oxalates and Urinary-Calculi

Increased level of oxalates in urine and plasma can be attributed to endogenous overproduction, increased ingestion or excessive intestinal absorption. When a supersaturation status is reached, oxalates combine with calcium and crystallize to form 80% of the urinary stones. Several cardiovascular diseases such as coronary heart disease and stroke are thought to be associated with the formation of urinary stones via sharing the same pathogenesis and/or risk factors. This review investigated the evidence linking oxalates/urinary stones to cardiovascular diseases. Eventually, two theories can explain the possible association between urinary stones and cardiovascular diseases: the theory of common origin and the theory of common risk factors. While the first theory is based on the common vascular pathophysiology of urinary stones and cardiac events, the later suggests that metabolic syndrome traits increase the risk of urinary stones and cardiovascular diseases independently. A few cohort studies showed a higher risk of coronary heart disease and stroke among people with history of urinary stones than people without it while other cohort studies did not. These studies had different definitions for cardiovascular diseases, used various methods to assess urinary stones, and some of them did not control for potential confounders. When they were pooled together in meta-analyses, a significant heterogeneity across studies was observed. In conclusion, although there is some evidence indicating that urinary stones could increase the risk of cardiovascular diseases, a substantial causal relationship cannot be settled.

Topics: Cardiovascular Diseases; Humans; Kidney Calculi; Oxalates; Urinary Calculi; Urolithiasis

With recent advances in sequencing technologies and increasing research into the gut microbiome (GMB), studies have revealed associations between the GMB and urinary stone disease (USD). We sought to determine whether the evidence pointed towards a few specific gut bacteria or the broader GMB network is seemingly responsible for this relationship.. Initially, Oxalobacter formigenes (OF) was pursued as the main link between GMB and USD given its ability to degrade oxalate in the gut. However, the latest studies consistently suggest that the entire GMB is much more likely to be involved in handling oxalate absorption and other risk factors for urinary stone formation, rather than just a few microbiota. The GMB has complex networks that are likely involved in the pathophysiology of USD, although the causal mechanisms remain unclear. With increasing interest and research, potential modalities that act on the GMB may help to prevent incidence of USD.

Topics: Gastrointestinal Microbiome; Humans; Oxalates; Oxalobacter formigenes; Risk Factors; Urinary Calculi

To report chronological trends and geographical distributions related to the prevalence of hyperoxaluria in stone-forming patients.. We systematically reviewed the existing literature between 1982 and 2013 seeking studies that assessed for hyperoxaluria (>45 mg/day [499.5 μmol/24 hour]) in recurrent stone formers. Studies that performed 24-hour urine analysis for urine oxalate in patients with recurrent urinary stones were included. Studies were divided chronologically and by geographical region, and prevalence rates of hyperoxaluria were compared between groups.. Our literature search provided 22 peer-reviewed articles involving 3636 patients in total. Ten studies were performed between 1982 and 2000, and 12 studies were performed between 2001 and 2013. The prevalence of hyperoxaluria in stone-forming patient cohorts was 24.8% and 45.1% (p = 0.019) in studies performed between 1982 and 2000 and 2001 and 2013, respectively. Hyperoxaluria rates were significantly higher in non-American cohorts compared with American cohorts (40.7% vs 23.0%; p = 0.018). Reported hyperoxaluria rates were higher in Asian countries compared with Western countries (56.8% and 23.8%; p < 0.001).. The prevalence of hyperoxaluria in stone-forming patients has increased over the past two decades and may be a contributing factor to the rising global prevalence of urolithiasis. A geographical disparity in hyperoxaluria may exist between Asian and Western countries. Future studies are needed to explain these trends and their consequences.

Topics: Asia; Geography, Medical; Humans; Hyperoxaluria; Oxalates; Prevalence; United States; Urinary Calculi; Urolithiasis

Although the primary hyperoxalurias (PH) are rare disorders, they are of considerable clinical importance in relation to calcium oxalate urolithiasis and as a cause of renal failure worldwide. Three distinct disorders have been described at the molecular level. The investigation of any child or adult presenting with urinary tract stones or nephrocalcinosis, must exclude PH as an underlying cause. This paper provides a practical approach to the investigation and diagnosis of PH, indicating the importance of distinguishing between the PH types for the purposes of targeting appropriate therapy. Conservative management is explored and the various transplant options are discussed.

Topics: Adult; Child; Diagnosis, Differential; Disease Management; Female; Humans; Hyperoxaluria, Primary; Male; Nephrocalcinosis; Nephrolithiasis; Oxalates; Renal Insufficiency; Urinary Calculi

Drug-induced urinary calculi, although they account for only 1-2% of urinary calculi, deserve consideration because most of them are preventable. In the drug-containing calculi resulting from the crystallization of a certain drug and its metabolites in the urine, stone analysis can identify the responsible drug. While, in the drug-induced metabolic calculi caused by interference with calcium, oxalate and purine metabolism, careful clinical inquiry is necessary to reveal involvement of a certain drug in stone formation. Better awareness of the possible drugs with lithogenic potential and close surveillance of patients on long-term treatment with these drugs are necessary. Especially, in patients with a history of urolithiaisis, prescription of lithogenic drugs deserve careful consideration.

Topics: Allopurinol; Anti-Bacterial Agents; Ascorbic Acid; Benzbromarone; Calcium; Calcium Compounds; Carbonic Anhydrase Inhibitors; Crystallization; Diuretics; Drug Combinations; Furosemide; Glucocorticoids; Humans; Magnesium Silicates; Oxalates; Protease Inhibitors; Purines; Time Factors; Triamterene; Urinary Calculi; Vitamin D

Epidemiologically, there are many same characteristics among patients with urolithiasis, life-style related diseases and metabolic syndrome. In a comparison with the major urological diseases, the patients with stone disease have the largest amount of visceral fat on computerized tomography. The patients who finally had a diagnosis of metabolic syndrome in urolithiasis were 43% of men and female 31%. The clinical features of the patients include increased urinary oxalate excretion, abnormal uric acid metabolism, and acidic urine. The basic studies by the animal experiments suggest that there is a close relationship between urolithiasis and metabolic syndrome. After the treatment of the urinary stone, it is very important to make a long-term follow-up by not only the prevention of recurrent stone episode but also life style management and medical treatment for metabolic syndrome.

Topics: Animals; Female; Humans; Insulin Resistance; Intra-Abdominal Fat; Life Style; Male; Metabolic Syndrome; Oxalates; Uric Acid; Urinary Calculi

Topics: Animals; Calcium; Chemical Precipitation; Circadian Rhythm; Humans; Oxalates; Phosphates; Solubility; Uric Acid; Urinary Calculi

Topics: Acidosis, Renal Tubular; Amino Acids; Calcium; Carbohydrate Dehydrogenases; Carrier Proteins; Chloride Channels; Cystinuria; Humans; Hyperoxaluria, Primary; Hypoxanthine Phosphoribosyltransferase; Mutation; Organic Anion Transporters; Organic Cation Transport Proteins; Oxalates; Proteinuria; Proton-Translocating ATPases; Purines; Transaminases; Uric Acid; Urinary Calculi

Urolithiasis is a multifactorial recurrent disease of world-wide distribution in rural, urban, industrial and non-industrial regions. Changes in urinary pH is a risk factor especially with hyperuricosuria, hypercalciuria or hyperoxaluria. With recurrence, hypercalcuria and higher urinary oxalate levels are more frequent. Hypercalciuria and hyperuricosuria showed correlation with family history of stones. The ionic relations between various stone forming salts in urine of patients are opposite to that in controls and are well represented in stone composition. Obesity is a risk factor in both genders. Over eating a diet rich in all nutrients was associated with hyperuricosuria while a diet high only in fat was associated with other urinary disturbances. High protein and fat intake are risk factors. High or low calcium diet was associated with urolithiasis and supplemental calcium is not a risk factor. Potassium and magnesium citrate are potent in inhibiting the growth of stone fragments after extracorporeal shock wave lithotripsy. Whether in patients or normal subjects, drinking hard water should be avoided; tap water or low calcium content water is preferable. Seasonal variations in temperature affected urinary volume, pH and relative saturation of uric acid. To prevent recurrence, patients should maintain high fluid intake achieving a urine volume of 2 liters per day.

Topics: Adult; Calcium; Diet; Drinking; Female; Humans; Male; Oxalates; Oxalic Acid; Risk Factors; Uric Acid; Urinary Calculi

Two major nitrogenous waste products, urea and ammonium (NH(4)(+)), are produced in humans when proteins are oxidized, and in this manuscript their excretions are examined from two perspectives. First, the specific physiology of each nitrogenous waste is reviewed and the current dogmas summarized. Second, their excretions are considered in the context of integrative physiology, i.e. the need to ensure that the urine composition is appropriate to minimize the risk of kidney stone formation. After the latter analysis, weak links in our understanding of the overall physiology become apparent and a conundrum is defined. The conundrum for the excretion of urea focuses on the fact that urea is not an effective osmole in the medullary-collecting duct when vasopressin acts. As a result, it appears that urinary urea cannot prevent a large decline in the urine flow rate and thereby minimize the risk of forming kidney stones in electrolyte-poor urine. The conundrum for the excretion of NH(4)(+) is: high rates of NH(4)(+) excretion require a low urine pH, yet a pH approximately 6.0 must be maintained in order to reduce the risk of precipitating uric acid in the urine. Possible ways of resolving these conundrums require novel physiological interpretations.

Topics: Calcium; Humans; Hydrogen-Ion Concentration; Kidney Medulla; Models, Biological; Oxalates; Quaternary Ammonium Compounds; Urea; Urinary Calculi; Vasopressins

Oxalate plays a crucial role in the formation of most renal stones. Oxalate is a common constituent of most diets and a byproduct of metabolism, and if it is not sufficiently degraded, it may accumulate. In humans, gut bacteria degrade 70 to 100 mg of oxalate per day. Oxalobacter formigenes is a gram-negative, obligately anaerobic, rod-shaped bacterium with an absolute requirement for oxalate. Although not present in the gut at birth, it quickly colonizes most children, and there is epidemiologic evidence that its absence is a risk factor in calcium oxalate stone formation. We review the metabolism, genetics, and identification of this organism and its possible therapeutic role in recurrent stone-forming patients.

Topics: Animals; Calcium Oxalate; DNA, Bacterial; Humans; Intestines; Oxalates; Oxalobacter formigenes; Urinary Calculi

Topics: Calcium; Child; Child, Preschool; Cystine; Female; Hematuria; Humans; Kidney Calculi; Magnesium Compounds; Male; Metabolic Diseases; Oxalates; Phosphates; Struvite; Uric Acid; Urinalysis; Urinary Calculi; Urinary Tract Infections

The data reviewed in this paper indicate that there is compelling direct and indirect evidence that certain dietary modifications can limit the risk for stone formation. Fluid therapy should be a front-line approach for all stone formers, because it is safe, cheap, and effective. Restricting sodium and animal-protein consumption produces changes in the urinary environment that should benefit the majority of stone formers, including a decrease in calcium and increase in citrate excretion. Minimizing the intake of processed goods limits sodium gluttony. These dietary modifications also reduce cardiovascular risks. Indiscriminant calcium restriction should be avoided, because it could accelerate stone formation and violate skeletal integrity. Oxalate restriction should be considered for calcium oxalate stone formers, especially those with hyperoxaluria. Specific recommendations for modifying the consumption of other nutrients cannot be made at this time because of the limited available information about the resultant effects. The aforementioned goals can be achieved within the context of a nutritionally balanced diet providing adequate sources of fruits and vegetables. There is a definite need for better designed studies of the nutritional effects on stone disease. This would promote a better understanding of the interplay between the genetic and environmental components of this disorder.

Topics: Ascorbic Acid; Calcium; Dietary Carbohydrates; Dietary Fats; Dietary Fiber; Dietary Proteins; Humans; Magnesium; Oxalates; Phosphorus; Potassium; Pyridoxine; Sodium, Dietary; Urinary Calculi; Vitamin D

Calcium oxalate is a major component of renal stones, and its urinary concentration plays an important role in stone formation. Even a small increase in urinary oxalate has a significant impact on calcium oxalate saturation. Although primary hyperoxaluria is relatively uncommon, patients with calcium oxalate stones have some degree of hyperoxaluria. To understand the underlying causes of such hyperoxaluria, the processes of oxalate synthesis and excretion must be clarified. This article focuses on the determination of oxalate, calculation of its saturation, and the hyperoxaluric syndromes with special reference to metabolic precursors of oxalate, including ascorbic acid, glyoxylate, and glycolate.

Topics: Humans; Oxalates; Urinary Calculi

Topics: Bifidobacterium; Calcium Oxalate; Diet; Dietary Proteins; Humans; Intestines; Oxalates; Urinary Calculi

The detection, treatment, and prevention of the causes underlying urolithiasis depend on knowledge of the composition and structure of the entire stone. Therefore, proper and complete analysis of uroliths is an important part of proper patient care. This article discusses methods of urolith retrieval, proper sample submission, methods of urolith analysis, and interpretation of results.

Topics: Animals; Cat Diseases; Cats; Cystine; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urinary Catheterization

Enteric hyperoxaluria complicates extensive disease or resection of the small intestine in the presence of an intact colon, and is associated with calcium oxalate nephrolithiasis. In addition to hyperoxaluria these patients have a low urine volume, low urinary ionic strength and hypocitraturia. Many forms of treatment have been recommended, but none has been subjected to a prospective clinical trial. Mild idiopathic hyperoxaluria is reported in 8-50% of idiopathic calcium oxalate stoneformers. Several pathophysiological mechanisms have been proposed, including low dietary calcium and possible oxalate transport defects in the gut and/or the kidney. Mild hyperoxaluria, or a high oxalate:calcium ratio in the urine, may be particularly important risk factors for calcium oxalate stone formation; an approach to the correction of these abnormalities is proposed.

Topics: Calcium Oxalate; Calcium, Dietary; Humans; Hyperoxaluria; Incidence; Intestinal Absorption; Oxalates; Prevalence; Urinary Calculi; Vitamin B 6 Deficiency

To review the current literature on the dietary modification of urinary risk factors as a means of reducing the likelihood of recurrent stone formation and to develop practical dietary recommendations that might be useful to this end.. MEDLINE was searched for English-language articles published from 1983 to 1990. Additional references were selected from the bibliographies of identified articles.. Nonrandomized trials and retrospective reviews were included because of a paucity of randomized controlled trials.. Information on the dietary intake of calcium, oxalate, protein, sodium and fibre and on alcohol and fluid intake was used to develop practical guidelines on dietary modification.. Dietary modification plays an important role in the reduction of urinary risk factors in patients with calcium stone disease of the urinary tract. As an initial form of prevention attention should be directed toward moderating the intake of calcium, oxalate, protein, sodium and alcohol and increasing the intake of fibre and water. Future research should include an assessment of the long-term reduction of dietary and urinary risk factors and the rates of recurrence of calcium stones.

Topics: Alcohol Drinking; Calcium, Dietary; Diet; Dietary Fiber; Dietary Proteins; Drinking; Humans; Oxalates; Patient Compliance; Recurrence; Risk Factors; Sodium, Dietary; Urinary Calculi

Topics: Animals; Gram-Negative Anaerobic Bacteria; Humans; Intestinal Mucosa; Intestines; Oxalates; Urinary Calculi

Topics: Humans; Inflammatory Bowel Diseases; Oxalates; Uric Acid; Urinary Calculi

A dose-related toxicity syndrome of renal, cerebral, and liver dysfunction; metabolic acidosis; and deposition of calcium oxalate crystals in tissues is reported in association with various apparently unrelated treatments for a wide range of diseases. The parenteral nutrient xylitol, the hyperosmolar agent glycerol, the polysorbate emulsifiers (e.g., in vitamin E preparations), the anesthetic methoxyflurane, and possibly the experimental hypoglycemic agent dichloroacetate all produce a toxicity syndrome very similar to that of ethylene glycol poisoning. In long-term, high-dose oral toxicity studies with rodents, these or similar agents also produce calcium oxalate bladder stones and bladder tumors. Studies with both unlabeled and labeled agents in humans and animals and in vitro experiments with purified enzymes, tissue homogenates, and isolated hepatocytes have provided both strong circumstantial and direct evidence for the existence of minor pathways of carbohydrate metabolism and of oxidative dealkylation and dehalogenation reactions in drug biotransformations that link these agents to endogenous oxalate production. Because urinary oxalate is now considered to be a critical factor in stone formation and because it is increasingly accepted that 80-90% of urinary oxalate is produced endogenously, it is now possible to formulate pathways that link oxalate production with dietary macronutrients. Therapeutic modifications of diet, in vivo hormonal milieu, and intracellular metabolic controls in relation to endogenous oxalate production may provide new forms of treatment for urolithiasis.

Topics: Animals; Humans; Oxalates; Urinary Calculi

Topics: Calcium, Dietary; Climate; Diet; Female; Humans; Male; Occupations; Oxalates; Oxalic Acid; Risk Factors; Seasons; Socioeconomic Factors; Stress, Physiological; Urinary Calculi

This article reviews the mechanisms involved in the synthesis, absorption, excretion and transport of oxalic acid, and the factors controlling these processes in man. The clinical syndromes associated with hyperoxaluria and recurrent calcium oxalate stone disease are reviewed, including new studies that raise the possibility of a generalized oxalate transport abnormality in some patients with renal stone disease. The important role of oxalate in the determination of calcium oxalate solubility in patients with calcium oxalate stone disease is emphasized and future directions for research in the prevention of recurrent calcium oxalate stone disease are discussed.

Topics: Animals; Biological Transport; Calcium Oxalate; Humans; Hyperoxaluria; Intestinal Absorption; Kidney; Oxalates; Syndrome; Urinary Calculi

Topics: Allopurinol; Calcium, Dietary; Female; Humans; Kidney Calculi; Male; Oxalates; Recurrence; Ureteral Calculi; Urinary Calculi

Calcium stones is responsible for 80 per cent of the stones in the upper track. It is a frequent and particularly recurrent disease and for this reason it is important to prevent its recurrence by medical treatment, dissolution of calcium stones being impossible. In the first part of this review, we have presented the theoretical basis and the clinical studies concerning conservative therapy involving high fluid intake and dietary advice on calcium and oxalate intake. Then, for the various drugs proposed for recurrence prevention we have reviewed their mechanisms of action and the controlled clinical trials concerning these drugs. Finally, the practical therapeutical choices for the management of these patients are presented according to the results of the previous metabolic evaluation.

Topics: Calcium Oxalate; Calcium, Dietary; Diuresis; Food Analysis; Humans; Mineral Waters; Oxalates; Urinary Calculi

Whereas the etiology of urinary calculi and their metabolic exploration should be known, it appears unreasonable to conduct exhaustive metabolic explorations in all patients, therapy being usually symptomatic and based on advice on hygiene and diet. However, etiologic diagnosis is essential in a small number of cases: those which could benefit from effective preventive and curative measures and for which morbidity is elevated: cystinuria, hyperparathyroidism, uric acid calculi, patients at high developmental risks. It is possible, by simple, low cost means to select 95% of these patients. After a theoretical study of the distribution and lithiasic etiology, a practical conduct is proposed which takes into account the cost-effective ratio.

Topics: Acidosis; Calcium; Citrates; Cystinuria; Humans; Hypercalcemia; Hyperparathyroidism; Intestinal Absorption; Kidney Calices; Osteoporosis; Oxalates; Sarcoidosis; Uric Acid; Urinary Calculi

Topics: Adult; Alcoholism; Animals; Calcium; Child; Child, Preschool; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Female; Glycine; Glyoxylates; Humans; Infant; Magnesium; Male; Middle Aged; Oxalates; Phosphorus; Rats; Urinary Calculi; Vitamin B 6 Deficiency

Urinary stones are much more common in subjects with intestinal diseases than in the general population. The chemical composition of the stones depends on the type of intestinal disease. In diarrhoeas with loss of water and electrolytes (inflammatory colitis and, chiefly, ileostomy), the urine is acid and concentrated and the stones are composed of uric acid. Extensive lesions of the ileum or wide resections of the small bowel increase the intestinal absorption of oxalates and expose the patients to oxalate stones. Treatment, which must be preventive, is based upon a knowledge of the pathophysiology of urolithiasis.

Topics: Humans; Intestinal Diseases; Oxalates; Uric Acid; Urinary Calculi

Topics: Allopurinol; Calcium; Calcium Oxalate; Female; Humans; Male; Oxalates; Urinary Calculi

Topics: Calcium; Diet; Dietary Carbohydrates; Dietary Proteins; Humans; Magnesium; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Changes in oxalate excretion (together with changes in urinary volume) constitute the most important factors in altering the probability of renal stone formation. However, investigations on oxalate metabolism have been sparse, perhaps because of the lack of an accurate method for measuring oxalate in biologic fluids. Available data clearly implicate increased urinary oxalate excretion as the etiological factor in stone formation in two groups of patients--those with primary hyperoxaluria and those with gastrointestinal malabsorption. Evidence for the existence of hyperoxaluria in the patient with the "garden" variety of calcium oxalate stones is less persuasive.

Topics: Animals; Biological Transport; Calcium Oxalate; Diet; Gastrointestinal Diseases; Glyoxylates; Humans; Intestinal Absorption; Kidney Calculi; Oxalates; Oxalic Acid; Rats; Rats, Inbred Strains; Urinary Calculi

Topics: Adolescent; Adult; Age Factors; Calcium; Child; Child, Preschool; Cystinuria; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Phosphates; Sex Factors; Uric Acid; Urinary Calculi

The present state of knowledge of the pathophysiology of urolithiasis and the assignment to subgroups according to varying aetiology is outlined. In addition, a diagnostic programme is insight proposed which has proved of value in ambulatory patients attending specialist departments. It permits into the underlying disturbances and may be considered a prerequisite for effective treatment. It is suggested that this general scheme of clinical investigation is a reasonable basis to the medical care of patients with urinary calculi.

Topics: Anti-Bacterial Agents; Body Weight; Calcium; Diuresis; Humans; Hydrogen-Ion Concentration; Infrared Rays; Oxalates; Spectrum Analysis; Urinary Calculi; Urinary Tract Infections; X-Ray Diffraction

It is reported on individual methods for the estimation of the oxalic acid in body fluids, particularly in the urine. The case in question is a survey of the oxalate estimation methods, which, however, has no pretensions to completeness. The at present most actualestimation methods are brought somewhat more in detail. The data are not sufficient for the laboratorytechnical performance of the individual methods, this would transgress the possibilities of the work. However, the original papers are cited which contain all the necessary details. Some technical difficulties and disturbances in the individual estimation methods are also entered. Despite excellent work of several teams the problems of standardization, of the absolutely reliable reference methoda as well as of an objective consideration of advantages and disadvantages of individual, often subjectively judged methods is not yet solved. Comparing these methods, one gets the impression that several reliable methods of the same value are established. It seems that this estimation method brings the greatest progress which will reliably establish so small quantities of oxalate as they are in the blood or in the liquor. By this also the oxalate clearance and the renal oxalate treatment becomes more exactly establishable than up to now.

Topics: Carbon Radioisotopes; Chemical Precipitation; Humans; Hydrogen-Ion Concentration; Methods; Oxalates; Solubility; Urinary Calculi

Both urate and oxalate are organic acids of considerable clinical interest, owing to their limited solubility. Calcium oxalate is the most frequent constituent of renal calculi and occasionally precipitates in body fluids. Urate precipitations are common in the kidney and in various other tissues. In this paper, a short outline of the present knowledge of renal handling of these substances will be followed by some conclusions as to the possible relevance of this knowledge for the understanding of urolithiasis and intrarenal precipitation. Direct (micropuncture) data are available for urate in the rat (1, 6, 7, 10, 21, 23, 28, 36, 42), rabbit (35), dog (34) and cebus monkey (33) and in the rat only for oxalate (11, 15, 20).

Topics: Alkalies; Animals; Diuretics; Dogs; Haplorhini; Kidney; Kidney Glomerulus; Kidney Tubules, Proximal; Nephrons; Oxalates; Rabbits; Rats; Uric Acid; Urinary Calculi

Topics: Ascorbic Acid; Celiac Disease; Citrates; Colitis, Ulcerative; Crohn Disease; Dietary Fats; Gastrointestinal Diseases; Humans; Hyperparathyroidism; Ileostomy; Intestine, Small; Liver Diseases; Malabsorption Syndromes; Oxalates; Solubility; Urinary Calculi

Three types of hypercalciuria are described; their existence and frequent association with calcium urolithiasis in humans are accepted. Various dietary factors such as minerals, electrolytes, fluids, vitamin D, carbohydrates, proteins are discussed with regard to their ability to alter the nature and the degree of calcium excretion following their ingestion. It is emphasised that at present we have only limited knowledge on the chain of events linking calorie intake and the response of the kidney.

Topics: Adult; Aged; Animals; Calcium; Diet; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Female; Humans; Kidney; Magnesium Deficiency; Male; Middle Aged; Oxalates; Phosphates; Rats; Sodium; Urinary Calculi; Vitamin D

Topics: Calcium; Glycosaminoglycans; Humans; Oxalates; Solubility; Solutions; Urinary Calculi

Topics: Calcium; Cystine; Cystinuria; Humans; Nutritional Physiological Phenomena; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Calcium; Calcium Phosphates; Crystallization; Energy Transfer; Humans; Mathematics; Oxalates; Salts; Urinary Calculi

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.

