient age increased (p < 0.001) with 45.6% of patients being 60 or older in 2015. Females formed more CO dihydrate (COD; p = 0.008) and struvite (p = 0.001) overall. The incidence of COM (p = 0.007) and UA (p < 0.001) rose significantly in men whereas both sexes saw a decrease in carbonate apatite (CA; p < 0.001). COM increased considerably from 12 to 75% amongst mixed stones with UA over the 11-year span. We concluded that stone formers have become older and more gender-equal. The increase in female patients parallels the increase in female obesity in the US. The rising predominance of COM, including when mixed with UA, and the scarcity of pure stones indicates it may be necessary to develop new approaches to managing and preventing urolithiasis.
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Affiliation(s)
- Vidit M Talati
- Feinberg School of Medicine, Department of Urology, Northwestern University, 675 N St Clair St, Galter Pavilion, 20th Floor, Chicago, IL, 60611, USA
| | - Ricardo M O Soares
- Feinberg School of Medicine, Department of Urology, Northwestern University, 675 N St Clair St, Galter Pavilion, 20th Floor, Chicago, IL, 60611, USA.
| | - Aziz Khambati
- Feinberg School of Medicine, Department of Urology, Northwestern University, 675 N St Clair St, Galter Pavilion, 20th Floor, Chicago, IL, 60611, USA
| | - Robert B Nadler
- Feinberg School of Medicine, Department of Urology, Northwestern University, 675 N St Clair St, Galter Pavilion, 20th Floor, Chicago, IL, 60611, USA
| | - Kent T Perry
- Feinberg School of Medicine, Department of Urology, Northwestern University, 675 N St Clair St, Galter Pavilion, 20th Floor, Chicago, IL, 60611, USA
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Castiglione V, Sacré PY, Cavalier E, Hubert P, Gadisseur R, Ziemons E. Raman chemical imaging, a new tool in kidney stone structure analysis: Case-study and comparison to Fourier Transform Infrared spectroscopy. PLoS One 2018; 13:e0201460. [PMID: 30075002 PMCID: PMC6075768 DOI: 10.1371/journal.pone.0201460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The kidney stone's structure might provide clinical information in addition to the stone composition. The Raman chemical imaging is a technology used for the production of two-dimension maps of the constituents' distribution in samples. We aimed at determining the use of Raman chemical imaging in urinary stone analysis. MATERIAL AND METHODS Fourteen calculi were analyzed by Raman chemical imaging using a confocal Raman microspectrophotometer. They were selected according to their heterogeneous composition and morphology. Raman chemical imaging was performed on the whole section of stones. Once acquired, the data were baseline corrected and analyzed by MCR-ALS. Results were then compared to the spectra obtained by Fourier Transform Infrared spectroscopy. RESULTS Raman chemical imaging succeeded in identifying almost all the chemical components of each sample, including monohydrate and dihydrate calcium oxalate, anhydrous and dihydrate uric acid, apatite, struvite, brushite, and rare chemicals like whitlockite, ammonium urate and drugs. However, proteins couldn't be detected because of the huge autofluorescence background and the small concentration of these poor Raman scatterers. Carbapatite and calcium oxalate were correctly detected even when they represented less than 5 percent of the whole stones. Moreover, Raman chemical imaging provided the distribution of components within the stones: nuclei were accurately identified, as well as thin layers of other components. Conversion of dihydrate to monohydrate calcium oxalate was correctly observed in the centre of one sample. The calcium oxalate monohydrate had different Raman spectra according to its localization. CONCLUSION Raman chemical imaging showed a good accuracy in comparison with infrared spectroscopy in identifying components of kidney stones. This analysis was also useful in determining the organization of components within stones, which help locating constituents in low quantity, such as nuclei. However, this analysis is time-consuming, making it more suitable for research studies rather than routine analysis.
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Affiliation(s)
- Vincent Castiglione
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Pierre-Yves Sacré
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Philippe Hubert
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Romy Gadisseur
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Eric Ziemons
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
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Ma Q, Fang L, Su R, Ma L, Xie G, Cheng Y. Uric acid stones, clinical manifestations and therapeutic considerations. Postgrad Med J 2018; 94:458-462. [PMID: 30002092 DOI: 10.1136/postgradmedj-2017-135332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/07/2018] [Accepted: 05/02/2018] [Indexed: 12/23/2022]
Abstract
Uric acid stones account for 10%-15% of all urinary stones. Changes in dietary habits, environment or both can result in the increase of uric acid stones. The formation of uric acid stones is related to hyperuricosuria, low urinary volume and persistently low urinary pH. Diabetes and obesity also significantly increase the risk of stone formation. Dual-energy CT provides a convenient and reliable method for diagnosis. Stone composition analysis and 24-hour urine metabolic evaluations should be considered for further evaluation. Most small uric acid stones (diameter <2 cm) can be treated by pharmacotherapy or extracorporeal shock wave lithotripsy. However, ureteroscopy and other minimally invasive procedures should be reserved for larger stones (diameter ≥2 cm), or patients with concomitant urinary tract obstruction and/or infections. Additionally, adjustment of potential pathophysiologic defects by pharmacotherapy and dietary modification is strongly recommended for the prevention of uric stone recurrence.