Topics: Animals; Calcium; Calcium Phosphates; Crystallization; Diphosphonates; Humans; Oxalates; Proteinuria; Urinary Calculi

On the basis of almost 15 years of experience with thiazide treatment in 346 patients with calcium stones, we believe that the following conclusions are justified: 1) Stone progression ceases in at least 90% of patients who take hydrochlorothiazide (50 mg, twice daily) on a regular basis. 2) A reduced dose of hydrochlorothiazide, i.e., 25 mg twice daily, appears to be effective in a significant proportion of patients. 3) Thiazides are effective in normocalciuric as well as hypercalciuric patients and in most patients with tubular ectasia (medullary sponge kidney). 4. Side effects necessitate discontinuation of thiazide treatment in approximately 7% of patients. The incidence and severity of side effects is reduced by initiating treatment with a small dose and by increasing the dose progressively until the full maintenance dose is achieved. A trial with a reduced dose is warranted in patients who are unable to tolerate the regular maintenance dose. 5) The therapeutic efficacy of thiazides in stone prevention cannot be accurately predicted by the degree of hypocalciuric response. Stone prevention may cease despite a minimal hypocalciuric response, whereas stone progression may occur when an adequate hypocalciuric response has taken place. 6) In addition to the hypocalciuric action, thiazides reduce urine oxalate excretion and increase urine zinc and (probably) magnesium; these effects probably contribute to the efficacy of this agent in stone prevention.

Topics: Animals; Benzothiadiazines; Calcium; Diuretics; Dogs; Drug Administration Schedule; Female; Humans; Magnesium; Male; Oxalates; Recurrence; Sodium Chloride Symporter Inhibitors; Urinary Calculi; Zinc

Topics: Calcium; Cellulose; Drinking; Humans; Hydrogen-Ion Concentration; Magnesium; Organophosphorus Compounds; Osmolar Concentration; Oxalates; Phosphates; Recurrence; Uric Acid; Urinary Calculi

Topics: Animals; Calcium Phosphates; Humans; Magnesium Deficiency; Magnesium Oxide; Male; Oxalates; Pyridoxine; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Calcium Phosphates; Cystine; Fibrin; Humans; Hyperparathyroidism; Oxalates; Recurrence; Urinary Calculi; Xanthines

There is a definite increased incidence of calculi associated with extensive small bowel disease or resection. Hyperoxaluria appears to play a major role and may be due to increased intestinal oxalate absorption. Forced fluids and dietary discretion are mainstays of stone prophylaxis.

Topics: Bile Acids and Salts; Calcium; Carbon Radioisotopes; Colitis, Ulcerative; Crohn Disease; Enteritis; Humans; Intestine, Small; Intestines; North Carolina; Obesity; Oxalates; Radiotherapy; Urinary Calculi

Topics: Adult; Animals; Benzothiadiazines; Calcium; Chemical Precipitation; Child; Citrates; Crystallization; Diphosphates; Diuretics; Female; Humans; Kidney Calculi; Magnesium; Male; Methylene Blue; Milk; Oxalates; Particle Size; Phosphates; Phosphorus; Sodium Chloride Symporter Inhibitors; Solubility; Urinary Calculi

Topics: Acidosis, Renal Tubular; Bacterial Infections; Citrates; Crystallization; Cystinuria; Diphosphates; Female; Gastrointestinal Diseases; Humans; Hypercalcemia; Hyperparathyroidism; Magnesium; Male; Metabolism, Inborn Errors; Mucoproteins; Oxalates; Quaternary Ammonium Compounds; Sarcoidosis; Solubility; Uric Acid; Urinary Calculi; Vitamin D; Xanthine Oxidase

Topics: Humans; Hydrogen-Ion Concentration; Kidney Calculi; Oxalates; Phosphates; Urinary Bladder Calculi; Urinary Calculi; Urine

Topics: Apatites; Calcium; Calcium Carbonate; Calcium Phosphates; Crystallization; Cystine; Humans; Hydroxyapatites; Magnesium; Methods; Microscopy, Polarization; Oxalates; Quaternary Ammonium Compounds; Silicic Acid; Spectrum Analysis; Uric Acid; Urinary Calculi; Urinary Tract Infections; X-Ray Diffraction; Xanthines

Topics: Acute Kidney Injury; Alcohol Oxidoreductases; Animals; Asia, Southeastern; Calcium; Chemical Phenomena; Chemistry; Female; Glycols; Humans; Hydroxyproline; Infant; L-Lactate Dehydrogenase; Malabsorption Syndromes; Male; Methoxyflurane; Muscles; NAD; Oryza; Oxalates; Thiamine Deficiency; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Animals; Ascorbic Acid; Calcium; Chemical Phenomena; Chemistry; Child, Preschool; Diet; Glycine; Glycolates; Humans; Hydrogen-Ion Concentration; Isoenzymes; L-Lactate Dehydrogenase; Male; Metabolism, Inborn Errors; Mitochondria, Liver; Nutritional Physiological Phenomena; Oxalates; Rats; Solubility; Urinary Calculi

Topics: Age Factors; Aged; Calcium; Child; Child, Preschool; Female; Humans; Infant; Kidney Calculi; Male; Nutrition Disorders; Nutritional Physiological Phenomena; Oxalates; Phosphates; Rural Population; Sex Factors; Urban Population; Uric Acid; Urinary Bladder Calculi; Urinary Calculi

Topics: Adolescent; Adult; Calcium; Child; Diet Therapy; Humans; Oxalates; Phosphates; Recurrence; Urinary Calculi; Urinary Tract Infections

Topics: Administration, Oral; Age Factors; Allopurinol; Animals; Anti-Bacterial Agents; Bicarbonates; Cystine; Diet Therapy; Dog Diseases; Dogs; Female; Hydrogen-Ion Concentration; Male; Oxalates; Phosphates; Postoperative Complications; Sex Factors; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Calcium Phosphates; Cystine; Humans; Magnesium; Microscopy, Electron; Microscopy, Polarization; Oxalates; Phosphates; Quaternary Ammonium Compounds; Spectrum Analysis; Urinary Calculi

Topics: Calcium; Cystine; Diet Therapy; Humans; Oxalates; Phosphates; Sulfates; Uric Acid; Urinary Calculi

Topics: Ascorbic Acid; Bone and Bones; Calcium; Cell Membrane Permeability; Erythrocytes; Feces; Glycine; Humans; Intestinal Absorption; Intestinal Mucosa; Kidney; Kidney Diseases; Kidney Function Tests; Liver; Metabolism, Inborn Errors; Microsomes; Mitochondria; Muscles; Oxalates; Plants, Edible; Urinary Calculi

Topics: Calcium; Diet; Humans; Hydrogen-Ion Concentration; Metabolic Diseases; Oxalates; Phosphorus; Solubility; Urinary Calculi

Topics: Animals; Calcium; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Rats; Urinary Calculi

Topics: Calcium; Cystinuria; Diphosphates; Humans; Magnesium; Oxalates; Phosphates; Urea; Urinary Calculi

Topics: Hyperoxaluria; Metabolic Diseases; Nephrocalcinosis; Oxalates; Pathology; Urinary Calculi; Urine

The aim of this study was to determine the early effect of the administration of Oxalobacter formigenes on the metabolic pattern of patients with calcium oxalate stones, comparing it with potassium magnesium citrate (KMgCit).. Eighty patients were randomized to receive either 30 mEq of KMgCit or 700 million O. formigenes, both twice a day. Serum creatinine, serum urate, serum calcium and phosphorus, serum intact parathyroid hormone (if serum calcium >10.5 mg/dl) and 24 h urine metabolic evaluation for various metabolites (e.g. oxalate, calcium, phosphorus, citrate, magnesium, urate and creatinine) were evaluated at baseline and 1 month after starting the treatment.. In both groups hyperoxaluria was the most common abnormality, followed by hypercalciuria. The incidence of hyperoxaluria decreased at 1 month compared to baseline in both KMgCit (77.5% vs 37.5%, p = 0.0006) and O. formigenes preparation (82.5% vs 15%, p < 0.0001) groups, while other urinary metabolic abnormalities were similar at baseline and 1 month in both groups. Three patients in the KMgCit had mild self-limiting secondary symptoms.. Compared with KMgCit, O. formigenes preparation is more effective in decreasing the incidence of hyperoxaluria, opening the door to probiotic therapy as a potential new weapon against hyperoxaluria.

Topics: Adult; Bifidobacterium; Calcium Oxalate; Citric Acid; Humans; Hyperoxaluria; Lactobacillus; Magnesium Compounds; Middle Aged; Oxalates; Oxalobacter formigenes; Potassium Compounds; Probiotics; Treatment Outcome; Urinary Calculi; Young Adult

This paper reports the results of a cohort study and randomised clinical trial (RCT) in cross-over design. In the cohort study, the range of urinary oxalate (Uox) and calcium (Uca) excretion was determined within a sample of the Dutch population of dogs and cats, and dietary and animal-related factors associated with these urine parameters were identified. Spot urine samples were collected from privately owned dogs (n=141) and cats (n=50). The RCT determined the effect of a commercial raw meat diet versus a dry diet on Uox and Uca excretion rate in 23 dogs. In the cohort study, Uox excretion ranged from 21.1 to 170.6 mmol oxalate/mol creatinine in dogs and 27.5 to 161.6 in cats. Urinary calcium excretion ranged from 3.4 to 462.8 mmol calcium/mol creatinine in dogs and 10.1 to 128.0 in cats. In dogs, increased Uox and Uca excretion was associated with (1) the intake of a dry diet as the primary source of energy, (2) receiving no snacks and (3) breed. Increased Uox excretion was associated with males as well. In cats, urine collection in anaesthetised subjects was identified as a confounder. In the RCT, feeding the dry diet resulted in higher Uox (P<0.001) and Uca (P=0.021) excretion rates in dogs.

Topics: Animal Feed; Animals; Breeding; Calcium; Calcium Oxalate; Cat Diseases; Cats; Cohort Studies; Creatinine; Cross-Over Studies; Dog Diseases; Dogs; Female; Male; Oxalates; Sex Factors; Urinary Calculi

Recent studies suggest that a high calcium diet protects against calcium oxalate stone formation. We compared the effect of high and low calcium diets on urinary saturation of calcium oxalate during liberal oxalate intake.. A total of 10 healthy subjects (5 male, 5 female) participated in a 2-phase, randomized, crossover study comparing high (1,000 mg daily) and low (400 mg daily) calcium intake on a liberal oxalate diet (200 mg daily). During each phase subjects adhered to an instructed diet for 3 days followed by a controlled, metabolic diet for 4 days. Blood and 24-hour urine specimens collected on the last 2 days of each phase were analyzed for serum biochemistry studies and stone risk factors, respectively.. Urinary calcium was higher (mean +/- SD 171 +/- 64 vs 124 +/- 49 mg daily, p = 0.002) and oxalate was lower (25 +/- 4.8 vs 27 +/- 4 mg daily, p = 0.02) on the high vs low calcium diet. Overall, the urinary relative saturation ratio of calcium oxalate was higher on the high compared with the low calcium diet (3.3 vs 2.5, p <0.0001) even after adjusting for confounding variables.. In normal subjects urinary saturation of calcium oxalate was higher on a high calcium diet than a low calcium diet during liberal oxalate intake because the decrease in urinary oxalate did not overcome the effect of increased calcium. A high calcium diet during liberal oxalate intake may pose an increased risk of calcium oxalate stone formation.

Topics: Adult; Calcium; Calcium Oxalate; Calcium, Dietary; Cross-Over Studies; Female; Humans; Male; Oxalates; Risk Factors; Urinary Calculi

Phyllanthus niruri is a plant used for years in Brazil to treat urinary calculi. We prospectively evaluated the effect of P. niruri intake on 24 h urinary biochemical parameters in an attempt to assess its in vivo effect in calcium stone forming (CSF) patients. A total of 69 CSF patients (39 males and 30 females, 38+/-8 years old) were randomized to take either P. niruri ( n=33) (450 mg capsules, td) or placebo ( n=36) for 3 months. Blood calcium, uric acid, citrate, magnesium, oxalate, sodium and potassium were determined at baseline and at the end of the study. A subset analysis was made in patients classified according to the presence of metabolic abnormalities (hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia and hypomagnesiuria). Overall, there were no significant differences in the mean values of urinary parameters between the urine samples before and after P. niruri intake, except for a slight reduction in mean urinary magnesium after P. niruri, which was within the normal range. However, in the subset analysis, we observed that P. niruri induced a significant reduction in the mean urinary calcium in hypercalciuric patients (4.8+/-1.0 vs 3.4+/-1.1 mg/kg/24 h, P<0.05). In this short-term follow-up, no significant differences in calculi voiding and/or pain relief between the groups taking P. niruri or the placebo were detected. Our data suggest that P. niruri intake reduces urinary calcium based on the analysis of a subset of patients presenting with hypercalciuria. Larger trials including primary hypercalciuric stone formers should be performed in order to confirm these findings and to determine the possible clinical consequences of urinary calcium reduction during P. niruri administration.

Topics: Adult; Brazil; Calcium; Citric Acid; Female; Freeze Drying; Humans; Magnesium; Male; Middle Aged; Oxalates; Phyllanthus; Phytotherapy; Plant Extracts; Potassium; Prospective Studies; Sodium; Uric Acid; Urinary Calculi

We evaluated the effect of calcium citrate supplementation alone or in combination with potassium citrate on the stone forming propensity in healthy postmenopausal women.. A total of 18 postmenopausal women without stones underwent a randomized trial of 4 phases comprised of 2 weeks of treatment with placebo, calcium citrate (400 mg calcium twice daily), potassium citrate (20 mEq twice daily), and calcium citrate and potassium citrate (at same doses). During the last 2 days of each phase urine was collected in 24-hour pools for complete stone risk analysis.. Compared to placebo, calcium citrate increased urinary calcium and citrate but decreased urinary oxalate and phosphate. Urinary saturation of calcium oxalate, brushite and undissociated uric acid did not change. Potassium citrate decreased urinary calcium, and increased urinary citrate and pH. It decreased urinary saturation of calcium oxalate and undissociated uric acid, and did not change the saturation of brushite. When calcium citrate was combined with potassium citrate, urinary calcium remained high, urinary citrate increased even further and urinary oxalate remained reduced from the calcium citrate alone, thereby marginally decreasing the urinary saturation of calcium oxalate. Urinary pH increased, decreasing urinary undissociated uric acid. The increase in pH increased the saturation of brushite despite the decrease in urinary phosphorus.. Calcium citrate supplementation does not increase the risk of stone formation in healthy postmenopausal women. The co-administered potassium citrate may provide additional protection against formation of uric acid and calcium oxalate stones.

Topics: Aged; Calcium; Calcium Citrate; Calcium Phosphates; Citric Acid; Dietary Supplements; Drug Therapy, Combination; Female; Humans; Hydrogen-Ion Concentration; Middle Aged; Osteoporosis, Postmenopausal; Oxalates; Phosphorus; Postmenopause; Potassium Citrate; Risk Factors; Uric Acid; Urinary Calculi

To determine whether stone-formers have higher BP than controls drawn from the general population and matched for age, sex and ethnic origin and to compare the relationship between sodium and calcium excretion in the two groups.. Thirty-six patients [mean (+/-standard deviation, SD) = 49.0 +/- 11.7 years; range 27-70 years] with kidney or ureteric stones and 108 controls (mean age of 49.6 +/- 6.8 years; range 39-61 years), matched for gender, ethnic origin and age group were studied. Patients and controls underwent physical measurements, a venous blood sample and they were asked to collect a 24-h urine sample for sodium, potassium, calcium and creatinine.. Stone-formers were significantly heavier and had higher BP than age-, sex- and ethnic-matched population controls. Whilst the difference in systolic BP was independent of the difference in body mass index [16.8 mmHg (7.2-26.4 mmHg), p = 0.001), the difference in diastolic BP was attenuated after adjustment for body mass [1.8 (-3.4 to 7.1), p = 0.49]. Stone-formers passed less urine than controls [-438 ml/day (95% CI -852 to -25), p = 0.038]. They had higher urinary calcium than controls [+3.7 mmol/day (2.8-4.6 mmol/day), p < 0.001], even when expressed as ratio to creatinine [+0.20 (0.11-0.29), p < 0.001]. Sodium excretion was positively associated with urinary calcium in both stone-formers and in controls. The slopes were comparable (0.92 vs 0.98 mmol Ca/100 mmol Na) so that for any level of sodium excretion (or salt intake), stone-formers had a higher calcium excretion than controls.. In stone-formers, the BP is higher than in controls. Stone-formers excrete more calcium than controls do. In stone-formers and controls, the relationship between urinary sodium and calcium is similar. Since this relationship results from an effect of sodium on calcium, a reduction in salt intake may be a useful method of reducing urinary calcium excretion in stone-formers. However, the "relative" hypercalciuria seen in stone-formers is independent of salt intake and may well reflect an underlying genetic predisposition.

Topics: Adult; Aged; Antihypertensive Agents; Asian People; Black People; Blood Pressure; Body Mass Index; Calcium; Female; Humans; Hypertension; Lithotripsy; Male; Middle Aged; Nephrostomy, Percutaneous; Oxalates; Phosphates; Sodium Chloride, Dietary; Urinary Calculi; White People

Hyperoxaluria is defined as urinary oxalate excretion exceeding 0.45 mmol/1.73 m2/day and accounts for 15% of recurrent urolithiasis. There have been only a few reports on the prevalence and treatment of oxalate urolithiasis in children.. Of the study was to assess the efficacy and safety of the protocol of intensive and combined treatment of hyperoxaluria in children.. Seventeen children at the mean age of 11.5 +/- 4.5 years with positive history of urolithiasis and diagnosis of hyperoxaluria were studied. In this group hyperoxaluria was an isolated defect in 9 of 17 children, but in 3/17 it was accompanied by hyperuricosuria, in 5/17 by hypomagnesuria and in 1 case by hypercalciuria. During the 12-month period the children were intensively hydrated and received a low-oxalate diet and supplemental therapy with vitamin B6, magnesium, citrates and lactic acid bacteria preparations.. In all but one child oxaluria decreased below 0.45 mmol/1.73 m2/day (decrease by 45%). No new stone formation was seen during the observation period. In all patients abdominal pain and haematuria subsided.. We conclude that the intensive, complex, conservative treatment of hyperoxaluria in children is effective and safe. It allows to decrease hyperoxaluria and prevent the recurrence of urolithiasis.

Topics: Adolescent; Child; Citrates; Fatty Acids; Female; Humans; Hyperoxaluria; Magnesium Oxide; Male; Oxalates; Urinary Calculi; Vitamin B 6

The low incidence of atherosclerosis and other degenerative disease, including urolithiasis, in the Greenland Eskimo has been attributed to their high consumption of oily fish with its high concentration of eicosapentaenoic acid (EPA). With a westernized diet, the oxygenated products of renal prostaglandin synthesis are metabolites of the n-6 series and these are known to play important roles in several pathophysiological processes involved in calcium stone formation. Buck's group presented a hypothesis that the initiating factor for lithiasis triggers prostaglandin synthesis, and showed that this influenced by EPA treatment.. In order to ascertain the effects of EPA on plasma lipids and urinary parameters, we undertook a clinical study whereby a highly purified preparation was administrated (1,800 mg/day) to 88 patients with urinary stones for 3 months (short term) and 18 months (long term).. Hyperlipemia improved the affected individuals and urinary calcium was significantly reduced in the hypercalciuric but not in the normocalciuric group.. The results suggest that EPA by reducing urinary calcium might favorably affect urine composition in a way that possibly reduces the risk of calcium stone formation.

Topics: Adult; Aged; Calcium; Cholesterol; Eicosapentaenoic Acid; Female; Humans; Male; Middle Aged; Oxalates; Phospholipids; Triglycerides; Urinary Calculi

Calcium, in the form of regular food supplementation, can improve bone metabolism, but it can also increase the risk for renal calcium stones, and may aggravate pre-existing calcium urolithiasis. To study the first of these two aspects, ten healthy volunteers were given a conventional test meal (breakfast; calcium content 28 mg) with or without two dosages of calcium (as calcium-sodium citrate, CSC 1, 680 mg; CSC 2 1,360 mg), taken after an overnight 12 h fast. To study the latter aspect, patients with idiopathic recurrent calcium urolithiasis (ICU) received a balanced test meal of fixed composition, containing 1,000 mg calcium either as CSC (Meal + CSC3; n = 6) or as calcium gluconate (Mcal; n = 8). In normals, CSC induced a dose-dependent increasing intestinal absorption of calcium, and a decrease in oxalate absorption; in serum, CSC increased calcitonin and suppressed parathyroid hormone, but left unchanged the markers of bone turnover, serum osteocalcin and bone alkaline phosphatase. In urine, CSC decreased bone resorption markers (collagen crosslinks) and phosphaturia increased citrate, created signs of metabolic alkalosis, and inhibited several parameters of CaOx crystallization. In ICU, the CSC3 load failed to promote the crystallization of CaOx and calcium phosphate. It was concluded that CSC supplementation of a meal: (1) is well tolerated by healthy subjects and ICU patients, renders calcium highly available to bone, and prevents post-prandial oxaluria from rising; and, (2) is followed by the inhibition of crystallization of renal stone forming calcium-containing substances. Long-term studies aimed at evaluating the usefulness of CSC in preserving healthy bone, and in the metaphylaxis of renal stones would appear justified.

Topics: Adult; Biological Availability; Blood Gas Analysis; Calcium; Calcium Citrate; Calcium Oxalate; Female; Homeostasis; Humans; Male; Middle Aged; Minerals; Oxalates; Urinary Calculi

While in vitro the protective effect of magnesium on calcium oxalate crystallization is well known, its clinical relevance in calcium nephrolithiasis is still debated. Therefore, the clinical and metabolic effects of magnesium hydroxide therapy were evaluated in calcium stone formers.. Nine patients (7 M, 2 F), selected for a low urinary magnesium excretion (uMg 56 +/- 12 mg/day), were given Mg hydroxide (500 mg/day), with clinical and metabolic controls at 3, 12 and 18 months.. Urinary Mg/uCreat increased throughout the study; uOx/uCreat decreased significantly; uCa/uCreat increased but not significantly. The stone recurrence rate decreased from 0.75 to 0.11 stones/year/patient, throughout the study period. The decrease of uOx is considered a more important risk factor in calcium stone patients than a similar uCa change; it may be due to a reduced intestinal Ox absorption, for the formation of insoluble and not absorbed Mg oxalate.. In conclusion, Mg hydroxide therapy was encouraging in patients with calcium nephrolithiasis and low uMg; nevertheless a longer period of treatment is needed to confirm these data.

Topics: Calcium; Creatinine; Female; Follow-Up Studies; Humans; Intestinal Absorption; Magnesium; Magnesium Hydroxide; Male; Oxalates; Recurrence; Urinary Calculi

Topics: Administration, Oral; Bacteria, Anaerobic; Calcium Oxalate; Circadian Rhythm; Feces; Food, Formulated; Humans; Intestines; Oxalates; Recurrence; Risk Factors; Urinary Calculi; X-Ray Diffraction

We treated 87 patients with calcium-containing urinary stones with either allopurinol alone (44 patients) or in combination with thiazide (43 patients) and studied new stone formation before, during, and after the discontinuation of the drug therapy. The number of stones formed were 1.18, 0.24, and 0.13 before, during, and after discontinuation of the drug therapy, respectively, in the patients treated with allopurinol alone and 1.32, 0.20, and 0.09 in those treated in combination with thiazide. No differences were observed in these values and the duration of each observation period between the two groups. Decreases in the incidence of stone formation even after interruption of drug therapy suggested that recurrence-preventive effects observed following administration of these drugs include the effects of medical guidance. However, allopurinol therapy was effective in preventing recurrence in patients with hyperuricosuria.

Topics: Allopurinol; Calcium; Calcium Oxalate; Calcium Phosphates; Citrates; Drug Therapy, Combination; Humans; Incidence; Male; Oxalates; Recurrence; Trichlormethiazide; Uric Acid; Urinary Calculi

Hypocitraturia was found in 75% of oxalate stone formers, and combined with hypercalciuria in 27%. By short-term alkalinizing therapy (3 weeks) with sodium-potassium-citrate (Uralyt-U) a 118% increase in citrate- and a 29.5% decrease in calcium excretion could be achieved in 71 patients. There was no change in the 24 h urinary excretion of oxalate, urate, magnesium and phosphate. In 10 recurrent oxalate stone formers long-term (10 to 20 months) alkalinizing therapy was performed. The quantitative effect on the excretion of citrate and calcium remained unchanged. Seven patients, who have completed at least one year of therapy have had no recurrence of stones.

Topics: Alkalies; Calcium; Citrates; Citric Acid; Clinical Trials as Topic; Humans; Oxalates; Oxalic Acid; Urinary Calculi

In patients with urolithiasis "Nephrolith" has a favourable influence on many parameters which are responsible for the development of renal calculi. I could never observe a complete dissolution of the urinary calculi.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Calcium; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Female; Humans; Khellin; Kidney Calculi; Male; Middle Aged; Oxalates; Phosphates; Sulfonamides; Urinary Calculi

Topics: Calcium; Crohn Disease; Humans; Magnesium; Oxalates; Uric Acid; Urinary Calculi

Recent observational studies reporting a lack of benefit from 24-hour urine testing for urinary stone disease (USD) prevention assumed testing included all components recommended from clinical guidelines. We sought to assess the completeness of 24-hour urine testing in the VA population.. From the VHA Corporate Data Warehouse (2012-2019), we identified patients with USD (n=198,621) and determined those who saw a urologist and/or nephrologist, and received 24-hour urine testing within 12 months of their index USD encounter. Through Logical Observation Identifiers Names and Codes, we evaluated each collection's completeness, defined as including all of urine volume, calcium, oxalate, citrate, uric acid, and creatinine. We then fit a multilevel logistic regression model with random effects for VHA facility to evaluate factors associated with specialist follow-up, testing, and testing completeness.. Specialist follow-up occurred in 54.3% and was stable over time. Testing occurred in 8.4%, declining from 9.3% in 2012 to 7.2% in 2019. Of tests performed, 54.6% were complete (43.7% increasing to 62.7% from 2012-2019). In adjusted analysis, there was high between-facility variation in specialist follow-up (median OR 2.0; 95% CI 1.7-2.0), testing (median OR 2.2, 95% CI 1.9-2.4), and testing completeness (median OR, 6.0, 95% CI 4.5-7.3). Individual facilities contributed 52% (intraclass correlation coefficient, 0.52; 95% CI, 0.44-0.57) towards the observed variation in testing completeness.. Approximately 1 in 12 U.S. Veterans with USD receive metabolic testing and half of these tests are complete. Addressing facility level variation in testing completeness may improve USD care.

Topics: Citric Acid; Humans; Oxalates; Urinary Calculi; Urolithiasis; Veterans

Intact and non-intact urinary stones richening with calcium oxalate were collected and characterized. The elemental analysis, phase quantifications, and function groups were determined by different spectroscopic techniques, namely: energy-dispersive X-ray fluorescence (EDXRF), the synchrotron radiation X-ray diffraction (SR-XRD), and attenuated total reflection Fourier transform infrared (ATR-FTIR). The quantitative analysis of twenty elements was demonstrated in the most of the urinary stones and these elements are: Ca, Na, P, S, Mg, Cl, Zn, K, Ti, Sr, Ni, Co, Fe, Cu, Cd, Br, Pb, Se, I, and Mn. Using the Rietveld method, the diffraction phase quantification was illustrated. The main found phases are calcium oxalate (monohydrate and dihydrate) and hydroxyapatite phase. The FTIR outcomes reveal that the functional groups of O-H, N-H, C=O, and C-O indicate to the calcium oxalate whereas the P-O and O-P-O, and PO

Topics: Calcium Oxalate; Humans; Oxalates; Spectrum Analysis; Urinary Calculi; X-Rays

Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. Therefore, we assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. Mean ± standard deviation age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had one or more stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. Thus, these data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group.. Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited.. We assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate.. Mean ± SD age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had ≥1 stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event.. These data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group.

Topics: Adult; Female; Humans; Hyperoxaluria; Kidney Calculi; Middle Aged; Oxalates; Retrospective Studies; Urinary Calculi

Our aim was to investigate the validity of osmolality from 24-h urine collection in examining the risk for calcium-oxalate (CaOx) kidney stone formation in patients with recurrent urolithiasis. Three hundred and twelve subjects (males/females: 184/128) from France with a history of recurrent kidney stones from confirmed or putative CaOx origin were retrospectively included in the study (46 ± 14 years, BMI: 25.3 ± 5.0 kg·m

Topics: Calcium; Calcium Oxalate; Crystallization; Female; Humans; Kidney Calculi; Male; Osmolar Concentration; Oxalates; Retrospective Studies; Urinary Calculi; Urolithiasis

Topics: Homeostasis; Humans; Oxalates; Urinary Calculi; Urologic Diseases

The incidence of urinary stone disease is rapidly increasing, with oxalate being a primary constituent of approximately 80% of all kidney stones. Despite the high dietary exposure to oxalate by many individuals and its potential nephrotoxicity, mammals do not produce enzymes to metabolize this compound, instead relying in part on bacteria within the gut to reduce oxalate absorption and urinary excretion. While considerable research has focused on isolated species of oxalate-degrading bacteria, particularly those with an absolute requirement for oxalate, recent studies have pointed to broader roles for microbiota both in oxalate metabolism and inhibition of urinary stone disease. Here we examined gut microbiota from patients with and live-in individuals without urinary stone disease to determine if healthy individuals harbored a more extensive microbial network associated with oxalate metabolism. We found a gender-specific association between the gut microbiota composition and urinary stone disease. Bacteria enriched in healthy individuals largely overlapped with those that exhibited a significant, positive correlation with Oxalobacter formigenes, a species presumed to be at the center of an oxalate-metabolizing microbial network. Furthermore, differential abundance analyses identified multiple taxa known to also be stimulated by oxalate in rodent models. Interestingly, the presence of these taxa distinguished patients from healthy individuals better than either the relative abundance or colonization of O. formigenes. Thus, our work shows that bacteria stimulated by the presence of oxalate in rodents may, in addition to obligate oxalate users, play a role in the inhibition of urinary stone disease in man.

Topics: Aged; Case-Control Studies; DNA, Bacterial; Female; Gastrointestinal Microbiome; Humans; Hyperoxaluria; Male; Middle Aged; Oxalates; Oxalobacter formigenes; RNA, Ribosomal, 16S; Urinary Calculi

Intestinal regulation of oxalate absorption is a complex mechanism, not exclusively reliant on the oxalate-degrading anaerobe Oxalobacter formigenes. Using metagenomics, Miller et al. were able to describe a network of bacterial taxa co-occurring with Oxalobacter formigenes in fecal samples from non-stone forming controls and less represented in stone formers. These findings may help to illuminate why previous intervention studies with probiotics have failed to reduce the risk of hyperoxaluria, opening new possibilities for future research.

Topics: Gastrointestinal Microbiome; Homeostasis; Humans; Kidney Calculi; Oxalates; Oxalobacter formigenes; Urinary Calculi

to study the calcium level in the urine, serum and hairs and to assess the diagnostic value of the calcium level in various biosubstrates in patients with calcium and non-calcium stones.. a total of 99 patients with urinary stone disease were included in the study. A diagnostic value of calcium level in biosubstrates according to the chemical analysis of stone composition performed using qualitative chemical reactions and microcrystalloscopy was evaluated.. Urinary level of calcium and oxalate is proved to have high diagnostic value in patients with calcium nephrolithiasis (specificity 93.9% and 96.9%, and positive predictive value 88.2% and 97.2%, respectively). The specificity and positive predictive value of the calcium level in the hairs was 81.2% and 87.2%, respectively.. A comprehensive study of the elemental spectrum in urine, hair, and serum increases the diagnostic value of the evaluation of calcium, determined by the type of studied biosubstrate and stone type in patients with nephrolithiasis.

Topics: Calcium; Hair; Humans; Kidney Calculi; Oxalates; Urinary Calculi

Topics: ErbB Receptors; Humans; Hyperoxaluria; Hyperoxaluria, Primary; Oxalates; Urinary Calculi; Urologic Diseases

Urinary stone disease (USD) has known associations with the gut microbiota. Approximately 80% of kidney stones contain oxalate as a primary constituent and diverse oxalate-degrading bacteria exist within the human gut, which may protect against USD. Although bacteriotherapy represents a promising strategy to eliminate oxalate and reduce the risk of USD, oxalate-degrading probiotics have had limited success. To identify limitations of oxalate-degrading probiotics and refine development of bacteriotherapies to prevent USD, we review the literature associated with the gut microbiota and USD.. A literature search was performed to identify publications that examine the role of oxalate-degrading bacteria or the whole gut microbiota in oxalate metabolism and the pathophysiology of USD. We conducted a meta-analysis of studies that examined the association of the whole gut microbiota with USD. In addition, we evaluated the gut microbiota of healthy individuals and those with comorbidities related to USD using publically available data from the American Gut Project (AGP).. Studies on Oxalobacter formigenes reveal that colonization by this species is not a good predictor of USD risk or urinary oxalate excretion. The species of oxalate-degrading bacteria used in probiotics and duration of administration do not impact efficacy or persistence. Studies focused on the whole gut microbiota reveal broad shifts in the gut microbiota associated with USD and a diverse microbial network is associated with oxalate metabolism. AGP data analysis demonstrated a strong overlap in microbial genera depleted in diseased individuals among USD and comorbidities.. The associations between the gut microbiota and USD extend beyond individual functional microbial species. Common shifts in the gut microbiota may facilitate the onset of USD and/or comorbidities. The successful development of bacteriotherapies to inhibit USD will need to incorporate strategies that target a broad diversity of bacteria rather than focus on a few specialist species.

Topics: Calcium Oxalate; Gastrointestinal Microbiome; Humans; Oxalates; Oxalobacter formigenes; Urinary Calculi; Young Adult

Since plasma oxalate (POx) concentrations increase at lower glomerular filtration rate (GFR) levels, even among those without enteric (EH) or primary hyperoxaluria (PH), the appropriate thresholds for considering a disorder of oxalate metabolism are poorly defined. The current study was completed to establish relationships between POx, GFR, and urine oxalate excretion (UOx) among patients with PH, EH, and routine urinary stone disease (USD).. The most recent POx measurement on all Mayo Clinic patients between 2005 and 2015 were electronically pulled from the Lab Information System together with the closest serum creatinine within 14days and 24h urine study within 60days. After exclusion of patients not in steady state at the time of blood draw, 270 patients were available for study. Records were reviewed for clinical diagnoses to categorize patients as PH, EH, or USD. Waste plasma for Pox was also obtained from controls without USD undergoing clinical GFR testing.. In all 3 groups POx increased as eGFR fell. For any given eGFR, POx was highest in the PH group and lowest in the USD and control groups (p<0.0001). POx was also influenced by UOx excretion (reflecting total body oxalate burden, absorption from diet and endogenous production). Generalized estimating equations of POx vs eGFR revealed higher average POx levels in PH compared to EH,USD or control, and for EH compared to USD or control. GEE prediction models were created that use POx, UOx, age, and serum creatinine to estimate the probability of a PH diagnosis.. New models were developed to help interpret POx when considering PH in clinical practice even when it was not previously suspected and/or eGFR is reduced.

Topics: Adult; Calcium Oxalate; Female; Glomerular Filtration Rate; Humans; Hyperoxaluria; Hyperoxaluria, Primary; Kidney Diseases; Kidney Failure, Chronic; Male; Metabolic Diseases; Middle Aged; Oxalates; Urinary Calculi

Some in vitro and animal studies have shown endothelial dysfunction in hyperoxaluria models indicating its role in pathogenesis of urolithiasis and relation to CVD. The aim of this study was to investigate endothelial function in patients with urolithiasis in relation to urinary stone risk factors and metabolic parameters. A total of 120 subjects without any known CVD (60 with urolithiasis and 60 healthy subjects) were included into study. Fasting blood and 24-h urine samples were collected to study metabolic parameters (glucose and lipids) and urine stone risk factors (oxalate, citrate, uric acid, and calcium, pH). Endothelial function was assessed as flow-mediated dilation (FMD) at the brachial artery. Age, sex, and body mass index were similar in patients and controls. Of urine stone risk factors, oxalate and citrate were higher in patients than controls. Fasting blood glucose, total LDL cholesterol, and triglyceride were higher, and HDL cholesterol was lower in patients than controls. Although within normal limits systolic blood pressure was higher in patient group, patients with urolithiasis had a lower %FMD than controls. Percent FMD was negatively correlated with urinary oxalate/creatinine ratio (p = 0.019, r = -0.315), calcium/creatinine ratio (p = 0.0001, r = -0.505) age (p < 0.001, r = -0.694), BMI (p < 0.001, r = -0.838), total cholesterol (p < 0.001, r = -0.559), and triglyceride (p < 0.001, r = -0.529). Urine oxalate/creatinine ratio was positively correlated with age (p = 0.01, r = 0.327) and calcium/creatinine ratio with BMI (p = 0.001, r = 0.410). This is the first study demonstrating endothelial dysfunction in human subjects with urolithiasis. This indicates a possible predictive role of urolithiasis in future development of cardiovascular diseases.

Topics: Adult; Blood Circulation; Blood Glucose; Blood Pressure; Brachial Artery; Cardiovascular Diseases; Case-Control Studies; Cholesterol, HDL; Cholesterol, LDL; Citrates; Creatinine; Endothelium, Vascular; Female; Humans; Male; Middle Aged; Oxalates; Risk Factors; Triglycerides; Urinary Calculi

Topics: Calcium; Calcium Oxalate; Humans; Kidney Calculi; Mitochondria; Monocytes; Oxalates; Urinary Calculi

Shared medical appointments (SMAs) have decreased patients' wait time to initial stone clinic appointment, standardized education, and increased exposure to nutrition therapy. We assessed the effectiveness of SMAs in reducing patients' urinary stone risk factors.. Patients who established care in our stone clinic in an SMA between March 2012 and August 2015 were sequentially identified. After eliminating those without follow-up urine collections or whose urinary creatinine excretion between the two collections varied by >40%, 113 patients were included (M:F 63:50; 54 ± 15 years; body mass index [BMI] 30.6 ± 6.7). Results from before and after the SMA were compared with those from a similar cohort of patients who attended individual patient appointments (IPAs) for their first stone clinic visit (n = 63; M:F 37:26; 54 ± 14 years; BMI 30.1 ± 8.2). All patients received individualized medical therapy for stone prevention.. After medical and nutritional therapy, SMA patients with elevated risk(s) at baseline achieved significant reductions in uric acid, calcium, and sodium; p ≤ 0.001 for all. Those with low urine magnesium, low urine volume, low urine pH, and/or low urine citrate at baseline achieved increases; p ≤ 0.0008 for all. IPA patients with elevated baseline risk factors achieved reductions in oxalate and uric acid (p ≤ 0.004 for both) but neither calcium nor sodium and an increase in citrate (p = 0.003) but not magnesium.. Patients from SMAs reduced their stone recurrence risk and compared favorably with patients from IPAs. Contributing factors may include shorter time from stone event to appointment and more standardized education for patients attending SMAs.

Topics: Adult; Aged; Calcium Oxalate; Calcium, Dietary; Citrates; Citric Acid; Cohort Studies; Creatinine; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Patient Education as Topic; Patient Satisfaction; Risk Factors; Sodium; Uric Acid; Urinalysis; Urinary Calculi; Urology

Urinary calculi in infants are relatively infrequent, but their incidence has increased in the recent decades. The aim of this study was to investigate the clinical presentation, metabolic risk factors, and urinary tract abnormalities in infants suffering from kidney calculus.. A total of 152 infants were admitted between 2009 and 2012 with ultrasonography-proven urolithiasis. A Foley catheter was fixed and 24-hour urine samples were analyzed for calcium, citrate, oxalate, uric acid, and magnesium. For detecting cystinuria, qualitative measurement of urinary cystine was done by nitroprusside test. Urinary tract structural abnormalities were also evaluated.. The mean age at the diagnosis of kidney calculus was 5.46 months (range, 15 days to 12 months). The most common clinical findings were restlessness and urinary tract infection. A family history of calculi was found in 67.1% of the patients and 68.4% were born to consanguineous marriages. Metabolic abnormalities and urinary tract abnormalities were found in 96.1% and 15.1% of children, respectively. Urinary tract abnormalities were more common in girls. The most common metabolic risk factors were hypercalciuria (79.6%) and hypocitraturia (40.9%). Hyperoxaluria and hypomagnesuria were found in about 28% of patients, both of which were associated with bilateral urolithiasis.. These findings show that urinary metabolic abnormalities are very common in infants with urolithiasis. Appropriate evaluation of urinary metabolic parameters can lead us to proper diagnosis and treatment.

Topics: Calcium; Citric Acid; Cystinuria; Female; Humans; Infant; Infant, Newborn; Iran; Magnesium; Male; Oxalates; Risk Factors; Ultrasonography; Uric Acid; Urinary Calculi; Urinary Tract; Urolithiasis

We used computer modeling to investigate the influence of physicochemical stone risk factors on urinary supersaturation (SS) of calcium oxalate (CaOx) in patients with severe hyperoxaluria, relative hypocalciuria, hypocitraturia, and CaOx nephrolithiasis after extensive small bowel resection, usually performed for Crohn's disease. We also simulated different treatment strategies, including oral calcium supplements and citrate, in such patients.. A baseline urine model was derived by consolidating data acquired by ourselves with those from another patient cohort. Calcium and oxalate excretions in this model were altered to obtain an extreme case. For comparison, additional models were based on published urine data from normal subjects (N) and idiopathic CaOx stone formers (SF). The Joint Expert Speciation System was used to simulate different urine situations based on reported compositional values.. [Ca(2+)][Ox(2-)] ionic concentration products and SS(CaOx) are substantially higher in enteric hyperoxaluric patients than in N and SF, despite their relatively lower calcium excretions. Molar Ca:Ox ratios are substantially lower in enteric hyperoxalurics than in N and SF. Oral calcium supplements can reduce SS(CaOx), but monitoring is required to avoid exceeding a safe dosing threshold. A simple calculation can alert the clinician that this threshold is being approached or even exceeded. Increasing urinary pH and citrate decreases SS(CaOx) but not to the same extent as decreasing Ox excretion.. Calcium supplements can help reduce stone risk in patients with severe enteric hyperoxaluria, but initial efforts should be directed toward reducing urinary oxalate by reducing dietary oxalate. Citrate therapy that increases both urine pH and urinary citrate provides an additional therapeutic benefit.

Topics: Calcium Oxalate; Calcium, Dietary; Chelating Agents; Citric Acid; Clinical Protocols; Computer Simulation; Diagnosis, Computer-Assisted; Diet; Female; Humans; Hyperoxaluria; Intestine, Small; Male; Middle Aged; Nephrolithiasis; Oxalates; Postoperative Complications; Risk Factors; Urinary Calculi

Renal calculi formation is one of the most common urological disorders. Urinary stone disease is a common disease, which affects 10‑12% of the population in industrialized countries. In males, the highest prevalence of the disease occurs between the age of 20 and 40 years, while in females, the highest incidence of the disease occurs later. Previous studies have shown that long‑term exposure to oxalate is toxic to renal epithelial cells and results in oxidative stress. In the present study, a methanolic extract of aerial parts of Urtica dioica was screened for antiurolithiatic activity against ethylene glycol and ammonium chloride‑induced calcium oxalate renal stones in male rats. In the control rats, ethylene glycol and ammonium chloride administration was observed to cause an increase in urinary calcium, oxalate and creatinine levels, as well as an increase in renal calcium and oxalate deposition. Histopathological observations revealed calcium oxalate microcrystal deposits in the kidney sections of the rats treated with ethylene glycol and ammonium chloride, indicating the induction of lithiasis. In the test rats, treatment with the methanolic extract of Urtica dioica was found to decrease the elevated levels of urinary calcium, oxalate and creatinine, and significantly decrease the renal deposition of calcium and oxalate. Furthermore, renal histological observations revealed a significant reduction in calcium oxalate crystal deposition in the test rats. Phytochemical analysis of the Urtica dioica extract was also performed using liquid chromatography‑electrospray ionization tandem mass spectrometry and high-performance liquid chromatography with photodiode array detection, to determine the chemical composition of the extract. The eight chemical constituents identified in the extract were protocatechuic acid, salicylic acid, luteolin, gossypetin, rutin, kaempferol‑3‑O‑rutinoside, kaempferol‑3‑O‑glucoside and chlorogenic acid. In conclusion, the results of the present study suggest that Urtica dioica has strong antiurolithiatic activity and may have potential as a natural therapeutic agent for various urological disorders.

Topics: Ammonium Chloride; Animals; Calcium; Calcium Oxalate; Chlorogenic Acid; Creatinine; Ethylene Glycol; Flavonoids; Hydroxybenzoates; Kaempferols; Kidney; Luteolin; Male; Methanol; Monosaccharides; Oxalates; Plant Extracts; Protective Agents; Rats; Rats, Sprague-Dawley; Rutin; Salicylic Acid; Urinary Calculi; Urtica dioica

Helicobacter pylori (H. pylori) is a atypical gram-negative bacteria preferring gastric mucosa which also have bizarre multisystem effects extended to some malignancies, hematologic and vascular disorders through some not well defined pathophysiologic pathways. Our pioneer data was pointing that the urinary system stone existence was seemed to be high in the group of H. pylori+cases. While the explanation of the reason of the coincidence of renal-gall bladder stones, it was previously suggested that there may be a shift mechanism of intestinal microbial flora, from Oxalobacter formigenes that may reduce the risk of renal stone by consuming intestinal oxalate, to H. pylori which is known to induce gallstone by unknown mechanism. This hypothesis is an indirect one and highly controversial for the effect of H. pylori in the renal stone formation because intestinal absorption of oxalate is not significant when it is compared with the endogen oxalate. The present preliminary unique data in connection with our hypothesis claimed that a possible relation between H. pylori and renal stones. We think that this detrimental effect is due to the possible systemic influence such as vascular and/or endoluminal sickness due to the H. pylori other than directs bacteriologic colonization. There is strong evidence that H. pylori have some role in the atherosclerotic procedure. The vascular theory of Randall plaque formation at renal papilla and subsequent calcium oxalate stone development that suggests microvascular injury of renal papilla in an atherosclerotic-like fashion results in calcification near vessel walls that eventually erodes as a calculus format into the urinary system. Briefly, theories of stone and atherosclerosis seemed to be overlap and H. pylori is one of the factor of both processes. In addition to our hypothesis, we claimed that H. pylori might have same detrimental effect on endoluminal surfaces of urinary and genital systems and resulting in some special pathologies as Hunner's ulcers in interstitial cystitis and even posttesticular infertility. The accumulating knowledge about extragastric sequelae of H. pylori may open new aspects on therapeutic and the prevention strategies of urolithiasis and even this progress may reach to chronic pelvic pain syndromes and idiopathic infertility.

Topics: Apoptosis; Atherosclerosis; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Intestines; Kidney Calculi; Models, Theoretical; Oxalates; Oxalobacter formigenes; Urinary Calculi; Urolithiasis

The role of metals in urinary stone formation has already been studied in several publications. Moreover, urinary calculi can also be used for assessing exposure of humans to minor and trace elements in addition to other biological matrices, for example, blood, urine, or hair. However, using urinary calculi for biomonitoring of trace elements is limited by the association of elements with certain types of minerals. In this work, 614 samples of urinary calculi were subjected to mineralogical and elemental analysis. Inductively coupled plasma mass spectrometry and thermo-oxidation cold vapor atomic absorption spectrometry were used for the determination of major, minor, and trace elements. Infrared spectroscopy was used for mineralogical analysis, and additionally, it was also employed in the calculation of mineralogical composition, based on quantification of major elements and stoichiometry. Results demonstrate the applicability of such an approach in investigating associations of minor and trace elements with mineralogical constituents of stones, especially in low concentrations, where traditional methods of mineralogical analysis are not capable of quantifying mineral content reliably. The main result of this study is the confirmation of association of several elements with struvite (K, Rb) and with calcium phosphate minerals, here calculated as hydroxylapatite (Na, Zn, Sr, Ba, Pb). Phosphates were proved as the most important metal-bearing minerals in urinary calculi. Moreover, a significantly different content was also observed for Fe, Zr, Mo, Cu, Cd, Se, Sn, and Hg in investigated groups of minerals. Examination of such associations is essential, and critical analysis of mineral constituents should precede any comparison of element content among various groups of samples.

Topics: Aged; Aged, 80 and over; Child, Preschool; Czech Republic; Female; Humans; Male; Mass Spectrometry; Middle Aged; Minerals; Oxalates; Phosphates; Spectrophotometry, Atomic; Trace Elements; Uric Acid; Urinary Calculi

High level of urinary oxalate substantially increases the risk of hyperoxaluria, a significant risk factor for urolithiasis. The primary goal of this study was to reduce urinary oxalate excretion employing liposome encapsulated oxalate oxidase in animal model.. A membrane bound oxalate oxidase was purified from Bougainvillea leaves. The enzyme in its native form was less effective at the physiological pH of the recipient animal. To increase its functional viability, the enzyme was immobilized on to ethylene maleic anhydride (EMA). Rats were injected with liposome encapsulated EMA- oxalate oxidase and the effect was observed on degradation of oxalic acid.. The enzyme was purified to apparent homogeneity with 60-fold purification and 31 per cent yield. The optimum pH of EMA-derivative enzyme was 6.0 and it showed 70 per cent of its optimal activity at pH 7.0. The EMA-bound enzyme encapsulated into liposome showed greater oxalate degradation in 15 per cent casein vitamin B 6 deficient fed rats as compared with 30 per cent casein vitamin B 6 deficient fed rats and control rats.. EMA-oxalate oxidase encapsulated liposome caused oxalate degradation in experimental hyperoxaluria indicating that the enzyme could be used as a therapeutic agent in hyperoxaluria leading to urinary stones.

Topics: Animals; Humans; Hyperoxaluria; Liposomes; Oxalates; Oxidoreductases; Rats; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Aged; Apatites; Humans; Male; Oxalates; Urinary Calculi

To examine erythrocyte band III transport protein (SLC4A1), erythrocyte oxalate flux, and plasmatic, cellular, and urine oxalate concentrations and blood gas analyses in calcium oxalate monohydrate stone-forming patients (COM) in comparison with normal controls (NC).. Isolated red cells from 51 NC and 25 COM cases were divided for cellular oxalate measurement and for measurement of transcellular erythrocyte oxalate flux (pH 7.48-8.24). SLC4A1 protein levels were determined by Western blot analyses. Plasmatic and urinary oxalate levels and the venous blood gas analysis were measured simultaneously.. SLC4A1 protein levels were significantly higher in COM (8.76 ± 2.12) than in NC (4.17 ± 0.61; P < .02). Cellular oxalate and venous HCO(3)(-) were significantly lower in COM (2.35 ± 0.26 μmol/L) and (24.06 ± 0.24 mmo/l) than in NC (4.03 ± 0.49 μmol/L; P < .05) and (24.93 ± 0.17 mmol/L; P < .01). Urinary oxalate was significantly higher in COM (0.31 ± 0.02 mmol/L) than in NC (0.25 ± 0.01 mmol/L; P < .04). The erythrocyte transmembrane oxalate flux correlated with the pH value and with the urinary oxalate in both groups (r = .25-.55; P = .01). With increased pH values, the oxalate flux showed inverse effects in both groups.. SLC4A1 associated changes of HCO(3)(-) and pH levels influenced the cellular oxalate levels and urinary oxalate clearance. Under normal conditions (pH 7.55) the oxalate efflux in COM was comparable with the acid stimulated oxalate efflux in NC. The addition of HCO(3)(-) compensated the flux of COM stone formers to the levels of normal controls.