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Affiliation(s)
- Qi Ma
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China.,Translational Research Laboratory for Urology, the Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li Fang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Rui Su
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Liang Ma
- Translational Research Laboratory for Urology, the Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Guohai Xie
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China.,Translational Research Laboratory for Urology, the Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, China
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He Z, Jing Z, Jing-Cun Z, Chuan-Yi H, Fei G. Compositional analysis of various layers of upper urinary tract stones by infrared spectroscopy. Exp Ther Med 2017; 14:3165-3169. [PMID: 28912866 DOI: 10.3892/etm.2017.4864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/03/2017] [Indexed: 11/06/2022] Open
Abstract
The objective of the present study was to determine the composition of various layers of upper urinary stones and assess the mechanisms of stone nucleation and aggregation. A total of 40 integrated urinary tract stones with a diameter of >0.8 cm were removed from the patients. All of the stones were cut in half perpendicularly to the longitudinal axis. Samples were selected from nuclear, internal and external layers of each stone. Fourier transform infrared spectroscopy (FT-IR) was adopted for qualitative and quantitative analysis of all of the fragments and compositional differences among nuclear, internal and external layers of various types of stone were subsequently investigated. A total of 25 cases of calcium oxalate (CaOx) stones and 10 cases of calcium phosphate (CaP) stones were identified to be mixed stones, while 5 uric acid (UA) calculi were pure stones (purity, >95%). In addition, the contents of CaOx and carbapatite (CA.AP) crystals in various layers of the mixed stones were found to be variable. In CaOx stones, the content of CA.AP in nuclear layers was significantly higher than that of the outer layers (32.0 vs. 6.8%; P<0.05), while the content of CaOx was lower in the inner than in the outer layers (57.6 vs. 86.6%; P<0.05). In CaP stones, the content of CA.AP in the nuclear layers was higher than that in the outer layers (74.0 vs. 47.3%; P<0.05), while the content of CaOx was lower in the inner than in the outer layers (7.0 vs. 40.0%; P<0.05). The UA stones showed no significant differences in their composition among different layers. In conclusion, FT-IR analysis of various layers of human upper urinary tract stones revealed that CaOx and CaP stones showed differences in composition between their core and surface, while all of the UA calculi were pure stones. The composition showed a marked variation among different layers of the stones, indicating that metabolism has an important role in different phases of the evolution of stones. The present study provided novel insight into the pathogenesis of urinary tract stones and may contribute to their prevention and treatment.
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Affiliation(s)
- Zhang He
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
| | - Zhang Jing
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
| | - Zheng Jing-Cun
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
| | - Hu Chuan-Yi
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
| | - Gao Fei
- Department of Urology, The Second People's Hospital of Yulin, Yulin, Shaanxi 719000, P.R. China
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Sun XY, Xue JF, Xia ZY, Ouyang JM. Component analyses of urinary nanocrystallites of uric acid stone formers by combination of high-resolution transmission electron microscopy, fast Fourier transformation, energy dispersive X-ray spectroscopy, X-ray diffraction and Fourier transform infrared spectroscopy. IET Nanobiotechnol 2015; 9:114-21. [PMID: 26023155 DOI: 10.1049/iet-nbt.2014.0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study aimed to analyse the components of nanocrystallites in urines of patients with uric acid (UA) stones. X-ray diffraction (XRD), Fourier transform infrared spectroscopy, high-resolution transmission electron microscopy (HRTEM), fast Fourier transformation (FFT) of HRTEM, and energy dispersive X-ray spectroscopy (EDS) were performed to analyse the components of these nanocrystallites. XRD and FFT showed that the main component of urinary nanocrystallites was UA, which contains a small amount of calcium oxalate monohydrate and phosphates. EDS showed the characteristic absorption peaks of C, O, Ca and P. The formation of UA stones was closely related to a large number of UA nanocrystallites in urine. A combination of HRTEM, FFT, EDS and XRD analyses could be performed accurately to analyse the components of urinary nanocrystallites.
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Affiliation(s)
- Xin-Yuan Sun
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, People's Republic of China
| | - Jun-Fa Xue
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, People's Republic of China
| | - Zhi-Yue Xia
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, People's Republic of China
| | - Jian-Ming Ouyang
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, People's Republic of China.
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