Topics: Anion Exchange Protein 1, Erythrocyte; Calcium Oxalate; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

Elevated sodium excretion in urine resulting from excessive sodium intake can lead to hypercalciuria and contribute to the formation of urinary stones. The aim of this study was to evaluate salt intake in patients with urinary lithiasis and idiopathic hypercalciuria (IH).. Between August 2007 and June 2008, 105 lithiasic patients were distributed into 2 groups: Group 1 (n = 55): patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50): normocalciuric patients (NC). Inclusion criteria were: age over 18 years, normal renal function (creatinine clearance ≥ 60 ml/min), absent proteinuria and negative urinary culture. Pregnant women, patients with intestinal pathologies, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated by the three-day dietary record quantitative method, and the Body Mass Index (BMI) was calculated and classified according to the World Health Organization (WHO). Sodium intake was evaluated based on 24-hour urinary sodium excretion.. The distribution in both groups as regards mean age (42.11 ± 10.61 vs. 46.14 ± 11.52), weight (77.14 ± 16.03 vs. 75.99 ± 15.80), height (1.64 ± 0.10 vs. 1.64 ± plusorminus 0.08) and BMI (28.78 ± 5.81 vs. 28.07 ± 5.27) was homogeneous. Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group (p < 0.05). There was no statistical difference in calcium intake between the groups, and there was significantly higher salt intake in patients with IH than in NC.. This study showed that salt intake was higher in patients with IH as compared to NC.

Topics: Adult; Calcium; Case-Control Studies; Creatinine; Female; Humans; Hypercalciuria; Logistic Models; Magnesium; Male; Middle Aged; Oxalates; Prospective Studies; Risk Factors; Sodium; Sodium Chloride, Dietary; Uric Acid; Urinary Calculi

Urinary stones have an estimated lifetime morbidity of 15.1% in males and 6.1% in females ; in other words, one out of seven males and one out of fifteen females are affected with this disease at least once in their life. Previously, we reported a simple and easy method using microplates to measure the metastable limit (ML), which indicate the upper limit of supersaturation dissolution. In this study, we examined the usability of this microplate method. We confirmed that ML is correlated with the urinary calcium concentration in healthy subjects, single stone formers (SF), and recurrent stone formers (RSF). There was no significant difference between healthy subjects and RSF in urinary magnesium concentration, and ML was found to be correlated with urinary the concentration of oxalate and citrate acid in healthy subjects only. These results suggest that ML is a simple and easy way to measure the urinary calcium level and that ML could be a useful test item in outpatient settings as a convenient indicator for preventing recurrence of urinary stones in the future.

Topics: Calcium; Citrates; Humans; Magnesium; Male; Oxalates; Urinalysis; Urinary Calculi

The aim of this study was to investigate the current impact of dietary counseling on the risk for urolithiasis.. A retrospective cohort study of the patients treated in our stone clinics from July 2007 to February 2009 was carried out. Patients' urinary risk factors for stone disease were evaluated with pre- and postintervention 24-hour urine collections. All patients received dietary recommendations from a registered dietician at each visit.. One hundred thirty-seven subjects were identified and managed initially with only dietary interventions to address their urinary stone risk parameters. Average follow-up for this group was 15.19 ± 13.7 months. Subjects showed significant changes in urine volume (71.1%, 1.68 ± 0.68 to 2.59 ± 0.80 L/day, p < 0.0001), urine sodium (58.1%, 229.68 ± 72.51 to 144.65 ± 52.70 mmol/day, p < 0.0001), urine calcium (43.8%, 314.33 ± 95.75 to 216.81 ± 80.90 mg/day, p < 0.0001), urinary uric acid (50%, 0.821 ± 0.210 to 0.622 ± 0.128 g/day, p < 0.0001), urinary citrate (50.7%, 583.19 ± 330.86 to 797.36 ± 412.31, p < 0.0001), and urine oxalate (55.5%, 46.28 ± 10.31 to 32.56 ± 9.02 mg/day, p < 0.0001). The supersaturation for calcium oxalate also decreased significantly from baseline (9.34-5.03, p < 0.0001).. Urolithiasis is a multifactorial disease requiring a multidisciplinary approach. Our results support the use of dietary counseling by a registered dietician in the management of urolithiasis.

Topics: Calcium; Citric Acid; Counseling; Female; Humans; Male; Middle Aged; Oxalates; Recurrence; Risk Factors; Sodium; Uric Acid; Urinary Calculi

To better understand intestinal oxalate transport by correlating oxalate and sucralose absorption in idiopathic calcium oxalate stone formers. Oxalate has been hypothesized to undergo absorption in the large and small intestine by both paracellular and transepithelial transport. Sucralose is a chlorinated sugar that is absorbed by paracellular mechanisms.. Idiopathic calcium oxalate stone formers were recruited to provide urine specimens on both a self-selected diet and after a meal containing 90 mg of (13)C(2-)oxalate and 5 g of sucralose, and a stool sample for determination of Oxalobacter formigenes colonization. The 24-hour urine collections were fractionated into the first 6 hours and the subsequent 18 hours. Sucralose and oxalate excretion were measured during these periods and used to estimate absorption.. Thirty-eight subjects were evaluated. The majority of both the (13)C(2-)oxalate and sucralose absorption occurred within the 0-6-hour collection. The (13)C(2-)oxalate and sucralose absorptions were significantly correlated at the 0-6 hour, the 6-24 hour, and the total 24-hour time periods (P <.04). All 5 oxalate hyperabsorbers(>15% absorption) also absorbed significantly more sucralose during the 0-6 hour and whole 24-hour time points (P <.04). Oxalobacter formigenes colonization did not significantly alter oxalate absorption.. The results suggest that most oxalate is absorbed in the proximal portion of the gastrointestinal tract and that paracellular transport is involved. Augmented paracellular transport, as evidenced by increased sucralose absorption, may also influence oxalate absorption.

Topics: Calcium Oxalate; Female; Humans; Intestinal Absorption; Male; Middle Aged; Oxalates; Sucrose; Sweetening Agents; Urinary Calculi

Renal stones in children, although rare, may be associated with morbidity and renal damage. Scottish children have a different ethnic composition and diet compared with paediatric populations previously studied. Urinary stone promoters include calcium, oxalate and urate. Postulated inhibitors include citrate and glycosaminoglycans (GAGs). We tested the hypothesis that Scottish paediatric stone-formers have higher excretion of urinary stone promoters (calcium/oxalate/urate) and/or lower excretion of stone inhibitors (citrate/GAGs) than children with isolated haematuria and controls.. In this case-controlled study, we measured creatinine, calcium, oxalate, urate, citrate and GAGs in random urine samples from 24 stone-formers (excluding inherited metabolic disorders), median age 10.2 (range 1.0-17.2) y; 25 patients with isolated haematuria, 6.3 (0.6-13.7) y; and 32 controls, 7.5 (0.8-14.7) y.. Excretion of urinary promoters and inhibitors differed among stone-formers, haematuria and control groups for (median (range)): calcium (0.82 (0.02-2.19), 0.43 (0.08-2.65), 0.31 (0.04-2.12) mmol/mmol creatinine, respectively, P = 0.005), citrate (0.42 (0.13-0.72), 0.33 (0.05-0.84), 0.61 (0.11-1.75) mmol/mmol creatinine, P = 0.001), calcium:citrate ratio (1.68 (0.19-4.81), 1.30 (0.19-9.57), 0.54 (0.10-2.27) mmol/mmol, P < 0.0001) and the promoter:inhibitor ratio (calcium x oxalate)/(citrate x GAGs) (8.3 (1.0-82.5), 4.3 (1.2-69.5), 2.8 (0.3-13.2) mmol/g, P < 0.0001).. Scottish paediatric stone-formers had lower urinary citrate excretion and higher urinary calcium excretion, calcium:citrate ratio and promoter:inhibitor ratio compared with controls. Urinary calcium excretion and promoter:inhibitor ratio was also higher than children with isolated haematuria. Nevertheless, marked overlap between the stone-former and haematuria groups for promoter:inhibitor and calcium:citrate ratios suggests that some patients with isolated haematuria may be at future risk of urolithiasis.

Topics: Calcium; Calcium Oxalate; Calcium, Dietary; Case-Control Studies; Child; Citrates; Creatinine; Diet; Hematuria; Hospitals, Pediatric; Humans; Kidney Calculi; Oxalates; Population Groups; Risk Factors; Scotland; Uric Acid; Urinary Calculi; Urolithiasis; White People

Urinary tract stones are an important clinical problem in human and veterinary medicine. Hyperoxaluria is the single strongest promoter of kidney stone formation. The aims of the present study were to (a) evaluate oxalate degradation by a range of Bifidobacteria species and Lactobacillus species isolated from the canine and feline gastrointestinal tract in vitro and (b) to determine the impact of oxalate degradation by selected strains in vivo. The bacteria were grown in oxalate-containing media and their ability to degrade oxalate in vitro was determined using reverse-phased HPLC. Bifidobacteria species and Lactobacillus species that degraded oxalate in vitro and survived gastric transit were selected for further examination. The selected probiotics were fed to rats for 4 weeks. Urine was collected at week's 0, 2 and 4 and oxalate levels determined by HPLC. In vitro degradation was detected for 11/18 of the Lactobacillus species. In contrast, the capacity to degrade oxalate was not detected for any of the 13 Bifidobacterium species tested. Lactobacillus animalis 223C, Lactobacillus murinus 1222, L. animalis 5323 and L. murinus 3133 were selected for further investigation in a rat model. Urinary oxalate levels were significantly reduced (p<0.05) in animals fed L. animalis 5323 and L. animalis 223C but were unaltered when fed L. murinus 1222, L. murinus 3133 or placebo. Probiotic organisms vary widely in their capacity to degrade oxalate. In vitro degradation does not uniformly translate to an impact in vivo. The results have therapeutic implications and may influence the choice of probiotic, particularly in the setting of enteric hyperoxaluria.

Topics: Animals; Bifidobacterium; Body Weight; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Gastrointestinal Tract; Lactobacillus; Oxalates; Probiotics; Rats; Rats, Sprague-Dawley; Urinary Calculi

To test the hypothesis that patients with hyperoxaluria, who modified their dietary calcium intake, would reduce their urinary oxalate excretion without raising their urinary calcium excretion. Diet is a major factor in idiopathic calcium oxalate urolithiasis, yet controversy exists regarding the ideal clinical recommendations. Approximately 20% of patients with calcium oxalate stone formation have hyperoxaluria (> or = 45 mg oxalate/d). Calcium supplements to bind dietary oxalate have been suggested, but clinical evidence of this therapy is lacking.. Of 144 adult patients with stone formation seen by a registered dietitian from September 2006 to September 2007, 26 (18%) had hyperoxaluria on > or = 1 24-hour urinalyses. Of those with > or = 2 complete 24-hour collections and whose hyperoxaluria was observed before their last visit with the registered dietitian, 22 patients were identified. The patients were retrospectively separated into 2 groups according to whether they had been advised dietary changes alone (diet group, n = 10) or calcium citrate with meals, in addition to the dietary changes (supplement group, n = 12). The mean follow-up time was 317 and 266 days for the diet and supplement groups, respectively. Statistical comparisons within and between groups were made for urinary risk factors.. Urinary oxalate excretion decreased from 56 to 43 mg/d and from 60 to 46 mg/d in the diet and supplement groups, respectively (P = .003 and P = .038, respectively). Calcium oxalate supersaturation decreased from 3.48 to 1.83 and from 2.37 to 1.52 in the diet and supplement groups, respectively (P = .043 and P = .002, respectively). Urinary calcium excretion did not change in either group.. Gastrointestinal binding of oxalate by calcium is an effective clinical strategy for hyperoxaluria, whether mediated by calcium citrate with meals or by inclusion of calcium-containing foods with meals.

Topics: Calcium Oxalate; Cross-Sectional Studies; Diet; Female; Humans; Hyperoxaluria; Male; Middle Aged; Oxalates; Retrospective Studies; Urinary Calculi

To examine the cellular, plasma, and urinary oxalate and erythrocyte oxalate flux in patients with calcium oxalate monohydrate (COM) stone formation vs normal controls. Pathologic oxalate clearance in humans is mostly integrated in calcium oxalate stone formation. An underlying cause of deficient oxalate clearance could be defective transmembrane oxalate transport, which, in many tissues, is regulated by an anion exchanger (SLC26).. We studied 2 groups: 40 normal controls and 41 patients with COM stone formation. Red blood cells were divided for cellular oxalate measurement and for resuspension in a buffered solution (pH 7.40); 0.1 mmol/L oxalate was added. The supernatant was measured for oxalate immediately and 1 hour after incubation. The plasma and urinary oxalate were analyzed in parallel.. The mean cellular oxalate concentrations were significantly greater in the normal controls (5.25 +/- 0.47 micromol/L) than in those with COM stone formation (2.36 +/- 0.28 micromol/L; P < .01). The mean urinary oxalate concentrations were significantly greater in those with COM stone formation (0.31 +/- 0.02 mmol/L) than in the controls (0.24 +/- 0.02 mmol/L; P < .01). The cellular oxalate concentrations correlated significantly with the plasma (r = 0.49-0.63; P < .01) and urinary oxalate (r = -0.29-0.41; P < .03) concentrations in both groups. The plasma oxalate concentrations correlated significantly with the urinary oxalate concentrations (r = -0.30; P < .03) in the controls and with the erythrocyte oxalate flux (r = 0.25; P < .05) in those with COM stone formation.. Our data implicate the presence of a cellular oxalate buffer to stabilize plasma and urinary oxalate concentrations in normal controls.

Topics: Calcium Oxalate; Cells; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

We evaluated the clinical, radiological and metabolic features of 162 children with urolithiasis or microlithiasis who had been referred to our pediatric nephrology clinics between 1998 and 2008 with suspected urolithiasis. The medical histories of these children (78 girls, 84 boys), who ranged in age from 2 months to 16 years (mean age 5.59 +/- 0.35 years), were reviewed retrospectively for clinical and metabolic features of urinary tract calculi. Urinary tract infections (UTI) were present in 45.9% of the cases. The most common presenting symptoms were flank pain or restlessness (25.3%) and hematuria (21.6%), followed by UTI (16%), whereas 23.5% of the cases were detected incidentally during evaluation for other medical conditions. Other symptoms at presentation included dysuria, passing stones, penile edema, enuresis, vomiting and anorexia. Urine analysis revealed metabolic abnormalities in 87% of the cases, including hypercalciuria (33.8%), hypocitraturia (33.1%), hyperoxaluria (26.5%), hyperuricosuria (25.4%), hypocitraturia + hypercalciuria (21.1%), hyperphosphaturia (20.8%) and cystinuria (5.7%). Almost 50% of the patients had a positive family history for urolithiasis. The most frequently involved site was in the kidneys (86%). Ureters and bladder were involved in 12 and 2% of the cases, respectively. A family history of urolithiasis, presenting symptoms and underlying metabolic abnormalities were similar for microlithiasis and the patients with larger stones. However, in our study population, microlithiasis was mainly a disease of young infants, with a greater chance for remission and often not associated with structural changes. The presenting symptoms of urolithiasis show a wide spectrum, so that a high index of suspicion is important for early detection. A metabolic abnormality can be identified in 87% of cases of urolithiasis. Detection of microlithiasis may explain a number of symptoms, thus reducing invasive diagnostic procedures and allowing early recognition of metabolic abnormalities. These results draw attention to the importance of screening for UTIs in patients with urolithiasis.

Topics: Calcium; Child; Child, Preschool; Citric Acid; Cystinuria; Female; Humans; Hypercalciuria; Hyperoxaluria; Hypophosphatemia, Familial; Infant; Male; Metabolic Diseases; Oxalates; Phosphates; Retrospective Studies; Uric Acid; Urinary Calculi; Urinary Tract Infections; Urolithiasis

The secretion of the oxalate anion by intestinal epithelia is a functionally significant component of oxalate homeostasis and hence a relevant factor in the etiology and management of calcium oxalate urolithiasis. To test the hypothesis that human cystic fibrosis transmembrane conductance regulator (hCFTR) can directly mediate the efflux of the oxalate anion, we compared cAMP-stimulated 36Cl-, 14C-oxalate, and 35SO(4)2- efflux from Xenopus oocytes expressing hCFTR with water-injected control oocytes. hCFTR-expressing oocytes exhibited a large, reversible cAMP-dependent increase in whole cell conductance measured using a two-electrode voltage clamp and a 13-fold increase in rate of cAMP-stimulated 36Cl- efflux. In contrast, the rate constants of oxalate and sulfate efflux were low and unaffected by cAMP in either control or hCFTR-expressing oocytes. We conclude that the human CFTR gene product does not directly mediate oxalate efflux in secretory epithelia and hence is not directly involved in oxalate homeostasis in humans.

Topics: Animals; Chlorine; Cyclic AMP; Cystic Fibrosis Transmembrane Conductance Regulator; Female; Homeostasis; Humans; Membrane Potentials; Oocytes; Oxalates; Radioisotopes; RNA, Complementary; Urinary Calculi; Xenopus laevis

Although the measurement of oxalate in urine and serum by Amaranthus leaf oxalate oxidase immobilized on free arylamine glass beads is highly sensitive and specific, the handling of glass beads is tedious and cumbersome. The present study was undertaken to overcome this problem.. Partially purified Amaranthus spinosus leaf oxalate oxidase was immobilized through diazotization onto arylamine glass beads affixed on the surface of a plastic strip by a non reactive fixative and employed for oxalate determination in urine and serum samples collected from healthy individuals and urinary stone formers.. The immobilized enzyme retained 56 per cent of its initial activity with a conjugation yield of 40 mg/g support. The strip bound enzyme showed maximum activity at pH 3.5 when incubated at 40 degrees C for 15 min. The minimum detection limit of the method was 0.01 mM/l in the urine and 2.5 microM/l in the serum. The analytical recovery of added oxalate was 97.7+/-1.2 per cent in urine and 92.0+/-2.4 per cent in serum. Within and between assay coefficient of variation (CV) were 4.6 and 5.2 per cent in urine and 7.4 and 5.8 per cent in serum respectively. A good correlation for oxalate in urine (r1= 0.99) and in serum (r2= 0.92) was obtained between Sigma kit method and the present method. The strip could be reused 150 times over a period of 2 months, when stored at 4 degrees C in reaction buffer.. Immobilization of Amaranthus leaf oxalate oxidase on to affixed glass beads provided enormous ease in its reuse for determination of oxalate in urinary and serum samples.

Topics: Amaranthus; Chemistry, Clinical; Enzymes, Immobilized; Glass; Humans; Microspheres; Oxalates; Oxidoreductases; Urinary Calculi

Hyperoxaluria is one of the crucial risk factors for calcium stone formation.. Estimation of own reference range for 24-hour urinary oxalate (OX) excretion and evaluation of incidence of primary and secondary hyperoxaluria in children with calcium urolithiasis.. The study comprised 128 healthy children aged 4-17,9 years and 137 children aged 3.7-18 years with calcium urolithiasis.. In healthy children, the mean 24-hour urinary OX excretion was 0.305 +/- 0.109 mmol/ 1.73 m2/ 24 h. An upper normal limit for urinary OX excretion was assumed at 0.474 mmol/1, 73 m2 / 24 h (95th percentile). Patients with stones had significantly higher urinary OX excretion (0.381 +/- 0.173 mmol / 1.73 m/ 24 h) in comparison to healthy children. Secondary hyperoxaluria was revealed in 37 (27%) children, whereas primary hyperoxaluria type I was diagnosed in only 1 (0.7%).. Secondary hyperoxaluria occurred in a significant percentage of children with calcium urolithiasis, predominantly in males, whereas primary hyperoxaluria is casuistic.

Topics: Adolescent; Calcium; Child; Child, Preschool; Comorbidity; Female; Humans; Hyperoxaluria; Male; Oxalates; Reference Values; Urinary Calculi

The in vitro study of calcium oxalate (CaOx) stone formation is usually based on crystallisation models but it is recognised that both healthy individuals and stone formers have crystalluria. We have established a robust in vitro stone growth model based on the principle of mixed suspension, mixed product removal system (MSMPR). Utilising this technique we studied the influence of CaOx crystallisation kinetics and the variation of calcium and oxalate concentrations on CaOx stone growth in vitro. Six stones received standard concentration of Ca (6 mM) and Ox (1.2 mM) in the medium while another six received variable concentrations of both Ca and Ox at various intervals. Stone mass was plotted against the experiment duration (typically 5-7 weeks). The stone growth was dependent on sufficient input calcium and oxalate concentrations and once triggered, stone growth could not be maintained at reduced calcium and oxalate inputs. The stone growth rate was positively correlated to the number of crystals in suspension around the stone and to the crystal nucleation rate and negatively correlated to the crystal growth rates. This leads to the conclusion that aggregation of crystals from the surrounding suspension was the dominant mechanism for stone enlargement.

Topics: Calcium; Calcium Oxalate; Crystallization; Models, Biological; Oxalates; Urinary Calculi

Prevention of recurrent stone formation will only be possible with careful metabolic evaluation and appropriate management. In this present prospective study, a total of 95 patients with calcium oxalate (CaOx) stone disease were evaluated with respect to the effects of a calcium channel blocking agent (verapamil) therapy on stone-forming risk factors. A total of 95 patients with CaOx urolithiasis were well evaluated for the possible specific effects of verapamil administration on stone-forming risk factors during long-term follow-up. All patients had calcium-containing stones with normal renal morphology and function without any urinary tract infection. The follow-up period ranged from 12 to 36.6 months, with a mean value of 24.4 months. The age of the patients (54 male and 41 female; M/F: 1.31) ranged from 20 to 46 years (mean 34.3 years). On metabolic evaluation all patients had some kind of risk factors and patients were independently randomized into two groups, namely group 1 (n = 49): patients receiving calcium entry blocker, verapamil hydrochloride (isoptin 240 mg KKH tablets, oral t.i.d.); group 2 (n = 46): patients receiving no specific therapy (control patients) that were matched for sex and age. Follow-up results (at least 1 year) with respect to the changes in urinary stone-forming risk factors were recorded in both groups. During long-term follow-up patients undergoing no specific therapy did not show a significant change with respect to the urinary levels of stone-forming risk factors when compared with the others receiving verapamil on a regular basis. In the light of our results as well as the literature data, we believe that the pathophysiological mechanisms underlying the effect of verapamil on stone formation (as a result of enhanced crystal deposition) and on the excretion of the urinary stone-forming risk factors have to be well evaluated in further experimental as well as clinical studies. Although the exact mechanism of action is not clear; we may claim that the limitation of internal calcium shift by these agents may also well effect the tubular process related to oxalate handling which ultimately limits its excretion in urine.

Topics: Adult; Calcium Channel Blockers; Citrates; Female; Humans; Hyperoxaluria; Male; Middle Aged; Oxalates; Recurrence; Risk Factors; Time Factors; Urinary Calculi; Verapamil

Urolithiasis is a disease of a complex, often systemic and not fully unequivocal, etiopathological mechanism, resulting in concrement crystallization The aim of study was the evaluation of frequency of occurrences of crystallization risk states and urolithiasis in children with IBD.. The study was conducted on 35 children aged between 12 and 18 with confirmed ulcerative colitis (25 children) and Crohn disease (10 children). In all children regiular urine examination and urine inoculation were conducted, as well as stimation of concrement crystallization risk index in a twenty-four hour urine collection. Urinary tract ultrasound as well as evaluation of erythrocytes in urine sediment in phase contrast microscope,have been performed. Control group consisted of 20 children without digestive tract complains.. In 13 (37%) of examined children, urolithiasis occured in family history. The general urine examination revealed in 27 (77%) examined children existence of erytrocyturia of various degree and the evaluation in phase contrast microscope indicated their extraglomucal origin. The ion-creatininal analysis of twenty-four hour urine collection revealed in 29 (82.2%) children risk of oxalate-calcium concrements crystallization and in 6 (17%) children--of oxalate concrements crystallization. USG examination revealed in 4 (11.4%) children existence of single or multiple concrements in urinary system. Analysis of 1 twenty-four hour urine collection indicated the decrease of magnesium ions in 27 (77%) examined children. In control group only in 2 (5.7%) children the risk of occurrence of phosphate-ammonium concrements crystallization, which was significantly lower in examined group (p < 0.01).. Unspecific intestine inflammations have an influence on the occurrence of crystallization risk states, as well as a fully symptomatic urolithiasis.

Topics: Adolescent; Calcium Oxalate; Colitis, Ulcerative; Crohn Disease; Crystallization; Female; Hematuria; Humans; Inflammatory Bowel Diseases; Lithiasis; Magnesium; Male; Oxalates; Oxalic Acid; Risk Factors; Urinary Calculi; Urine; Urolithiasis

The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1+/-24.0 vs 16.1+/-20.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=-0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependent from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of the diet of the individual patient.

Topics: Acids; Adolescent; Adult; Aged; Aged, 80 and over; Calcium; Citric Acid; Female; Food; Humans; Male; Middle Aged; Oxalates; Regression Analysis; Risk Factors; Uric Acid; Urinary Calculi

The purpose of this pilot study was to establish the dependence or independence of oxalate absorption on the quantity of the test dose of sodium oxalate over a range of test doses corresponding to physiological dietary oxalate intake values. Gastrointestinal oxalate absorption was measured with the [13C2]oxalate absorption test. Six healthy volunteers were always tested under standardized dietary conditions with 63 mg dietary oxalate and 800 mg dietary calcium per day. The volunteers were tested thrice each with sodium oxalate test doses of 25, 50, 200, and 600 mg. Additionally, 1000 mg sodium oxalate was applied once to three of these volunteers. The oxalate absorption of the six volunteers tested under the standardized conditions with 50 mg sodium [13C2]oxalate was 7.2 +/- 2.62 % (mean +/- SD), similar to the 120 volunteers tested previously: 8.0 +/- 4.4 % (mean +/- SD). The tests with sodium [13C2]oxalate doses in the range 25-1000 mg revealed similar percent oxalate absorption values. In conclusion, in healthy volunteers, the amount of oxalate absorbed in the gastrointestinal tract increased proportionally with the higher test doses of oxalate. However, percent oxalate absorption remained unchanged with test doses in the dose range of physiological dietary oxalate intakes.

Topics: Adult; Carbon Isotopes; Digestive System; Female; Humans; Intestinal Absorption; Male; Middle Aged; Oxalates; Pilot Projects; Reference Values; Urinary Calculi

The primary goal of this study was to test the hypothesis that Oxalobacter colonization alters colonic oxalate transport thereby reducing urinary oxalate excretion. In addition, we examined the effects of intraluminal calcium on Oxalobacter colonization and tested the hypothesis that endogenously derived colonic oxalate could be degraded by lyophilized Oxalobacter enzymes targeted to this segment of the alimentary tract. Oxalate fluxes were measured across short-circuited, in vitro preparations of proximal and distal colon removed from Sprague-Dawley rats and placed in Ussing chambers. For these studies, rats were colonized with Oxalobacter either artificially or naturally, and urinary oxalate, creatinine and calcium excretions were determined. Colonized rats placed on various dietary treatment regimens were used to evaluate the impact of calcium on Oxalobacter colonization and whether exogenous or endogenous oxalate influenced colonization. Hyperoxaluric rats with some degree of renal insufficiency were also used to determine the effects of administering encapsulated Oxalobacter lysate on colonic oxalate transport and urinary oxalate excretion. We conclude that in addition to its intraluminal oxalate-degrading capacity, Oxalobacter interacts physiologically with colonic mucosa by inducing enteric oxalate secretion/excretion leading to reduced urinary excretion. Whether Oxalobacter, or products of Oxalobacter, can therapeutically reduce urinary oxalate excretion and influence stone disease warrants further investigation in long-term studies in various patient populations.

Topics: Animals; Biological Transport; Calcium; Colon; Creatinine; Intestinal Mucosa; Intestines; Male; Nephrectomy; Oxalates; Oxalobacter formigenes; Probiotics; Rats; Rats, Sprague-Dawley; Renal Insufficiency; Urinary Calculi

We assessed the importance of oxalate hyperabsorption for idiopathic calcium oxalate urolithiasis, oxalate absorption in healthy volunteers and recurrent calcium oxalate stone formers was compared.. The [(13)C2]oxalate absorption test, a standardized, radioactivity-free test, was performed. On 2 days 24-hour urine was collected and an identical standard diet containing 800 mg Ca daily was maintained. On the morning of day 2 a capsule containing 0.37 mmol sodium [(13)C2]oxalate was ingested. A total of 120 healthy volunteers (60 women and 60 men) and 120 patients (30 women and 90 men) with idiopathic CaOx urolithiasis (60% or greater CaOx) were tested.. Mean intestinal oxalate absorption in the volunteers was 8.0 +/- 4.4%, and in the patients was 10.2 +/- 5.2% (p <0.001). There was no significant difference in mean absorption values between men and women within both groups. A high overlap between the absorption values of volunteers and patients was found. Only in the patient group did absorption values greater than 20% occur. Oxalate absorption correlated with oxalate excretion in the patients, r = 0.529 (p <0.01) and in the volunteers, r = 0.307 (p <0.01).. In high oxalate absorbers dietary oxalate has a significant role in oxalate excretion and, therefore, increases the risk of calcium oxalate stone formation.

Topics: Adolescent; Adult; Calcium Oxalate; Carbon Isotopes; Female; Humans; Intestinal Absorption; Male; Middle Aged; Oxalates; Urinary Calculi

We aimed to objectively determine changes in the various urinary parameters along with CaOx saturation level during pregnancy. The study included 15 pregnant women who had no known diseases and were taking no medication except prenatal supplements. Mean age of the patients was 26 years (range 20-30). In all of them, this study was carried out in each trimester and 3 months post partum. All participants were followed up, and blood and urine samples were obtained during the pregnancy and during 3 months post partum. All subjects collected 24-h urine samples. The pregnant women had hypercalciuria in all three trimesters. Except for the first trimester, urine calcium levels in all trimesters were significantly higher when compared with the post-partum period (P<0.01 for second trimester, P<0.05 for third trimester). Urine oxalate level in post-partum period was significantly higher than urine oxalate levels in each trimester (P<0.05). The urine citrate levels were similarly higher than normal levels in three trimesters. Urine citrate level of the post-partum period was in normal reference ranges. This difference was not statistically significant (P>0.05). We believe that hypercalciuria encountered at pregnancy is a reversible physiologic condition. Also, citrate and magnesium as urinary inhibitors increased in urine during gestation preventing stone formation. We think that long time periods are needed for hypercalciuria to be able to lead to the formation of urinary calculi in pregnant women (except women having a positive family history). Therefore, we think that the pregnancy alone does not predispose to a suitable condition for calculi.

Topics: Calcium; Citric Acid; Female; Humans; Magnesium; Oxalates; Pregnancy; Prospective Studies; Sodium; Uric Acid; Urinary Calculi

The rat kidney H1 oxalate binding protein was isolated and purified. Oxalate binds exclusively with H1B fraction of H1 histone. Oxalate binding activity is inhibited by lysine group modifiers such as 4',4'-diisothiostilbene-2,2-disulfonic acid (DIDS) and pyridoxal phosphate and reduced in presence of ATP and ADP. RNA has no effect on oxalate binding activity of H1B whereas DNA inhibits oxalate binding activity. Equilibrium dialysis method showed that H1B oxalate binding protein has two binding sites for oxalate, one with high affinity, other with low affinity. Histone H1B was modeled in silico using Modeller8v1 software tool since experimental structure is not available. In silico interaction studies predict that histone H1B-oxalate interaction take place through lysine121, lysine139, and leucine68. H1B oxalate binding protein is found to be a promoter of calcium oxalate crystal (CaOx) growth. A 10% increase in the promoting activity is observed in hyperoxaluric rat kidney H1B. Interaction of H1B oxalate binding protein with CaOx crystals favors the formation of intertwined calcium oxalate dehydrate (COD) crystals as studied by light microscopy. Intertwined COD crystals and aggregates of COD crystals were more pronounced in the presence of hyperoxalauric H1B.

Topics: Amino Acid Sequence; Animals; Binding Sites; Computational Biology; Computer Simulation; Disease Models, Animal; Histones; Male; Models, Chemical; Models, Molecular; Molecular Conformation; Molecular Sequence Data; Nucleocytoplasmic Transport Proteins; Oxalates; Protein Binding; Protein Interaction Mapping; Rats; Rats, Wistar; Sequence Analysis, Protein; Urinary Calculi

Supplementation of certain calcium crystallization inhibitors, such as citrate and magnesium, and the dilution of urine with water are now considered consolidated practice for the prevention of calcium kidney stones. The aim of this study is to verify, using tried and true in vitro methods, whether the effect of these inhibitors can manifest itself in different ways depending on whether the urine is concentrated or diluted. Calcium oxalate crystallization was studied on 4-h urine of 20 male idiopathic calcium oxalate stone formers, first under low hydration conditions (non-diluted urine) and then under high hydration conditions (diluted urine). Both the diluted and the non-diluted urine samples were subjected to three types of load: (a) an oxalate concentration increment of 1.3 mmol/l only; (b) an oxalate concentration increment of 1.3 mmol/l with a citrate concentration increment of 1.56 mmol/l; (c) an oxalate concentration increment of 1.3 mmol/l with a magnesium concentration increment of 2.08 mmol/l. In non-diluted urine, the addition of the citrate and magnesium did not modify the crystallization parameters under study. In contrast, in the diluted urine the addition of the citrate and magnesium led to a reduction in the total quantity of crystals (equivalent to 35-45%) and their aggregates (equivalent to 30-40%); at the same time, there was an increase in the diameter of the monohydrate calcium oxalate crystals, which also underwent a morphological change. In conclusion, the inhibitory effects of citrate and magnesium on the crystallization of calcium oxalate do not manifest themselves in highly concentrated urine.

Topics: Calcium Oxalate; Citrates; Crystallization; Humans; Magnesium; Male; Oxalates; Urinary Calculi; Urine

Timed urine collections are a standard part of the evaluation for predisposition to stone formation in children with urolithiasis. Supersaturation is defined as the ratio of the concentration of dissolved salt to its solubility in urine. The purpose of the present study was to determine if adding supersaturation to the standard timed urine collection increased the ability to detect a metabolic predisposition to stone formation. Thirty-two children with urolithiasis had 24-hour urine measurements of calcium, oxalate, citrate, uric acid, and cystine (the "traditional" evaluation), as well as supersaturation for calcium oxalate, calcium phosphate, and uric acid, on the same urine sample. Nine (28%) of the 32 were hypercalciuric, 2 (6%) hyperoxaluric, and 4 (12%) hypocitraturic. In total, 14 (44%) had a metabolic predisposition that was detected by the traditional evaluation. Supersaturation was elevated in 18 (56%), including nine who did not have metabolic predisposition detected by traditional evaluation. Urine volume was low in 17 (53%) of 32 children, including eight of nine children with abnormal supersaturation but normal traditional evaluation. Only one child with normal traditional evaluation and normal urine volume had elevated supersaturation. These results show that the benefit of adding supersaturation to the traditional evaluation was largely negated by consideration of urine volume.

Topics: Adolescent; Calcium; Child; Child, Preschool; Citric Acid; Female; Humans; Male; Osmolar Concentration; Oxalates; Uric Acid; Urinary Calculi

Our understanding of nitrosative stress in the process of urolithiasis is far from complete. Earlier studies carried out in our laboratory demonstrate the presence of nitrated THP in stone formers, l-arginine (l-arg) a precursor of nitric oxide (NO), attenuates the endothelial dysfunction caused by reactive nitrogen species. We investigated the role of l-arg in ethylene glycol (EG)-induced urolithic rat model and observed its antilithic and antioxidative properties.. Hyperoxaluria was induced using 0.75% EG in drinking water. l-arg [1.25 g/kg body weight] was given orally for a period of 28 days.. EG-treated rats showed significant loss in body weight and increase in the activities of oxalate synthesizing enzymes such as glycollic acid oxidase in liver. Lactate dehydrogenase activity in liver and kidney was increased. The activity of the free radical producing enzyme xanthine oxidase, tissue oxalate and calcium levels were significantly increased in EG-treated rats. Depletion in the antioxidant enzymes, membrane bound ATPases and thiol status was observed in these rats. l-arg co-supplementation to EG-treated rats maintained the activities of the oxalate synthesizing enzymes and free radical producing enzymes with in the normal range. Tissue oxalate and calcium levels were also maintained near normal in l-arg treated hyperoxaluric rats. l-arg, by its cytoprotective effect, maintained the thiol status, thereby preserving the activities of the membrane bound ATPases and preventing proteinuria and subsequent weight loss in EG-treated rats.. l-arg feeding prevents the retention of calcium oxalate crystals in hyperoxaluric rats by way of protecting the renal cells from oxidative injury and also by providing a second line of defense through the normalization of the oxalate metabolism. It reduces the risk of stone formation, by curtailing free radicals and hyperoxaluria as both of them have to work in close association to form stones.

Topics: Animals; Antioxidants; Arginine; Body Weight; Dietary Supplements; Disease Models, Animal; Ethylene Glycol; Free Radicals; Hyperoxaluria; Kidney; L-Lactate Dehydrogenase; Liver; Male; Nitrosation; Oxalates; Oxidative Stress; Oxidoreductases; Rats; Rats, Wistar; Uricosuric Agents; Urinary Calculi

Urine contains variable amounts of organic matter derived from cell degradation. The cellular detritus is composed by membranous and cytosolic glycoproteins, etc. The aim of this paper was to study the role of organic matter in calcium oxalate crystal development and to evaluate the action of some crystallization inhibitors on this process. Crystallization studies were carried out on urine in stagnant urine as well as under flow conditions, in presence and absence of cellular debris. Low amounts of cellular debris (when batch conditions were used), exhibited some inhibitory activity on heterogeneous nucleation of calcium oxalate monohydrate crystals, probably due to glycoproteins. Increasing amounts of cellular debris, however, promoted the nucleation of calcium oxalate monohydrate crystals. When cellular debris was retained in a cavity with a urine flow, this organic matter effectively induced the development of primary aggregates of calcium oxalate monohydrate crystals (crystallization range 2.8 mg/h per mg of organic matter). Presence of crystallization inhibitors prevented or minimized crystal development. These findings show that cell debris provides the necessary elements for the development of oxalate crystals and that this process can be effectively inhibited by presence of crystallization inhibitors.

Topics: Animals; Calcium Oxalate; Crystallization; Kidney; Lithiasis; Organic Chemicals; Oxalates; Rats; Rats, Wistar; Urinary Calculi

Oxalate is a metabolic end product excreted primarily by the kidney and associated with several pathologic conditions. The most common pathologic condition involving oxalate is the formation of calcium oxalate stones in the kidney. Several stimuli have been implicated in the development of glomerular and tubular injury in various forms of immune-mediated renal diseases. The elevated level of interleukin-6 (IL-6) has been reported in the urine of kidney stone-forming patients. In the present study, we investigated the role of oxalate, a major constituent of calcium oxalate kidney stone disease, in the production of IL-6 in normal human HK-2 kidney cells.. Confluent cultures of HK-2 cells (a renal epithelial cell line of human origin) were exposed to various concentrations of oxalate (0.2 to 2.0 mmol/L) and lipopolysaccharide (LPS) (0.1 and 10 mug/mL) for various time points (4-24 h) under serum-free conditions. The conditioned mediums were collected, and an IL-6 protein level was measured by enzyme-linked immunosorbent assay (ELISA). The total cellular RNA was isolated from the cells and subjected to relative quantitative reverse transcription-polymerase chain reaction (RT-PCR) to determine the expression of IL-6 mRNA. The statistical analysis of the results was carried out using the Student t test.. HK-2 cells express IL-6 mRNA and protein. Oxalate increased the secretion of IL-6 protein in HK-2 cells in a concentration-dependent fashion. Oxalate exposure to HK-2 cells also induced transcriptional up-regulation of the IL-6 gene, as determined by the increased level of IL-6 mRNA expression following treatment with oxalate. Moreover, the effects of oxalate on IL-6 expression were time- and concentration-dependent. This is the first report demonstrating the regulation of IL-6 by oxalate.. This study provides the first direct evidence that oxalate up-regulates the expression and secretion of IL-6 in renal epithelial cells. The increased IL-6 expression and secretion by renal epithelial cells may play a critical role in the progression of urolithiasis in hyperoxaluric conditions.

Topics: Cell Line; Dose-Response Relationship, Drug; Gene Expression; Humans; Hyperoxaluria; Interleukin-6; Kidney Tubules, Proximal; Lipopolysaccharides; Oxalates; RNA, Messenger; Up-Regulation; Urinary Calculi

Hyperoxaluria has been incriminated to account for the increased incidence of urolithiasis or nephrocalcinosis in patients with cystic fibrosis (CF). Hyperoxaluria presumably is caused by fat malabsorption and the absence of such intestinal oxalate-degrading bacteria as Oxalobacter formigenes. To better elucidate its pathophysiological characteristics, we prospectively studied patients with CF by determining these parameters and performing renal ultrasonography twice yearly.. In addition to routine tests in urine (lithogenic and stone-inhibitory substances), the presence of O formigenes was tested in stool, plasma oxalate was measured, and a [13C2]oxalate absorption test was performed in 37 patients with CF aged 5 to 37 years (15 females, 22 males) who were constantly hyperoxaluric before the study.. Hyperoxaluria (oxalate, 46 to 141 mg/1.73 m2/24 h [0.51 to 1.57 mmol/1.73 m2/24 h]; normal, < 45 mg/1.73 m2/24 h [< 0.5 mmol/1.73 m2/24 h]) was now found in 24 patients (64.8%). Plasma oxalate levels were elevated in 6 patients (7.92 to 19.5 micromol/L; normal, 6.3 +/- 1.1 micromol/L). Oxalobacter species were detected in only 1 patient. Intestinal oxalate absorption was elevated (11.4% to 28.5%; normal, < 10%) in 23 patients. Hypocitraturia was present in 17 patients (citrate, 0.35 to 2.8 g/1.73 m2/24 h [0.2 to 1.1 mmol/1.73 m2/24 h]; normal female, > 2.8 mg/1.73 m2/24 h [> 1.6 mmol/1.73 m2/24 h]; male, > 3.3 mg/1.73 m2/24 h [> 1.9 mmol/1.73 m2/24 h]). Urine calcium oxalate saturation was elevated in 17 patients (5.62 to 28.9 relative units; normal female, < 5.5 relative units; male, < 6.3 relative units). In 16% of patients, urolithiasis (n = 2) or nephrocalcinosis (n = 4) was diagnosed ultrasonographically.. Absorptive hyperoxaluria and hypocitraturia are the main culprits for the increased incidence of urolithiasis and nephrocalcinosis in patients with CF. We advocate high fluid intake, low-oxalate/high-calcium diet, and alkali citrate medication, if necessary. Additional studies are necessary to determine the influence of Oxalobacter species or other oxalate-degrading bacteria on oxalate handling in patients with CF.

Topics: Adolescent; Adult; Calcium, Dietary; Carbon Isotopes; Child; Child, Preschool; Citrates; Cystic Fibrosis; Dietary Fats; Feces; Female; Fluid Therapy; Humans; Hyperoxaluria; Intestinal Absorption; Intestines; Malabsorption Syndromes; Male; Nephrocalcinosis; Oxalates; Oxalobacter formigenes; Risk; Urinary Calculi

The interaction between tubular epithelial cells and calcium oxalate crystals or oxalate ions is a very precarious event in the lithogenesis. Urine contains ions, glycoproteins and glycosaminoglycans that inhibit the crystallization process and may protect the kidney against lithogenesis. We examined the effect of oxalate ions and calcium oxalate crystals upon the synthesis of glycosaminoglycans in distal [Madin-Darby canine kidney (MDCK)] and proximal (LLC-PK1) tubular cell lines.. Glycosaminoglycan synthesis was analyzed by metabolic labeling with (35)S-sulfate and enzymatic digestion with specific mucopolysaccharidases. Cell death was assessed by fluorescent dyes and crystal endocytosis was analised by flow cytometry.. The main glycosaminoglycans synthesized by both cells were chondroitin sulfate and heparan sulfate most of them secreted to the culture medium or present at cellular surface. Exposition of MDCK cells to oxalate ions increased apoptosis rate and the incorporation of (35)S-sulfate in chondroitin sulfate and heparan sulfate, while calcium oxalate crystals were endocyted by LLC-PK1, induced necrotic cell death, and increased (35)S-sulfate incorporation in glycosaminoglycans. These effects seem to be specific and due to increased biosynthesis, since hydroxyapatite and other carboxylic acid did not induced cellular death or glycosaminoglycan synthesis and no changes in sulfation degree or molecular weight of glycosaminoglycans could be detected. Thapsigargin inhibited the glycosaminoglycan synthesis induced by calcium oxalate in LLC-PK1, suggesting that this effect was sensitive to the increase in cytosolic calcium.. Tubular cells may increase the synthesis of glycosaminoglycans to protect from the toxic insult of calcium oxalate crystals and oxalate ions, what could partially limit the lithogenesis.

Topics: Animals; Calcium; Calcium Oxalate; Cell Death; Cell Survival; Crystallization; Dogs; Durapatite; Endocytosis; Formates; Glycosaminoglycans; Ionophores; Ions; Kidney Tubules, Distal; Kidney Tubules, Proximal; LLC-PK1 Cells; Necrosis; Oxalates; Sulfates; Sulfur Radioisotopes; Swine; Thapsigargin; Urinary Calculi

While the effect of jejunoileal bypass (JIB) reversal has been well studied regarding hepatic function, there is little information regarding the effect of reversal on renal function and even less data regarding the metabolic urinary stone environment. We evaluated the results of JIB reversal on renal function, the urinary stone milieu and the clinical development of recurrent calculi in affected patients.. From 1995 to 2003, 4 female patients with a mean age of 48.2 years underwent JIB reversal primarily for refractory stone disease. The clinical and metabolic courses prior to and following bypass reversal were reviewed specifically to evaluate renal function, serum and urinary metabolic stone profiles, and clinical stone formation.. At initial presentation following JIB all 4 patients had significantly increased 24-hour urinary oxalate (range 80 to 160 mg, mean 112.5, normal less than 50) and significantly low 24-hour urinary citrate (range 5 to 62 mg, mean 21.5, normal greater than 320). Following reversal 24-hour urinary oxalate normalized to between 31 and 36 mg (mean 33.75). However, 24-hour urinary citrate continued to be low (range 215 to 248 mg, mean 226.5). After JIB reversal all 4 patients continued to have new stones until the commencement of urinary alkalization, following which only 1 had 1 calculus, which occurred 47 months after reversal. After JIB mean serum creatinine was 1.48 mg/dl (range 0.8 to 1.9) and mean urinary creatinine excretion was 0.91 mg per hour (range 0.69 to 1.15). After JIB reversal mean serum creatinine was 1.28 mg/dl (range 0.6 to 2.0) and mean urinary creatinine excretion was 1.0 mg per hour (range 0.85 to 1.10).. JIB reversal normalizes 24-hour urinary oxalate. While urinary citrate improves, it continues to be low and such patients are at high risk for recurrent stone formation. However, in this setting appropriate replacement therapy has a significant and positive impact on that propensity.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Intestinal Absorption; Jejunoileal Bypass; Kidney Calculi; Kidney Function Tests; Oxalates; Probability; Reoperation; Risk Assessment; Sampling Studies; Severity of Illness Index; Treatment Outcome; Urinary Calculi

Despite hyperoxalurogenic eating habits relative to white subjects, South African blacks have urinary oxalate excretions, Tiselius risk indices (AP(CaOx)) and calcium oxalate saturations, which do not differ significantly from those of their white counterparts. The present study was undertaken to establish whether the BONN-Risk-Index (BRI) might discriminate between the urines of the two population groups and whether differences might exist in their respective gastrointestinal absorption rates of oxalate. Participants (n = 15 in each group) provided 24 h urines on their free diets for BRI determination. Gastrointestinal oxalate absorption was measured using the [13C2]oxalate absorption test. Results showed that BRI values were significantly lower in black subjects (2.04 vs 4.90, P = 0.034), but that there was no difference in the oxalate absorption between the groups (10.30 vs 9.95%, P = 0.87). These results suggest that South African black subjects handle dietary oxalate more efficaciously than white subjects and that this occurs via some endogenous mechanism, which has not yet been identified or characterized.

Topics: Black People; Humans; Male; Oxalates; Risk Factors; Urinary Calculi; White People

The aim of the study was to assess the influence of overweight and obesity on the risk of calcium oxalate stone formation.. BMI, 24-hour urine, and serum parameters were evaluated in idiopathic calcium oxalate stone formers (363 men and 164 women) without medical or dietetic pretreatment.. Overweight and obesity were present in 59.2% of the men and in 43.9% of the women in the study population. Multiple linear regression analysis revealed a significant positive relationship between BMI and urinary uric acid, sodium, ammonium, and phosphate excretion and an inverse correlation between BMI and urinary pH in both men and women, whereas BMI was associated with urinary oxalate excretion only among women and with urinary calcium excretion only among men. Serum uric acid and creatinine concentrations were correlated with BMI in both genders. Because no association was established between BMI and urinary volume, magnesium, and citrate excretion, inhibitors of calcium oxalate stone formation, the risk of stone formation increased significantly with increasing BMI among both men and women with urolithiasis (p = 0.015). The risk of calcium oxalate stone formation, median number of stone episodes, and frequency of diet-related diseases were highest in overweight and obese men.. Overweight and obesity are strongly associated with an elevated risk of stone formation in both genders due to an increased urinary excretion of promoters but not inhibitors of calcium oxalate stone formation. Overweight and obese men are more prone to stone formation than overweight women.

Topics: Adult; Body Mass Index; Calcium; Calcium Oxalate; Citric Acid; Creatinine; Diet; Female; Humans; Hydrogen-Ion Concentration; Linear Models; Magnesium; Male; Middle Aged; Obesity; Oxalates; Sex Characteristics; Uric Acid; Urinary Calculi; Urine

In idiopathic recurrent urolithiasis (IRCU) calcium oxalate and calcium phosphate are components of stones. It is not sufficiently known whether in urine the nucleation (liquid-solid transition) of each salt requires a different environment, if so which environment, and whether there is an impact on stone formation. Nucleation was induced by in vitro addition of oxalate or calcium to post-test meal load whole urine of male stone patients (n=48), showing normal daily and baseline fasting oxaluria. The maximally tolerated (until visible precipitates occur) concentration of oxalate (T-Ox) or calcium (T-Ca) was determined; additionally evaluated were other variables in urine, including total, complexed and free citrate (F-Cit), protein (albumin, non-albumin protein) and the clinical intensity (synonymous metabolic activity; MA) of IRCU. In the first of three trials the accumulation of substances in stone-forming urine was verified (trial-V); in the second (clinical trial 1) two strata of T-Ox (Low, High) were compared; in the third (clinical trial 2) IRCU patients (n=27) and a control group (n=13) were included to clarify whether in stone-forming urine the first crystal formed was calcium oxalate or calcium phosphate, and to identify the state of F-Cit. T-Ox was studied at the original pH (average < 6.0), T-Ca at prefixed pH 6.0; the precipitates were subjected to electron microscopy and element analysis. Trial-V: Among the urinary substances accumulating at the indicated pHs were calcium, oxalate and phosphate, and the crystal-urine ratios were compatible with the nucleation of calcium oxalate, calcium-poor and calcium-rich calcium phosphate; citrate, protein and potassium also accumulated. Clinical trial 1: the two strata exhibited an inverse change of T-Ox and T-Ca, the ratio T-Ox/T-Ca and MA. The initial (before induction of Ox or Ca excess) supersaturation of calcium oxalate and brushite were unchanged, with the difference of proteinuria being borderline. Several correlations were significant (p < or = 0.05): urine pH with citrate and volume, protein with volume and MA, T-Ox with T-Ca and MA. Clinical trial 2: in patients with reduced urine volume and moderate urine calcium excess, the first precipitate appeared to be calcium oxalate, followed by amorphous calcium phosphate. Conversely, when the calcium excess was extreme, calcium-rich hydroxyapatite developed, followed by calcium oxalate; F-Cit, not total and complexed citrate, was decreased in IRCU vs.

Topics: Adult; Aged; Calcium; Calcium Chloride; Calcium Oxalate; Calcium Phosphates; Citric Acid; Creatine; Crystallization; Crystallography; Data Interpretation, Statistical; Electron Probe Microanalysis; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Phosphates; Postprandial Period; Potassium; Proteins; Proteinuria; Regression Analysis; Urinary Calculi; Urine

SELDI-TOF-MS is a highly sensitive protein-analysis tool capable of detecting minute protein profile differences between biological samples. As proteins have been associated with urinary tract calculi, protein-based urinalysis may offer insights into their diagnosis. The purpose of this study was to evaluate SELDI-TOF-MS as a potential method for identifying urinary biomarkers of urolithiasis. Midstream sterile urine samples were obtained from 25 male patients with a confirmed diagnosis of urolithiasis (test group) and 25 male subjects with no known history of the disease (controls). Urinary levels of oxalate, total protein, albumin, and osteopontin were determined. Protein profiles were generated using SELDI-TOF-MS.SELDI-TOF-MS profiling revealed a relationship between protein peak intensities at 67 and 24 kDa that differed between the two groups. The ratio of p67:p24 was found to be less than 1.0 in all of the control samples (mean 0.26), while 18 out of 25 (72%) of the test group samples displayed a ratio greater than 1.0 (total group mean 4.75, P<0.001). Albumin, total protein, and oxalate levels were higher in the test group than the controls. Although SELDI-TOF-MS is not yet in widespread use in hospital and diagnostic laboratories, this system represents a promising new method for rapidly identifying patients with urolithiasis.

Topics: Albumins; Biomarkers; Case-Control Studies; Humans; Male; Osteopontin; Oxalates; Proteins; Proteome; Sialoglycoproteins; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Urinary Calculi

Renal tubular epithelium is the major target for oxalate induced injury, and sustained hyperoxaluria together with CaOx crystal formation/deposition may induce renal tubular cell damage and/or dysfunction. This may express itself in cell apoptosis. To evaluate the possible protective effects of certain agents (vitamin E, potassium citrate, allopurinol, verapamil and MgOH) on the presence and the severity of apoptotic changes caused by hyperoxaluria on renal tubular epithelium, an experimental study in rabbits was performed. Seventy rabbits were divided into seven different groups (each group n = 10): in group I severe hyperoxaluria was induced by continuous ethylene glycol (0.75%) administration started on day 0 and completed on day 14. Histologic alterations including crystal formation together with apoptotic changes (by using the TUNEL method) were evaluated on days 21 and 42, respectively. In the remaining experimental groups (groups II-VI), animals received some agents in addition to the induction of hyperoxaluria in an attempt to limit apoptotic changes. Group VII) animals constituted the controls. Kidneys were examined histopathologically under light microscopy for the presence and degree of crystal deposition in the tubular lumen. The percentage of apoptotic nuclei in the control group was significantly different from the other group animals (2.9-2.4%) in all study phases (P < 0.05). Apart from potassium citrate and allopurinol, the other medications seemed to prevent or limit the formation of apoptotic changes in renal tubular epithelium during the early period (day 21). The percentage of positively stained nuclei in animals undergoing potassium citrate medication ranged from 24.3% to 28.6%, with an average of 27.1%. This was 18.4% in animals receiving allopurinol. On the other hand, animals receiving magnesium hydroxide (MgOH), verapamil and vitamin E demonstrated limited apoptotic changes (11.2, 9.7, 8.7%, respectively) during this phase(P < 0.05). In the long-term (day 42), the animals receiving allopurinol and vitamin E showed a decrease in the percentage of the positively stained nuclei (13.5% and 8.3%, respectively). Animals in the other groups showed an increase in the number and percentage of apoptotic cells. Although, there was a significant decrease in the mean values of apoptosis in animals receiving vitamin E (8.7%-8.3%) and allopurinol (18.4%-13.5%) (P < 0.05), animals on verapamil, MgOH and potassium citrate medication had an increas

Topics: Allopurinol; Animals; Apoptosis; Cells, Cultured; Disease Models, Animal; Hyperoxaluria; In Situ Nick-End Labeling; Kidney Tubules; Male; Oxalates; Potassium Citrate; Rabbits; Random Allocation; Reference Values; Sensitivity and Specificity; Urinary Calculi; Urothelium; Verapamil; Vitamin E

Topics: Ammonia; Animals; Cats; Creatinine; Diet; Dietary Proteins; Female; Male; Oxalates; Urea; Urinary Calculi

Urolithiasis is a disease that has a high recurrence rate. We think that dietary guidance is necessary for the prevention of urolithiasis. It is important that stone formers eat a well-balanced diet and proper quantity of foods.

Topics: Adult; Calcium; Fish Products; Humans; Male; Oxalates; Spinacia oleracea; Surveys and Questionnaires; Urinary Calculi

Hyperoxaluria is a prominent risk factor for calcium oxalate urinary stones. Oxalate in urine is synthesized in the body or absorbed from food in the gastrointestinal tract. The amount of oxalate absorbed by patients with calcium oxalate stones may vary from a few percent to 50% of the dietary intake. Reference values for oxalate absorption measured under a standardized diet have never been attained in sufficient numbers from healthy individuals. Therefore, to our knowledge we collected for the first time the values required to interpret test results in patients with recurrent urinary stones.. A total of 120 healthy volunteers, including 60 females and 60 males, received an identical standard diet on 2 consecutive days. On the morning of day 2 a capsule containing 0.37 mmol. sodium [13C2]oxalate (not radioactive) was ingested with water. Urinary oxalate was measured by gas chromatography-mass spectrometry. Absorption at a fixed 800 mg. daily Ca input is expressed as a percent of the labeled oxalate dose.. For the standardized [13C2]oxalate absorption test the reference range in 95% of the 120 volunteers was 2.2% to 18.5% (mean +/- SD 7.9% +/- 4.0%). The repeatability of the standardized test was determined in 26 of the 120 volunteers by repeating the test twice. The mean intra-individual SD was 3.39% +/- 1.68%.. We assessed reference values of intestinal oxalate absorption using a standardized diet. Interindividual and intra-individual variance was high.

Topics: Absorption; Adolescent; Adult; Calcium Oxalate; Digestive System; Female; Humans; Male; Oxalates; Reference Values; Urinary Calculi

To use infrared fiberoptic spectroscopy for the analysis of urinary salts in real time and with no sample processing; and to assess the practical role of this method for the quantitative measurement of the composition of urine and for the diagnosis of urolithiasis in patients.. Urine samples were obtained from two groups of patients: 24 patients with stone formation after shock wave lithotripsy and 24 normal subjects of similar age. Infrared absorption measurements were performed in real time, using infrared transmitting silver halide fibers. The absorption data were compared with the infrared absorption spectra of aqueous solutions prepared in our laboratory, with known concentrations of known urinary salts. The results were used for the study of the chemical composition of these salts in the urine samples and for a quantitative analysis of the concentration of the salts.. We determined the composition of the stones in 20 of the 24 patients on the basis of the characteristic absorption peaks for the oxalates, carbonates, urates, and phosphates observed in their urinary samples. Using the method mentioned above, we found the concentration of different salts in urine with an average error of 20%.. Fiberoptic infrared spectroscopy could be used as a new diagnostic tool for detecting different urinary salts in urine, finding their chemical composition, and determining their concentrations, without any sample preparation.

Topics: Carbonates; Fiber Optic Technology; Humans; Lithotripsy; Oxalates; Salts; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi; Urine

Hyperoxaluria is a major predisposing factor in calcium oxalate urolithiasis. The aim of the present study was to clarify the role of dietary oxalate in urinary oxalate excretion and to assess dietary risk factors for hyperoxaluria in calcium oxalate stone patients.. Dietary intakes of 186 calcium oxalate stone formers, 93 with hyperoxaluria (>or=0.5 mmol/day) and 93 with normal oxalate excretion (<0.4 mmol/day), were assessed by a 24-hour weighed dietary record. Each subject collected 24-hour urine during the completion of the food record. Oxalate content of foods was measured by a recently developed analytical method.. The mean daily intakes of energy, total protein, fat and carbohydrates were similar in both groups. The diets of the patients with hyperoxaluria were estimated to contain 130 mg/day oxalate and 812 mg/day calcium as compared to 101 mg/day oxalate and 845 mg/day calcium among patients without hyperoxaluria. These differences were not significant. The mean daily intakes of water (in food and beverages), magnesium, potassium, dietary fiber and ascorbic acid were greater in patients with hyperoxaluria than in stone formers with normal oxalate excretion. Multiple logistic regression analysis revealed that urinary oxalate excretion was significantly associated with dietary ascorbate and fluid intake, and inversely related to calcium intake. Differences of estimated diet composition of both groups corresponded to differences in urinary parameters.. These findings suggest that hyperoxaluria predominantly results from increased endogenous production and from intestinal hyperabsorption of oxalate, partly caused by an insufficient supply or low availability of calcium for complexation with oxalate in the intestinal lumen.

Topics: Adult; Calcium; Calcium Oxalate; Case-Control Studies; Female; Follow-Up Studies; Humans; Hyperoxaluria; Magnesium; Male; Middle Aged; Nutrition Assessment; Oxalates; Potassium; Risk Factors; Uric Acid; Urinary Calculi

Urolithiasis in children is recognized with an increasing frequency, while exact etiological factors remain to be determined. The aim of this study is to compare the metabolic risk factors and saturation of urine in pediatric and adult calcium oxalate (Ca-Ox) stone formers.. A total of 33 pediatric (mean age: 6.8 +/- 3.1 years) and 120 adult patients (mean age: 39.7 +/- 5.7 years), with documented Ca-Ox urinary stone disease, underwent a comprehensive metabolic evaluation at our institution. Beside a broad serum analysis, concentrations of calcium, oxalate, magnesium, uric acid and citrate were measured in 24-hour collected urine. Saturation of urine was calculated by Marshall-Robertson's nomograms.. Hypocitraturia, observed in 60.6%, and hypomagnesuria, detected in 39.4%, but not hypercalciuria, were the most common metabolic risk factors in the pediatric group. In adults, hypercalciuria still represented one of the major metabolic risk factors, detected in 44.1%, although hypocitraturia, observed in 45.8%, was the most prevalent metabolic risk factor, as it was in the pediatric group. Pediatric cases had significantly (p < 0.05) higher prevalence of hypocitraturia, hypomagnesuria and supersaturated urine when compared to adults. Metabolic abnormalities could be detected in a high percentage (82%) of primary and recurrent pediatric Ca-Ox stone formers, but not in primary adult stone formers.. Metabolic risk factors significantly differ in pediatric and adult Ca-Ox stone formers. Hypocitraturia and hypomagnesuria seem to play a major role in stone formation, and metabolic abnormalities can be detected in a significant percentage of both primary and recurrent pediatric stone formers. Thus, a comprehensive metabolic evaluation is of utmost importance for all children with Ca-Ox stones.

Topics: Adult; Calcium; Calcium Oxalate; Child; Citric Acid; Female; Humans; Magnesium; Male; Oxalates; Recurrence; Risk Factors; Uric Acid; Urinary Calculi

Urinary concentration of oxalate is considered an important factor in the formation of renal stones. Dietary oxalate is a major contributor to urinary oxalate excretion in most individuals. Furthermore, oxalate degrading bacteria have been isolated from human feces. We investigated the significance of oxalate degrading bacteria for urinary oxalate excretion and urinary stone formation.. Twenty-two known calcium oxalate stone-forming patients (stone formers) and 34 healthy volunteers (non-stone formers) were included in the study. Stool specimens were inoculated into pepton yeast glucose (PYG) medium supplemented with oxalate under anaerobic condition at 37 C for one week. After the incubation period, each colony was checked for the loss of oxalate from the culture medium. A 24-h urine sample was collected in 43 individuals and analyzed for oxalate excretion.. Twenty-eight of 34 (82%) healthy volunteers and 10 of 22 (45%) calcium oxalate stone formers were colonized with oxalate degrading bacteria. Calcium oxalate stone formers were more frequently free of oxalate degrading bacteria (P < 0.01). Urinary excretion of oxalate in those with oxalate degrading bacteria was significantly less than in those without oxalate degrading bacteria (P < 0.05). Hyperoxaluria (> 40 mg/day) was found in four of 27 individuals (15%) with oxalate degrading bacteria compared to seven of 16 (44%) without oxalate degrading bacteria (P < 0.05), suggesting an association between the absence of oxalate degrading bacteria and the presence of hyperoxaluria.. The absence of oxalate degrading bacteria in the gut could promote the absorption of oxalate, thereby increasing the level of urinary oxalate excretion. The absence of oxalate degrading bacteria from the gut appears to be a risk factor for the presence of absorptive hyperoxaluria and an increased likelihood of urolithiasis.

Topics: Adult; Aged; Bacteria; Case-Control Studies; Humans; Hyperoxaluria; Intestines; Middle Aged; Oxalates; Urinary Calculi

Dietary oxalate may contribute up to 50% to 80% of the oxalate excreted in urine. We studied the urinary response to an oral oxalate load in male and female idiopathic recurrent calcium oxalate stone formers with and without mild hyperoxaluria to evaluate the potential pathophysiological significance of dietary oxalate.. A total of 60 recurrent calcium stone formers underwent an oral oxalate load test. Urine samples were obtained after an overnight fast. Each patient then received an oral oxalate load (5 mM. sodium oxalate dissolved in 250 ml. distilled water) and 3, 2-hour urine samples were obtained 2, 4 and 6 hours after the oxalate load. We compared the response to the oxalate load in patients with and without mild hyperoxaluria, and in male and female patients without hyperoxaluria.. The peak urinary response occurred 4 hours after the oral oxalate load in all patients. Those with mild hyperoxaluria had a mean fasting urinary oxalate-to-creatinine ratio +/- SE of 0.027 +/- 0.003 and a mean peak urinary oxalate-to-creatinine ratio of 0.071 +/- 0.006. In comparison, patients with normal oxalate excretion had a fasting and peak urinary oxalate-to-creatinine ratio of 0.018 +/- 0.001 and 0.056 +/- 0.004, respectively (p <0.05). The mean 6-hour increment for urinary oxalate excretion after the oxalate load for patients with hyperoxaluria versus those with normal urinary oxalate excretion was 17.2 +/- 1.9 versus 12.1 +/- 0.98 mg. (p <0.05). In the subset of patients with normal urinary oxalate excretion mean 6-hour cumulative urinary oxalate excretion was 16.8 +/- 1.3 and 13.3 +/- 1.4 mg. in males and females, respectively (p not significant).. Recurrent calcium stone formers with mild hyperoxaluria have higher fasting urinary oxalate and an exaggerated urinary response to an oral oxalate load compared with recurrent calcium stone formers with normal urinary oxalate excretion. Men and women stone formers without hyperoxaluria excrete similar fractions of an oral oxalate load. Increased gastrointestinal absorption and renal excretion of dietary oxalate may be a significant pathophysiological mechanism of stone formation in patients with mild hyperoxaluria.

Topics: Administration, Oral; Adult; Calcium; Creatinine; Female; Humans; Hyperoxaluria; Male; Middle Aged; Oxalates; Recurrence; Urinary Calculi

Oxalobacter formigenes is an anaerobic commensal colonic bacterium capable of degrading oxalate through the enzyme oxalyl-CoA decarboxylase. It has been theorized that individuals who lack this bacterium have higher intestinal oxalate absorption, leading to a higher urinary oxalate concentration and an increased risk of calcium oxalate urolithiasis. We performed a prospective, controlled study to evaluate O. formigenes colonization in calcium oxalate stone formers and to correlate colonization with urinary oxalate and other standard urinary stone risk factors.. Thirty-five first-time calcium oxalate stone formers were compared with 10 control subjects having no history of urolithiasis and a normal renal ultrasound scan. All subjects underwent standard metabolic testing by submitting serum and 24-hour urine specimens. In addition, all subjects submitted stool samples for culture and detection of O. formigenes by Xentr(ix) O. formigenes Monitor.. Intestinal Oxalobacter was detected in only 26% of the stone formers compared with 60% of the controls (p < 0.05). Overall, the average urinary oxalate excretion by the two groups was similar (38.6 mg/day v 40.8 mg/day). Among stone formers, however, there were statistically higher urinary oxalate concentrations in O. formigenes-negative patients compared with those testing positive (41.7 mg/day v 29.4 mg/day) (p = 0.03). Furthermore, all 10 stone formers with hyperoxaluria (>44 mg/day) tested negative for O. formigenes (p < 0.05).. Calcium oxalate stone formers have a low rate of colonization with O. formigenes. Among stone formers, absence of intestinal Oxalobacter correlates with higher urinary oxalate concentration and an increased risk of hyperoxaluria. Introduction of the Oxalobacter bacterium or an analog of its enzyme oxalyl-CoA decarboxylase into the intestinal tract may be a treatment for calcium oxalate stone disease.

Topics: Adult; Aged; Calcium Oxalate; Feces; Female; Humans; Intestines; Male; Middle Aged; Oxalates; Oxalobacter formigenes; Urinary Calculi

A crucial role for cell-crystal interactions in the development of urolithiasis (UL) and nephrocalcinosis (NC) was previously observed in experiments with different cell lines mimicking renal epithelial cells. It was found that such cell-crystal interactions lead to tubular damage and/or or dysfunction. To find further proof for these observations, we measured the urinary N-acetyl-beta- d-glucosaminidase (NAG) excretion, a marker of proximal tubular damage, in children with UL or NC and in children with an increased risk of UL. We enrolled 142 children aged 4-16 years (mean 9.67+/-3.40 years), with 50 children having UL, 30 children with a history of UL (ULH), 20 patients with NC, 34 children with secondary hyperoxaluria (HyOx), and 8 children with idiopathic hypercalciuria (HC). Normal urinary NAG/Cr values were determined in a group of 70 healthy children aged 4-16 years (mean 10.06+/-3.97 years). The urinary NAG activity was measured using a colorimetric method and the results were expressed as molar creatinine (Cr) ratios. The highest median NAG/Cr ratios were found in children with UL plus hematuria (0.72 U/mM) and in children with UL (0.67 U/mM) or NC (0.48 U/mM), which were all significantly higher than those in controls (0.28 U/mmol, P<0.001 and P<0.05). The NAG/Cr ratios were increased above the upper normal reference interval of 0.63 U/mM (95th percentile) in 28 of 50 (56%) children with UL and in 9 of 20 (45%) children with NC. Although the ULH group also had significantly higher median NAG/Cr ratios (0.36 U/mM) compared with controls, the NAG/Cr ratio was only elevated in 4 of 30 (13%) patients. NAG values in children with secondary HyOx or HC were not different from controls. No correlation was found between the NAG/Cr ratios and the urinary excretion of oxalate or calcium. In conclusion, UL or NC may result in proximal tubular injury, which is rather the consequence of disease activity and of the mechanical influence of calculi, than of the metabolic background. The mechanism of cell damage in these conditions however, seems to be complex. Neither HyOx nor HC alone were sufficient to induce severe tubular damage expressed as an increase in NAG excretion in our patients.

Topics: Acetylglucosaminidase; Adolescent; Biomarkers; Calcium; Child; Child, Preschool; Female; Humans; Male; Nephrocalcinosis; Oxalates; Risk Factors; Urinary Calculi

We performed a prospective study to evaluate the intestinal colonization of Oxalobacter formigenes and its relationship with urinary oxalate levels in patients with calcium oxalate stone disease.. One hundred and three patients with calcium oxalate urolithiasis, ranging in age from 21 to 73 years (mean age, 47 years) who were followed from August 2000 to September 2001 participated in this study. Fresh stool and 24-hour urine samples were collected. Genus specific oligonucleotide sequences corresponding to the homologous regions residing in the oxc gene were designed. In order to quantify O. formigenes in clinical specimens, a quantitative-PCR-based assay system utilizing a competitive DNA template as an internal standard was developed. Urine volume, pH, creatinine, oxalate, calcium, magnesium, phosphate, citrate and uric acid were measured.. Intestinal Oxalobacteria were detected in 45.6% (n=47) of calcium oxalate stone patients by PCR. In stone formers who tested negative for Oxalobacteria, the average urinary oxalate level was 0.36 mmol/day, and this compared to 0.29 mmol/day for those patients that tested positive for Oxalobacteria (p<0.05). Mean colony forming units per gram of stool of all patients was 1.1 x 10(7) (0-4.1 x 10(8)), and the level of 24 hours urine oxalate significantly decreased with increasing level of colony forming units of O. formigenes (r=-0.356, p=0.021).. Our results support the concept that O. formigenes is important in maintaining oxalate homeostasis and that its absence from the gut may be the risk of calcium oxalate urolithiasis.

Topics: Adult; Aged; Calcium Oxalate; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oxalates; Oxalobacter formigenes; Prospective Studies; Urinary Calculi

Twenty-four hour urine samples were collected from 17 calcium oxalate (CaOx) stone-forming (SF) dogs and 17 normal (N), age-, breed- and sex-matched dogs. Urinary CaOx relative supersaturation (RSS) was calculated and found to be significantly higher in the SF group than the N group. RSS measurement is not readily applicable to veterinary practice; thus, alternatives were explored. Discriminant analysis failed to identify key factors differentiating most SF from N dogs. Urinary calcium, oxalate and uric acid, which differed between the SF and N animals, were combined into a measure of relative probability of CaOx stone formation (PSF) to establish whether this approach could be used to assess the risk of CaOx stone formation in dogs. Although there was good correlation between the techniques, RSS more clearly discriminated between SF and N dogs. These data suggest that neither PSF nor discriminant analysis is preferable to RSS for assessing the risk of CaOx stone formation in dogs.

Topics: Animals; Calcium; Calcium Oxalate; Case-Control Studies; Discriminant Analysis; Dog Diseases; Dogs; Factor Analysis, Statistical; Female; Male; Oxalates; Risk Factors; Specific Gravity; Uric Acid; Urinary Calculi

A Cl- and NO3- insensitive oxalate oxidase, purified from the roots of 10-day old seedlings of grain Sorghum has been immobilized on polyvinyl alcohol (PVA) membrane through entrapment with 96.07% retention of initial activity. The membrane bound enzyme showed an increase in optimum pH (from 5.0 to 6.5), time of incubation (from 5 to 10 min) and Km for oxalate (from 0.38 to 6.23 mM), but decrease in incubation temperature for maximum activity (from 37 to 30 degrees C) and Vmax (from 70 nmol/min/ml to 9.7 nmol H2O2/min) and was unaffected by Cl- and NO3. The membrane bound enzyme lost 50% of its initial activity after 30 days of storage at room temperature. The use of membrane bound oxalate oxidase in determination of serum oxalate of urinary stone patients is demonstrated.

Topics: Cell Membrane; Hydrogen Peroxide; Hydrogen-Ion Concentration; Kinetics; Oxalates; Oxalic Acid; Oxidoreductases; Plant Roots; Polyvinyl Alcohol; Sorghum; Temperature; Time Factors; Urinary Calculi

Hyperoxaluria may be idiopathic, secondary, or due to primary hyperoxaluria (PH). Hepatic alanine:glyoxylate aminotransferase (AGT) or glyoxylate/hydroxypyruvate reductase (GR/HPR) deficiency causes PHI or PHII, respectively. Hepatic glycolate oxidase (GO) is a candidate enzyme for a third form of inherited hyperoxaluria.. Six children were identified with marked hyperoxaluria, urolithiasis, and normal hepatic AGT (N = 5) and GR/HPR (N = 4). HPR was below normal and GR not measured in one. Of an affected sibling pair, only one underwent biopsy. GO mutation screening was performed, and dietary oxalate (Diet(ox)), enteric oxalate absorption (EOA) measured using [13C2] oxalate, renal clearance (GFR), fractional oxalate excretion (FE(ox)) in the children, and urine oxalate in first-degree relatives (FDR) to understand the etiology of the hyperoxaluria.. Mean presenting age was 19.2 months and urine oxalate 1.3 +/- 0.5 mmol/1.73 m2/24 h (mean +/- SD). Two GO sequence changes (T754C, IVS3 - 49 C>G) were detected which were not linked to the hyperoxaluria. Diet(ox) was 42 +/- 31 mg/day. EOA was 9.4 +/- 3.6%, compared with 7.6 +/- 1.2% in age-matched controls (P = 0.33). GFR was 90 +/- 19 mL/min/1.73 m2 and FE(ox) 4.2 +/- 1.4. Aside from the two brothers, hyperoxaluria was not found in FDR.. These patients illustrate a novel form of hyperoxaluria and urolithiasis, without excess Diet(ox), enteric hyper-absorption, or hepatic AGT, GR/HPR deficiency. Alterations in pathways of oxalate synthesis, in liver or kidney, or in renal tubular oxalate handling are possible explanations. The affected sibling pair suggests an inherited basis.

Topics: Alcohol Oxidoreductases; Calcium, Dietary; Child, Preschool; Family Health; Female; Glyoxylates; Humans; Hyperoxaluria; Hyperoxaluria, Primary; Infant; Male; Molecular Sequence Data; Oxalates; Pedigree; Phosphates; Urinary Calculi

The aim of the study was to determine the impact of defined diet modifications on urine composition and the risk of calcium oxalate crystallisation.. Ten healthy male volunteers consumed a self-selected diet (SD) for 14 days, and three different standard diets for a period of 5 days each. Whereas the western-type diet (WD) is representative of the usual dietary habits, the normal mixed diet (ND) and the ovo-lacto-vegetarian diet (VD) were calculated according to the requirements.. The risk of calcium oxalate crystallisation, calculated as relative supersaturation (EQUIL2) from urine composition, was highest during ingestion of diets SD and WD. The intake of diet ND resulted in a significant decrease in relative supersaturation with calcium oxalate by 58% (p<0.05) compared with diet WD, due to a significant decline in urinary calcium and uric acid excretion and a significant increase in urinary volume, pH-value and citrate excretion. In spite of an increase in urinary pH, citrate and magnesium excretion and a decline in calcium excretion, no further significant decrease in the risk of calcium oxalate crystallisation was observed on diet VD, due to a significant increase in urinary oxalate by 30% (p<0.05) on average.. The change of usual dietary habits for a normal mixed diet significantly reduces the risk of calcium oxalate crystallisation. With a vegetarian diet a similar decline in urinary supersaturation with calcium oxalate can be achieved compared to a normal mixed diet. Since urinary oxalate excretion increased significantly, a vegetarian diet without adequate intake of calcium may not be recommended to patients with mild hyperoxaluria.

Topics: Adult; Calcium; Calcium Oxalate; Citrates; Crystallization; Diet; Humans; Magnesium; Male; Oxalates; Treatment Outcome; Uric Acid; Urinary Calculi; Urine

Investigations were carried out to evaluate the efficacy of the pentacyclic triterpene, lupeol and its ester, lupeol linoleate, against calcium oxalate urolithiasis in rats. Administration of a pyridoxine deficient diet containing 3% glycollic acid for 21 days led to increased excretion of stone forming constituents such as calcium, oxalate and uric acid. Crystal deposition and subsequent renal tubular damage resulted in increased excretion of the tubular enzymes alkaline phosphatase, lactate dehydrogenase, gamma glutamyl transferase, beta glucuronidase and N-acetyl glucosaminidase along with reduced fibrinolytic enzymes. A reduction in the urinary inhibitory factors magnesium and glycosaminoglycans was also observed. Treatment with lupeol and lupeol linoleate reduced the extent of tubular damage as evidenced from reduced enzymuria and minimized the excretion of stone forming constituents.

Topics: Acetylglucosaminidase; Alkaline Phosphatase; Animals; Calcium; Calcium Oxalate; gamma-Glutamyltransferase; Glucuronidase; Hyperoxaluria; L-Lactate Dehydrogenase; Male; Oxalates; Pentacyclic Triterpenes; Pyridoxine; Rats; Rats, Wistar; Risk Factors; Triterpenes; Uric Acid; Urinary Calculi

We determined the incidence of urinary stone risk factors in pediatric patients with urolithiasis.. Between 1998 and 2001, 71 children with urolithiasis at 2 pediatric institutions underwent metabolic evaluation. The 24-hour urine samples were analyzed outside central laboratory using adult and known pediatric references. Supersaturation and traditional metabolic parameters were determined and compared.. All patients had metabolic abnormalities. Calcium related abnormalities were present in 92% of children, calcium oxalate supersaturation was abnormal in 69%, calcium phosphate supersaturation was elevated in 70% and traditional calcium parameters were abnormal in 80%. While 11% of the patients had abnormal calcium phosphate or oxalate supersaturation with normal traditional calcium parameters, 10% had normal calcium oxalate or phosphate supersaturation with abnormal traditional calcium parameters. Low urinary volume was identified in 75% of the children.. Metabolic abnormalities are extremely common in pediatric patients with urolithiasis. Calcium related abnormalities are the most common abnormality. Urinary supersaturation values are complementary to traditional metabolic parameters and may be more sensitive predictors of recurrent stone risk. It is important to establish pediatric reference ranges to interpret these data more accurately.

Topics: Adolescent; Adult; Calcium Oxalate; Calcium Phosphates; Child; Child, Preschool; Female; Humans; Male; Oxalates; Risk Factors; Uric Acid; Urinary Calculi

Topics: Animals; Crystallization; Humans; Hyperoxaluria, Primary; Oxalates; Plants; Urinary Calculi

We present a case of a patient with short bowel syndrome in a hemodialysis program, with recurrent episodes of serious acidosis. The presence of a D-lactic acidosis peak secondary to bacterial overgrowth in the intestine was discovered during an acute episode of acidosis, with neurological affection. The detection of acidosis in predialysis measurements and the acute episodes of acidosis, made it necessary to administer bicarbonate to the patient and give him additional hemodialysis sessions.

Topics: Acidosis, Lactic; Adult; Bicarbonates; Brain Diseases, Metabolic; Consciousness Disorders; Drug Therapy, Combination; Dysarthria; Gram-Positive Bacteria; Humans; Intestines; Kidney Failure, Chronic; Lactates; Male; Neomycin; Oxalates; Paromomycin; Recurrence; Renal Dialysis; Short Bowel Syndrome; Urinary Calculi

To analyze the impact of water hardness from public water supplies on calcium stone incidence and 24-hour urine chemistries in patients with known calcium urinary stone formation. Patients are frequently concerned that their public water supply may contribute to urinary stone disease. Investigators have documented an inverse relationship between water hardness and calcium lithogenesis. Others have found no such association.. Patients who form calcium stones (n = 4833) were identified geographically by their zip code. Water hardness information from distinct geographic public water supplies was obtained, and patient 24-hour urine chemistries were evaluated. Drinking water hardness was divided into decile rankings on the basis of the public water supply information obtained from the Environmental Protection Agency. These data were compared with patient questionnaires and 24-hour urine chemistries. The calcium and magnesium levels in the drinking water were analyzed as independent variables.. The number of total lifetime stone episodes was similar between patients residing in areas with soft public water and hard public water. Patients consuming the softest water decile formed 3.4 lifetime stones and those who consumed the hardest water developed 3.0 lifetime stones (P = 0.0017). The 24-hour urine calcium, magnesium, and citrate levels increased directly with drinking water hardness, and no significant change was found in urinary oxalate, uric acid, pH, or volume.. The impact of water hardness on urinary stone formation remains unclear, despite a weak correlation between water hardness and urinary calcium, magnesium, and citrate excretion. Tap water, however, can change urinary electrolytes in patients who form calcium stones.

Topics: Adolescent; Adult; Age Factors; Aged; Ambulatory Care; Calcium; Calcium Carbonate; Child; Child, Preschool; Electrolytes; Female; Humans; Incidence; Magnesium; Male; Middle Aged; Oxalates; Sex Factors; United States; Uric Acid; Urinary Calculi; Water; Water Softening; Water Supply

The primary hyperoxalurias are autosomal recessive disorders resulting from deficiency of hepatic alanine:glyoxylate aminotransferase (PHI) or D-glycerate dehydrogenase/glyoxylate reductase (PHII). Marked hyperoxaluria results in urolithiasis, renal failure, and systemic oxalosis. A direct comparison of PHI and PHII has not previously been available.. Twelve patients with PHI and eight patients with PHII with an initial creatinine clearance of greater than or equal to 50 mL/min/1.73 m2 underwent similar laboratory evaluation, clinical management, and follow-up. Diagnosis of PHI and PHII was made by hepatic enzyme analysis (N = 11), increased urinary excretion of glycolate or glycerate (N = 7), or complete pyridoxine responsiveness (N = 2). Six PHI and five PHII patients had measurements of calcium oxalate crystalluria, urine supersaturation, and urine inhibition of calcium oxalate crystal formation.. PHI and PHII did not differ in age at the onset of symptoms, initial serum creatinine, or plasma oxalate concentration. Urine oxalate excretion rates were higher in PHI (2.19 +/- 0.61 mmol/1.73 m2/24 hours) than PHII (1.61 +/- 0.43, P = 0.04). Urine osmolality, calcium, citrate, and magnesium concentrations were lower in PHI than PHII (P = 0.001, P = 0.019, P = 0.0002, P = 0.03, respectively). Crystalluria scores and calcium oxalate inhibitory activity of the urine did not differ between PHI and PHII. Calcium oxalate supersaturation in the urine was less in PHI (7.3 +/- 1.9) compared with PHII (14.0 +/- 3.3, P = 0.002). During follow-up of 10.3 +/- 9. 6 years in PHI and 18.1 +/- 5.6 years in PHII, stone-forming activity and stone procedures were more frequent in PHI than PHII (P < 0.01 and P = 0.01, respectively). Four of 12 PHI compared with 0 of 8 PHII patients progressed to end-stage renal disease (P = 0.03).. The severity of disease expression is greater in type I primary hyperoxaluria than in type II. The difference may be due to greater oxalate excretion and lower concentrations of urine citrate and magnesium in patients with PHI compared with PHII.

Topics: Adolescent; Adult; Calcium; Calcium Oxalate; Child; Child, Preschool; Citric Acid; Crystallization; Female; Humans; Hyperoxaluria; Kidney Failure, Chronic; Magnesium; Male; Osmolar Concentration; Oxalates; Phenotype; Urinary Calculi; Urine

Previous studies have described the inhibitory effects of citrate on calcium oxalate crystallization in place of crystal growth, but the effects of citrate on matrix proteins of stones has not been studied in vivo. To examine the effect of citrate on the matrix, we investigated the effect of citrate on osteopontin (OPN) expression, which we had previously identified as an important stone matrix protein. Control rats were treated with saline while rats of the stone group were treated with ethylene glycol (EG) and vitamin D3, and the citrate groups (low-dose and high-dose groups) were treated with a citrate reagent compound of sodium citrate and potassium citrate, in addition to EG and vitamin D3. The rate of renal stone formation was lower in the citrate groups than in the stone group. This was associated with a low expression of OPN mRNA in citrate-treated rats relative to that in the stone group. Citrate was effective in preventing calcium oxalate stone formation and reduced OPN expression in rats. Our results suggest that citrate prevents renal stone formation by acting against not only the crystal aggregation and growth of calcium oxalate but also OPN expression.

Topics: Animals; Blotting, Northern; Chelating Agents; Cholecalciferol; Citric Acid; Disease Models, Animal; Ethylene Glycol; Gene Expression; Immunohistochemistry; In Situ Hybridization; Male; Osteopontin; Oxalates; Rats; Rats, Wistar; RNA, Messenger; Sialoglycoproteins; Urinary Calculi

Whether specific metabolic abnormalities are related to nephrolithiasis in patients with medullary sponge kidney (MSK) remains a debated issue. The purpose of this study is to determine metabolic disorders in patients with MSK and nephrolithiasis compared with idiopathic calcium-stone-forming patients. One hundred eighty-four patients with recurrent calcium-stone formations were investigated with regard to metabolic abnormalities. Of these, 22 patients (11.9%; 13 men, 9 women) showed MSK by radiological examination. MSK was defined as a kidney that presented at least three linear or round papillary opacities in the affected papilla on urography. Multiple stones (more than five) existed in both kidneys in all patients with MSK. The remaining 162 patients (109 men, 53 women) were idiopathic calcium-stone formers. Frequencies of low urine volume (urine < 1,500 mL/24 h) and hyperoxaluria (oxalate > 40 mg/24 h) were similar between the groups. Hypercalciuria (men, calcium > 300 mg/24 h; women, calcium of 250 mg/24 h) was found less frequently in the MSK group. The frequency of hypocitraturia (citrate < 300 mg/24 h) was significantly greater in the MSK group than the idiopathic group (77.3% versus 33.9%, respectively). Mean 24-hour urinary excretions of calcium, citrate, uric acid, and magnesium were significantly less in the MSK group. No differences were found in serum calcium, phosphate, and parathyroid hormone levels between the groups. Low urinary excretions of citrate and magnesium are the most typical metabolic disorders that distinguish MSK stone patients from idiopathic calcium-stone-forming patients. In addition to such anatomic abnormalities as ectatic collecting ducts, low levels of urinary inhibitors of stones seem to contribute to the pathogenesis of nephrolithiasis in patients with MSK.

Topics: Calcium; Chlorides; Citrates; Creatinine; Female; Humans; Kidney Calculi; Kidney Medulla; Magnesium; Male; Medullary Sponge Kidney; Middle Aged; Oxalates; Phosphates; Sodium; Uric Acid; Urinary Calculi; Urination

Therapy with antibiotics in recurrent urinary tract infections may destroy colonies of Oxalobacter formigenes in the intestinal tract. A lack of oxalate degradation caused by the absence of this bacterium is suggested to contribute to the hyperabsorption of dietary oxalate and to the increase in urinary oxalate excretion. The present study was performed to evaluate the effect of recurrent urinary tract infections and subsequent changes induced in the urinary excretion profile in female calcium oxalate stone formers. Serum biochemical profiles, 24-h urinary parameters, and the personal characteristics of 57 female calcium oxalate stone patients with recurrent urinary tract infections (RUTI) were compared with 78 female calcium oxalate stone patients without a history of urinary tract infection. All subjects were recruited during the same period. In female patients with RUTI, urinary oxalate excretion was significantly higher (0.374 mmol/day) than in females without urinary tract infection (0.308 mmol/day) (P < 0.05). Moreover, the mean 24-h pH value and urinary sodium excretion were significantly higher in women with RUTI than in women without a history of urinary tract infection. The significantly higher urinary oxalate excretion in female calcium oxalate stone formers with recurrent urinary tract infections may be associated with the application of antibiotics and a subsequent temporary or permanent decolonization of Oxalobacter formigenes.

Topics: Adult; Aged; Calcium Compounds; Female; Humans; Medical Records; Middle Aged; Oxalates; Oxides; Recurrence; Urinary Calculi; Urinary Tract Infections

Naturally occurring pentacyclic triterpenes of plant origin have been identified as possessing a wide range of pharmacological effects. Lupeol (Lupa-21,20(29) dien, 3beta-ol) has been found to be efficient in reducing the risk of stone formation in animals by way of preventing crystal-induced tissue damage and dilution of urinary stone-forming constituents. In the present study, two structurally related triterpenes, lupeol and betulin (Lupa-20(29)ene-3,28 diol) were assessed for their antilithiatic effect. Foreign body implantation method followed by supplementation of ammonium oxalate was adapted to induce stone formation in the bladder. This led to elevated lipid peroxidation and depleted antioxidant status in the renal tissues. Both the triterpenes were equally efficient in minimizing crystal-induced renal peroxidative changes measured in terms of malondialdehyde and subsequent tissue damage. The antioxidant status, comprising of the enzymatic and non-enzymatic components, was found to be significantly depleted in the kidney and bladder of stone-forming animals. Both lupeol and betulin were comparable in their ability to restore the thiol status and the antioxidant enzymes like superoxide dismutase, catalase and glutathione peroxidase. The mechanism by which the two compounds render protection against oxalate-induced toxic manifestations and free radical production may involve the inhibition of calcium oxalate crystal aggregation and enhancement of the body defence systems. 2000 Academic Press.

Topics: Animals; Anti-Inflammatory Agents; Antineoplastic Agents; Catalase; Crystallization; Free Radicals; Glutathione; Glutathione Transferase; In Vitro Techniques; Lipid Peroxidation; Malondialdehyde; Oxalates; Pentacyclic Triterpenes; Plants, Medicinal; Rats; Thiobarbituric Acid Reactive Substances; Triterpenes; Urinary Bladder; Urinary Calculi

We studied the relationship of stone frequency and composition to age, sex and stone weight.. A retrospective study was performed of all 15,624 stones submitted for analysis with infrared and wet chemical methods in Newfoundland and Labrador from 1979 to 1998.. There were 1,067 bladder stones of which 216 contained magnesium ammonium phosphate. The remaining 14,557 stones were from the kidney and ureter, and 11,707 were composed only of calcium oxalate and/or phosphate. Of the remaining 2,850 kidney and ureter stones magnesium ammonium phosphate was present in 573, uric acid/urate without magnesium ammonium phosphate in 1,109 and other compounds in 1,168. The 11,707 oxalate phosphate group was subdivided by infrared peak analysis based on oxalate-to-phosphate ratio into phosphate-ratio 1 or less, intermediate-1 to 10 and oxalate-10+. Oxalate comprised 65% of the 11,707 stones compared to 16% for phosphate. Women submitted 52% of phosphate stones compared with 28% of oxalate stones. From the first (1980 to 1983) to the last (1995 to 1998) complete 4-year study periods, there was a relative increase in oxalate and decrease in phosphate stones, associated with increasing age from decades 5 to 6 for oxalate and phosphate stones, except that the age peak for phosphate stones in women remained in decade 3. Median weight of 1, 828 phosphate stones was 43 mg. (mean 234) compared with 25 mg. (mean 98) for 7,634 oxalate stones. Male-to-female ratio was 0.91 for phosphate stones compared with 2.62 for oxalate stones.. Phosphate stones were on average heavier and relatively more common in women, had an earlier age peak frequency in women than oxalate stones and became less frequent during our last 4-year study period. In contrast, oxalate stones were much more common, of lighter weight and became more frequent with time.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Female; Humans; Kidney Calculi; Magnesium Compounds; Male; Middle Aged; Oxalates; Phosphates; Retrospective Studies; Sex Factors; Struvite; Ureteral Calculi; Urinary Bladder Calculi; Urinary Calculi

This work focuses on the in vitro calcium-oxalate (CaOx) crystallization behaviour of native and synthetic urine samples in order to establish a CaOx crystallization risk index for unprepared native urine. Native 24-h urine samples from healthy persons and from stone-formers were examined. Within a [Ca2+] versus added oxalate (Ox2-) diagram, we observed fields which allow the discrimination of each urine sample in terms of more or less risk. The [Ca2+]/(Ox2-) ratio is calculated and termed the "Bonn-Risk Index" (BRI; per litre). We propose that BRIs > 1/l denote samples "at risk", whereas BRIs < or = 1/l denote those "without risk". Second. the effects of different concentrations of citrate and Mg2+ on BRI were investigated in artificial urine. The transferability of BRI between native and synthetic urine samples is proved. To evaluate the impact of the proposed BRI, it is compared with the more familiar relative urine saturation index calculated for CaOx and brushite. Urine sampled from stone-formers shows risk indexes between 0.278 and 23.0/l (mean 2.87/l), while urine from healthy persons varied between 0.060 and 4.890/l (mean 1.05/l). Comparing the results of healthy volunteers and patients, the significance of BRI and relative urine supersaturation (RS) with respect to CaOx is P < 0.0005 and P = 0.013, respectively. Fast and easy to perform, determination of the risk index is a suitable tool for estimating the actual CaOx formation "status"--"at risk" or "without risk"--from the native urine of any person.

Topics: Adult; Aged; Calcium Oxalate; Citric Acid; Crystallization; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Reference Values; Risk Factors; Urinary Calculi

Calcium interferes with oxalate absorption in the gut. We studied stone formation in rats fed diets containing various amounts of oxalate and calcium.. In one experiment, male Wistar rats were fed one of five experimental diets: basal diet (292 mM calcium + 8 mM oxalate) or basal diet plus either 100, 300, 500, or 1000 mM oxalate. In the other experiments, rats were given one of five diets: calcium-free diet alone or calcium-free diet plus 300 mM oxalate and either 0, 100, 200, or 300 mM calcium. Urine specimens were collected every week up to week 4. The kidneys were examined for stone formation and used for determination of tissue oxalate concentration by ion chromatography. Calcium and magnesium were measured by atomic absorption spectrophotometry.. The higher the amount of oxalate in relation to calcium in the diet, the higher the urinary oxalate excretion. A low calcium level in the intestine enhanced the uptake of oxalate, leading to hyperoxaluria and calcium oxalate stone formation.. The bioavailability of dietary oxalate in rats depends mainly on the relative intestinal calcium level. Hyperoxaluria without hyperabsorption of calcium could be induced by oral administration of a relatively high-oxalate and low-calcium (oxalate:calcium >1 [mol/mol]) diet. Exaggerated hyperabsorption of oxalate persists for several weeks and leads to calcium oxalate urolithiasis.

Topics: Animals; Biological Availability; Calcium; Citric Acid; Diet; Dose-Response Relationship, Drug; Hydrogen-Ion Concentration; Kidney; Magnesium; Male; Oxalates; Rats; Rats, Wistar; Spectrophotometry, Atomic; Time Factors; Urinary Calculi

Ascorbate breakdown reportedly accounts for 30% to 55% of urinary oxalate excreted. Three potential degradation routes can be postulated: bowel, endogenous, and urinary. Because the pH of normal urine ranges from 4.5 to 8.0, the urinary oxalate concentration in the presence of ascorbate may be influenced by urinary pH and environment, so we studied ascorbate conversion to oxalate in standard buffer solution and in urine. About 10% of infection stones associated with Proteus mirabilis are reportedly composed of calcium oxalate, and their pathogenesis is not well explained. Therefore, we studied whether a pH change induced by P. mirabilis contributes to ascorbate conversion to oxalate in vitro.. Oxalate production from ascorbate increased as a function of pH (7.0-10.0) and incubation time (30 minutes-24 hours) in standard and urine specimens. Two-hour exposure to pH 10 in a urinary milieu containing approximately 3 mM ascorbate converted approximately 40% of the ascorbate to oxalate, whereas 24-hour exposure to pH 8 in a urinary milieu that was approximately 3 mM ascorbate converted approximately 20% of the ascorbate to oxalate. The pH in Proteus cultures increased to 9.0 at 24 hours of culture. The ascorbate concentration in the culture medium significantly decreased at 12 hours and 24 hours, and the oxalate concentration increased significantly at 24 hours.. Urinary ascorbate, if present at a high concentration in association with Proteus mirabilis infection, appears to be locally degraded to oxalate, potentially leading to calcium oxalate deposition on infection stones.

Topics: Ascorbic Acid; Humans; Hydrogen-Ion Concentration; Oxalates; Proteus mirabilis; Temperature; Time Factors; Urinary Calculi

To determine extent and nature of regional differences in distribution of canine urinary calculi.. 13,552 calculus specimens: 7,056 (52.1%) from females, 6,492 (47.9%) from males, and 4 from dogs of unrecorded sex. Procedure Records were used to compile information from all specimens submitted between July 1981 and December 1995. Results from mixed-breed and various breeds of stone-forming dogs were analyzed. Interrelations of breed, sex, and age of dogs, and anatomic location and mineral composition of specimens were analyzed and compared for 6 US geographic regions.. Struvite-, apatite-, and urate-containing calculi were reported significantly most often from female dogs of the Mountain/Pacific region. Oxalate-, silica-, and brushite-containing calculi were reported significantly most often from male dogs in the New England/mid-Atlantic (NEMA) region. Cystine-containing calculi were reported most frequently from the NEMA and South Central (SC) regions. Dogs from the NEMA region were oldest in average age at diagnosis. Significant regional differences in distribution were found for several breeds. Sex distribution of renal calculi in 11 breeds of dogs (Lhasa Apso, Yorkshire Terrier, Shih Tzu, Basset Hound, Pug, Mastiff, Bichon Frise, Doberman Pinscher, Dalmatian, English Bulldog, and Pekingese) reported to be at high risk of renal lithiasis differed among the 6 geographic regions. Renal and ureteral calculi were reported significantly most often from dogs in the South Atlantic region, and bladder and urethral calculi were reported most often from dogs in the SC region.. Wide regional differences exist in distribution of stone-forming dogs by sex, average age at diagnosis, breed, and minerals contained within and anatomic location of calculi.

Topics: Age Factors; Animals; Apatites; Breeding; Calcium Phosphates; Cystine; Dog Diseases; Dogs; Female; Magnesium Compounds; Male; Odds Ratio; Oxalates; Phosphates; Retrospective Studies; Risk Factors; Sex Factors; Silicon Dioxide; Struvite; United States; Uric Acid; Urinary Calculi

Human calcium oxalate (CaOx) nephrolithiasis may occur if urine is supersaturated with respect to the solid-phase CaOx. In these patients, dietary oxalate is often restricted to reduce its absorption and subsequent excretion in an effort to lower supersaturation and to decrease stone formation. However, dietary oxalate also binds intestinal calcium which lowers calcium absorption and excretion. The effect of increasing dietary oxalate on urinary CaOx supersaturation is difficult to predict.. To determine the effect of dietary oxalate intake on urinary supersaturation with respect to CaOx and brushite (CaHPO4), we fed 36th and 37th generation genetic hypercalciuric rats a normal Ca diet (1.2% Ca) alone or with sodium oxalate added at 0.5%, 1.0%, or 2.0% for a total of 18 weeks. We measured urinary ion excretion and calculated supersaturation with respect to the CaOx and CaHPO4 solid phases and determined the type of stones formed.. Increasing dietary oxalate from 0% to 2.0% significantly increased urinary oxalate and decreased urinary calcium excretion, the latter presumably due to increased dietary oxalate-binding intestinal calcium. Increasing dietary oxalate from 0% to 2.0% decreased CaOx supersaturation due to the decrease in urinary calcium offsetting the increase in urinary oxalate and the decreased CaHPO4 supersaturation. Each rat in each group formed stones. Scanning electron microscopy revealed discrete stones and not nephrocalcinosis. X-ray and electron diffraction and x-ray microanalysis revealed that the stones were composed of calcium and phosphate; there were no CaOx stones.. Thus, increasing dietary oxalate led to a decrease in CaOx and CaHPO4 supersaturation and did not alter the universal stone formation found in these rats, nor the type of stones formed. These results suggest the necessity for human studies aimed at determining the role, if any, of limiting oxalate intake to prevent recurrence of CaOx nephrolithiasis.

Topics: Animals; Calcium; Calcium Oxalate; Calcium Phosphates; Diet; Female; Ions; Male; Osmolar Concentration; Oxalates; Rats; Rats, Sprague-Dawley; Urinary Calculi

We compared diagnostic information from limited and comprehensive metabolic evaluations of recurrent calcium stone formers.. A total of 74 men and 45 women with recurrent calcium stones underwent comprehensive metabolic evaluation. The number of specific and total metabolic abnormalities diagnosed on 1 or 2 random 24-hour urinalyses were compared to those obtained on a comprehensive metabolic evaluation. We also examined the ability of the comprehensive evaluation to detect dietary calcium sensitive oxaluria.. The comprehensive metabolic evaluation yielded a specific metabolic diagnosis in 90% of the patients compared to 68% for 1 and 75% for 2 urinalyses. Average total number of specific metabolic abnormalities for each patient was approximately 50% higher on a comprehensive metabolic evaluation compared to 1 urinalysis (1.59 +/- 0.08 versus 0.94 +/- 0.07, p <0.05). Hypercalciuria, hyperoxaluria and hypocitruria were diagnosed significantly more often by the comprehensive than by the limited evaluation. Type II absorptive hypercalciuria was the most common pattern of hypercalciuria, and dietary calcium sensitive oxaluria was present in 22% of the patients.. Comprehensive metabolic evaluation yields significantly more useful diagnostic information and allows implementation of a more specific therapeutic plan than limited metabolic evaluation for the recurrent calcium stone former.

Topics: Calcium; Calcium, Dietary; Citrates; Female; Humans; Male; Oxalates; Recurrence; Sensitivity and Specificity; Urinary Calculi

Urinary glycosaminoglycan (GAG) excretion was measured in children with idiopathic urolithiasis (15 girls and 10 boys; mean (SD) age 6.2 (2.4) years) and in healthy controls (10 girls and 14 boys; mean (SD) age 6.8 (3.8) years). GAG excretion was expressed as a GAG/creatinine (mg/g) ratio and was evaluated using dimethylmethylene blue. In healthy control children, the mean (SD) GAG/creatinine ratio was 31.67 (12.76) and it was similar in girls and boys. The children with idiopathic urolithiasis had significantly lower mean (SD) GAG/creatinine ratios than controls (22.59 (7.35)). Therefore, urinary GAG excretion may be important in the disease process in children with urolithiasis, as it is in adults.

Topics: Biomarkers; Calcium; Case-Control Studies; Child; Creatinine; Female; Glycosaminoglycans; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Baseline renal function data was collected during 24-hr periods of feeding and fasting from three male and three female adult Asian small-clawed otters (Aonyx cinerea) with calcium oxalate urolithiasis. Urine was analyzed for calcium, phosphorus, and oxalate, and urinalyses were performed. There was no evidence of glucosuria, which has been previously reported in Asian small-clawed otters with urolithiasis. Urinary oxalate levels were quite high when compared with those of dogs and humans without uroliths, and the ratio of urinary oxalate to calcium was close to 1:1 during periods of food consumption. There was no significant difference in urinary oxalate excretion between the fed and fasting states. Urinary calcium excretion was five times greater during feeding than during fasting. Calcium levels were higher in the otters than those reported for dogs without uroliths but were similar to those for normal humans. Water consumption and urine production were significantly higher during periods of food consumption. Serum chemistry analyses and electrolyte levels were also determined. There was no evidence of hypercalcemia. Fractional clearance of calcium and phosphorus and endogenous creatinine clearance were significantly higher during food consumption than during fasting. Parathyroid hormone levels were similar to those reported for dogs and cats. Serum 25-hydroxy-vitamin D was slightly lower in the otters than in dogs.

Topics: Animals; Animals, Zoo; Blood Chemical Analysis; Blood Urea Nitrogen; Calcium; Calcium Oxalate; Creatinine; Diet; Drinking; Electrolytes; Female; Male; Otters; Oxalates; Parathyroid Hormone; Phosphorus; Urinalysis; Urinary Calculi; Urination; Vitamin D

Estimation of urinary oxalate is one of important tools for the diagnosis and treatment of urolithiasis. And more precise, simple and inexpensive method is desirable. In the present study, we evaluated three methods which were clinically well-used.. From October 1996 to June 1997, 146 acidified urine samples were collected for 24 hours from 144 urolithiasis patients. We determined the urinary oxalates by three methods; the colorimetric method, the enzymic method and the ion chromatography (IC method). And we evaluated the correlations of these methods.. Correlation coefficients in the urine oxalate concentration were, 0.86 with the colorimetric method and the IC method, 0.91 with the enzymic method and the IC method, 0.90 with the colorimetric method and the enzymic method. The coefficients in the 24 hours-urinary excretion of oxalate (0.76, 0.87, 0.82) were lower than those in the urine oxalate concentration. The correlation coefficients with the colorimetric method and the IC method were, 0.58 in hyperoxaluric group, 0.34 in normooxaluric group. The coefficients with the enzymic method and the IC method, 0.93 in hyperoxaluric group, 0.71 in normooxaluric group.. The colorimetric method is least expensive, but is less useful. The enzymic method is less expensive, and is as useful as the IC method.

Topics: Adolescent; Adult; Aged; Calcium Oxalate; Chromatography, Ion Exchange; Colorimetry; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Oxalates; Sensitivity and Specificity; Spectrum Analysis; Urinary Calculi

In up to one-third of patients with calcium oxalate stones, a hyperoxaluria can be detected. Hyperoxaluria can result from increased endogenous production, from excessive oxalate content of the food, or from intestinal hyperabsorption. For a causal therapy, it is important to discriminate between metabolic and hyperabsorptive hyperoxaluria. Our new 13C-oxalate test allows this differentiation. Under standardized conditions, 50 mg of disodium salt of [13C2]oxalic acid was applied. From the amount of labeled oxalate excreted in urine as measured by a gas chromatographic-mass spectrometric assay, the intestinal absorption was calculated. Seventy patients with recurrent calcium oxalate urolithiasis who had no signs of inflammatory bowel disease were tested. Their mean intestinal oxalate absorption was 9.2+/-5.1%. This was significantly higher than the mean absorption of 50 healthy volunteers (6.7+/-3.9%). There was no difference in oxalate absorption between male (n = 25) and female volunteers. Oxalate absorption correlated with the oxalate excretion in the 24-h urine (volunteers: r = 0.46, P < 0.01; patients: r = 0.62, P < 0.001). Oxalate hyperabsorption was defined as an absorption exceeding 10%. According to this definition, 34% of the patients had oxalate hyperabsorption; 20% of the volunteers showed a hyperabsorption, too. The 13C-oxalate absorption test allows reliable determination of intestinal oxalate absorption. Because of the use of a stable isotope, this test may be repeated as often as required. It will allow the control of therapeutic regimens and also help to unravel genetic influences in stone formation.

Topics: Adolescent; Adult; Calcium Oxalate; Carbon Isotopes; Female; Humans; Intestinal Absorption; Male; Middle Aged; Oxalates; Recurrence; Urinary Calculi

Oxalobacter formigenes is a specific oxalate-degrading, anaerobic bacterium inhabiting the gastrointestinal tracts of vertebrates, including humans. This bacterium maintains an important symbiotic relationship with its host by regulating oxalate homeostasis, primarily by preventing enteric absorption. Increased absorption of oxalate can lead to multiple complications associated with hyperoxaluria, especially recurrent calcium oxalate urolithiasis. Detection of O. formigenes in the gastrointestinal tract has attracted attention because the absence of this bacterium appears to be a risk factor for development of hyperoxaluria and/or recurrent calcium oxalate kidney stone disease. In the present study, epidemiologic studies with patients at high risk for calcium oxalate urolithiasis showed a direct correlation between the number of recurrent kidney stone episodes and the lack of O. formigenes colonization. As expected, the lack of O. formigenes revealed a clear association with prophylactic antibiotic therapy. To confirm the importance of O. formigenes in regulating hyperoxaluria, laboratory rats known to be noncolonized were colonized with live bacteria or treated with a preparation of oxalate-degrading enzymes derived from O. formigenes to determine any subsequent increased resistance to high oxalate challenge. Rats receiving either bacteria or enzyme replacement therapy excreted far lower levels of oxalate, did not develop the crystalluria observed with control rats, and resisted the formation of calcium oxalate crystals in their nephrons. These observations, taken together, support the concept that O. formigenes is important in maintaining oxalate homeostasis, that its absence from the gut increases the risk for hyperoxaluria and recurrent kidney stone disease, and that replacement therapy is an efficient procedure to prevent hyperoxaluria and its complications.

Topics: Adult; Aged; Animals; Anti-Bacterial Agents; Bacteria, Anaerobic; Digestive System; Enzyme Therapy; Female; Humans; Hyperoxaluria; Male; Middle Aged; Oxalates; Rats; Rats, Sprague-Dawley; Recurrence; Urinary Calculi

To detect the role of the enzyme gamma-glutamyl carboxylase in an experimental stone-forming condition.. Urolithiasis was induced in experimental rats by (i) oral feeding of 1% ethylene glycol (EG) and (ii) feeding a calculus-producing diet containing 3% sodium glycolate.. A significant enhancement in the activity of renal vitamin-K-dependent gamma-glutamyl carboxylase was observed in both groups of experimental urolithic rats. Dicoumarol as well as EG treatment enhanced the accumulation of the endogenous substrate for the enzyme. The carboxylase activity was stimulated by sodium oxalate as well as calcium oxalate in vitro. A positive correlation was observed between lipid peroxidation and the renal gamma-glutamyl carboxylase activity.. The enhanced carboxylase activity observed in the hyperoxaluric condition is suggested to be due to stimulation of the enzyme by oxalate/calcium oxalate, increased concentration of endogenous carboxylase substrate and lipid peroxidation.

Topics: Animals; Carbon-Carbon Ligases; Dicumarol; Disease Models, Animal; Enzyme Activation; Ethylene Glycol; Glycolates; In Vitro Techniques; Kidney; Male; Oxalates; Rats; Rats, Wistar; Urinary Calculi

We investigated the effects of castration and finasteride administration on urinary oxalate (Ox) excretion in a rat ethylene glycol (EG) model of urolithiasis. Male adult SD rats were divided into six groups. Group 1 were normal, untreated rats. The other five groups, all treated with 0.75% EG for 4 weeks; were as follows: group 2, non-castrated (intact) rats; group 3, castrated rats; group 4, castrated rats with a 4-cm testosterone implant; group 5, intact rats treated with high-dose finasteride (7.5 mg%); and group 6, intact rats treated with low-dose finasteride (0.75 mg%). Urinary Ox excretion increased 12.8-fold after 4 weeks of EG treatment (group 2 vs group 1). Both castration (group 3) and finasteride administration (groups 5 and 6) significantly decreased urinary Ox excretion compared with intact rats (group 2). We conclude that dihydrotestosterone is partially responsible for the exaggerated hyperoxaluria observed in the rat EG model of urolithiasis.

Topics: Animals; Calcium Oxalate; Crystallization; Enzyme Inhibitors; Ethylene Glycol; Finasteride; Kidney; Male; Orchiectomy; Oxalates; Rats; Rats, Sprague-Dawley; Urinary Calculi

To study the variability in urine composition with respect to factors of importance for the calcium salt crystallization process and to test the reliability of using one or several urine samples in the clinical evaluation.. Twelve patients collected 16-hour daytime and 8-hour night urine samples during 4 days of the same week. The urine was analysed for calcium, oxalate, phosphate, magnesium, citrate and pH, and the ion activity products of CaOx [AP(CaOx) index] and CaP were calculated. The risk of CaOx crystallization, as well as the inhibition of CaOx crystal growth and aggregation, were assessed.. There was a good correlation between estimates of the AP(CaOx) index in the different samples, as well as between the AP(CaOx) index and the direct assessment of the risk of CaOx crystallization in the night and daytime urine samples. There was, however, a pronounced intra-individual variation of all variables and parameters. With the assumption that an abnormality would appear in at least one of the four samples, we found that in more than 80% of the cases, two 24-hour (16 + 8 h) urine samples were sufficient to establish whether the patient had a normal or an abnormal urine composition.. Urine samples collected during two 24-, 16- or 8-hour periods appear to be useful for detecting biochemical abnormalities considered of importance for CaOx stone formation.

Topics: Adolescent; Adult; Aged; Calcium; Calcium Oxalate; Citric Acid; Crystallization; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Urinary Calculi

To determine the efficacy of (L)-cysteine and (L)-2-oxothiazolidine-4-carboxylic acid (OTZ) in reducing urinary oxalate excretion under hyperoxaluric conditions and to determine whether by inclusion of glycolate in a standard diet, cysteine:glyoxylate adduct can be detected in hyperoxaluric rats given either compound.. Hyperoxaluria (200% above basal) was induced 2 days prior to commencement of the studies and maintained throughout. After a 3 days baseline, animals were randomly allocated to a control or treatment group. Standard diet containing either (L)-cysteine or OTZ was then fed to the treatment groups for 5 days while standard diet alone was fed to the control groups. Urinary oxalate excretion was subsequently monitored and average daily rates were then compared with basal values. Plasma and urine were analyzed for adduct.. Both (L)-cysteine and OTZ significantly reduced urinary oxalate excretion relative to the basal hyperoxaluric level (28.6 +/- 1.5 micromol./day). While (L)-cysteine reduced oxalate excretion over the 5 day treatment period by only 7.82 +/- 1.39 micromol./day (27%), OTZ reduced it by 12.34 +/- 1.58 micromol./day (43%). Adduct could not be detected in plasma or urine in this study.. This study confirms that both (L)-cysteine and OTZ are effective in reducing urinary oxalate excretion under hyperoxaluric conditions, with OTZ being more effective than (L)-cysteine. These compounds were shown to be 3- to 4-fold more effective in reducing urinary oxalate excretion under hyperoxaluric conditions when compared with the results from previous studies under normooxaluric conditions.

Topics: Animals; Cysteine; Disease Models, Animal; Male; Oxalates; Pyrrolidonecarboxylic Acid; Rats; Rats, Inbred Strains; Thiazoles; Thiazolidines; Urinary Calculi

To elucidate the intrarenal distribution of oxalate and to reveal the first site of calcium oxalate crystal fixation along the nephron, we carried out 14C-oxalate renal microautoradiography by the thaw mount method 30, 60 and 90 min after intravenous administration of 14C-oxalate, in normal rats and in hyperoxaluric rats fed a vitamin B6-deficient diet for 4 and 9 weeks. In normal rats, radioactivity was observed in the entire kidney area at 30 min after the injection and at 90 min there was radioactivity only in the papilla, where radioactivity appeared in the parenchyma, mamely the epithelial cells of collecting ducts and the surrounding interstitial tissue. In hyperoxaluric rats, microautoradiograms showed the spotted deposits of 14C-oxalate in both renal papilla and medulla. In 600 x magnification of the autoradiograms, most of the deposits were detected in the epithelial cells of collecting ducts and the surrounding interstitial tissue. These deposits were identified by a polarizing microscope and X-ray microanalysis as crystal deposits of calcium oxalate. These results indicated that oxalate remained for an extended period of time in the epithelial cells of collecting ducts and in the surrounding interstitial tissue in renal papilla, and the calcium oxalate crystals fixed to the same tissue was the first step in the development of calcium oxalate stones.

Topics: Animals; Autoradiography; Calcium Oxalate; Crystallization; Kidney; Male; Oxalates; Rats; Rats, Sprague-Dawley; Urinary Calculi

Topics: Automation; Carboxy-Lyases; Formate Dehydrogenases; Humans; Oxalates; Reagent Kits, Diagnostic; Reproducibility of Results; Urinary Calculi

In order to assess the significance of the intestinal absorption of oxalate from food for the hyperoxaluria of the individual patient, an oxalate absorption test has been developed using doubly 13C-labelled oxalate and a gas chromatographic selected ion monitoring mass spectrometric assay. This test has been applied to volunteers and patients with urinary stones. The percentage of dose absorbed (range 1-48%) could be determined with a coefficient of variation of 15.2%. The assay to measure doubly 13C-labelled oxalate in the presence of unlabelled oxalate in urine, using the homologue malonic acid as internal standard, is described.

Topics: Carbon Isotopes; Gas Chromatography-Mass Spectrometry; Humans; Intestinal Absorption; Oxalates; Reproducibility of Results; Sensitivity and Specificity; Time Factors; Urinary Calculi

Hyperoxaluria was reported to induce renal damage, probably due to toxic effects on renal tubules. Such tubular damage might be expressed by an increase in urinary excretion of marker enzymes such as N-acetyl-beta-D-glucosaminidase (NAG). We set out to examine a possible relationship between the excretion of NAG and that of urinary lithogenic and stone-inhibitory substances by analyzing 24-h urine specimens from 56 children with urolithiasis and 25 healthy children with normal renal function and without a history of urolithiasis. The NAG excretion was higher in patients with urolithiasis (3.5 +/- 0.51 U/g creatinine) as compared with healthy subjects (1.33 +/- 0.14 U/g creatinine, P < 0.05). A positive correlation between NAG and oxalate excretion was observed in female patients (r = 0.56: P < 0.01). In conclusion, the increase in urinary NAG in children with urolithiasis might express renal tubular damage. It seemed, however, not to be specifically related to the excretion of a single lithogenic substance.

Topics: Acetylglucosaminidase; Adolescent; Biomarkers; Calcium; Child; Child, Preschool; Citric Acid; Creatinine; Female; Follow-Up Studies; Humans; Hyperoxaluria; Kidney Tubules; Magnesium; Male; Oxalates; Phosphates; Photometry; Urinary Calculi

To identify biochemical and dietary factors which may play a role in the low incidence of stone formation in the black South African population.. The study included 31 semiurbanized black and 29 urbanized white subjects. The protocol and modern laboratory techniques used to assess recurrent stone formers were followed. Urinary sodium, potassium, creatinine, calcium, phosphate and urate levels were measured, and urinary citrate, oxalate and cystine assessed.. Black subjects ate a diet significantly higher in sodium (P < 0.04); there was no difference in serum levels but urinary sodium was significantly higher (P < 0.001) in black than in white subjects. Urinary potassium, calcium, citrate, phosphate and cystine were all significantly lower in black than in white subjects (P < 0.001 for the first four and P < 0.03 for cystine).. Certain intrinsic factors in South African black subjects may account for their lower frequency of stone formation than in white subjects. Of these, the very low urinary calcium, decreased urinary cystine and different interactions between sodium and calcium/cystine are probably important.

Topics: Adult; Black People; Calcium, Dietary; Citric Acid; Diet; Female; Humans; Incidence; Male; Oxalates; Phosphates; Potassium; Risk Factors; Sodium; South Africa; Urinary Calculi; White People

To search for the anticrystallization mechanism by vitamin B(6) and banana stem extract.. Thirty-six male China-1 mice were divided into 4 groups: normal, crystallization, vitamin B(6) and banana-stem extract groups. Calcium oxalate crystallization was induced by 1% glycol and 1% ammonium chloride in the last 3 groups. Vitamin B(6) was then given to the 3rd group and banana stem extract to the 4th group for 3 weeks. At the end of 3 weeks, all the mice were sacrificed and the kidneys were taken for morphometrical studies using image analysis system and assayed for calcium oxalate.. Morphometrical area density and numerical density of crystallization was significantly less in the vitamin B(6) group and the banana-stem extract group as compared with the crystallization group, being the least in the banana-stem extract group. Oxalate in renal tissue was also significantly reduced. Both vitamin B(6) and banana stem extract had no effect on renal tissue calcium.. Vitamin B(6) and banana-stem extract may be useful agents in the treatment of patients with hyperocaluric urolithiasis.

Topics: Animals; Calcium; Calcium Oxalate; Crystallization; Kidney; Male; Mice; Musa; Oxalates; Plant Extracts; Plant Stems; Urinary Calculi; Vitamin B 6

The effects of clofibrate feeding (5 g/kg diet) on oxalate metabolism were investigated in male and female rats. Following clofibrate feeding, 24-hour urinary excretion of oxalate increased until 4 days and then reached a plateau. Whereas the contribution of dietary oxalate (1.4 g/kg diet, as potassium salt) to urinary oxalate was less than 5% in both control and clofibrate-treated male rats, the contribution of dietary glycolate (1.0 g/kg diet, as sodium salt) to urinary oxalate was six times higher in clofibrate-treated male rats compared with controls, indicating that the clofibrate-induced hyperoxaluria is due to increased endogenous biosynthesis of oxalate. This was supported by the increased lactate dehydrogenase (LDH) activity observed in liver supernatants of clofibrate-treated rats compared with controls, and the increased rate of conversion of glycolate and glyoxylate to oxalate by clofibrate-treated male rat liver supernatants. Female rats had lower excretion of urinary oxalate and lower levels of liver glycolic acid oxidase (GAO) as compared with males. Clofibrate-treated female rat liver supernatants had higher LDH levels and produced more oxalate from glyoxylate. Thus, it can be concluded that the increase in LDH activity may be the cause of the increased endogenous biosynthesis of oxalate leading to increased urinary excretion of oxalate in male and female rats treated with clofibrate.

Topics: Alcohol Oxidoreductases; Animals; Clofibrate; Female; Hyperoxaluria; L-Lactate Dehydrogenase; Liver; Male; Oxalates; Rats; Rats, Sprague-Dawley; Risk Factors; Urinary Calculi

In this paper we describe a simple ion chromatographic method for determination of oxalate in urine. Acidified urine was diluted 1:2 with 0.03 mol/l benzidine hydrochloride in 0.3 mol/l boric acid to precipitate sulphate. The supernatant was passed through a C18-cartridge and 100 microliters of eluant were injected into an ion chromatographic system. Oxalate was measured by nonsuppressed conductivity detection. The detection limit for urinary oxalate was 0.05 mmol/l. The recovery for spiked urine samples was 101.5% with a CV of 4.5%. The within- and between-assay coefficients of variation were less than 4.5% and 2.5%, respectively. We found the results obtained by this method to be statistically equivalent to an enzymatic assay and a different ion-chromatographic method.

Topics: Analysis of Variance; Calcium Oxalate; Chromatography, High Pressure Liquid; Chromatography, Ion Exchange; Evaluation Studies as Topic; Humans; Hydrogen-Ion Concentration; Oxalates; Urinary Calculi

Previously it was shown that the polysaccharide G872 in vitro strongly inhibits calcium oxalate monohydrate crystallization processes. However, when rats on a stone-inducing diet of ethylene glycol plus vitamin D3 are given this polysaccharide, no changes in the urine capacity for crystallization inhibition were found. We investigated here how the inhibitory action of polysaccharides changes under high oxalate conditions, as they exist in the stone inducing diet.. Calcium oxalate monohydrate (COM) crystals were incubated in a series of 0.05 M PBS buffers containing polysaccharides with increasing oxalate concentrations (0-0.4 mmol/l). The coated crystals were collected, washed and resuspended in an artificial urine. We then measured the zeta potential of the crystals, using a Coulter DELSA 440, and the initial rates for crystal growth and agglomeration, using the Coulter Multisizer II.. Addition of oxalate to the medium shifts the negative zeta potential distribution of COM crystals coated by polysaccharides in positive direction. Particle size analysis demonstrated that the initial rates of COM crystal growth and agglomeration responding to oxalate concentration changes (0.1-->0.4 mmol/l) in the presence of G872 (0.2 mg/l) are approximately 2.5 times faster than that in the absence of G872.. Oxalate interferes with the binding of polysaccharides to crystals. This can be envisioned to occur through changes in the crystal surface properties or by induction of functional and secondary structural changes of urinary macromolecular inhibitors such as GAGs, resulting in a decrease of their inhibitory activity against COM crystallization. Thus, in urine, a high oxalate may increase the rate of crystallization both by increasing the supersaturation and by decreasing the inhibitory potential of the urine.

Topics: Calcium Oxalate; Crystallization; Glycosaminoglycans; Hydrogen-Ion Concentration; Oxalates; Polysaccharides; Software; Urinary Calculi

Urolithiasis is a major health problem in the northeast part of Thailand. In this study, we examined the prevalence of renal stone disease and differences of urinary components between stone formers and healthy control subjects in northeastern rural areas of Thailand.. We selected 3 villages in the rural areas of Khon Kaen province in northeast Thailand. Three hundred and sixty-seven persons were asked questions relating to urolithiasis and were examined by abdominal ultrasound (US). We collected a spot urine sample from stone formers and healthy control subjects from each village.. Abnormal findings by US were detected in 39 individuals (10.6%), and included 31 individuals with renal calculi (8.4%), 16 with hydronephrosis (4.4%), and 1 individual with a renal cyst (0.3%). This yielded a disease rate of urinary stones in this study of 16.9%. The male/female ratio was 2/1 and the average age of the individuals examined was 40.3 +/- 13.9 years. However, there was no significant difference between the urinary parameters of stone formers and the healthy control subjects.. There was a high incidence of renal stone disease in the northeast part of Thailand, but the tendency for hypocitraturia was only found in stone formers.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Citric Acid; Female; Humans; Incidence; Male; Middle Aged; Oxalates; Prevalence; Rural Population; Sex Characteristics; Surveys and Questionnaires; Thailand; Ultrasonography; Urinary Calculi

A simple method for the simultaneous determination of oxalic and citric acids had been developed using reversed-phase HPLC. An aqueous solution containing potassium dihydrogen phosphate (0.25%) and tetrabutylammonium hydrogen sulphate (2.5 mmol) at pH 2.0 was used as mobile phase. Under these conditions both the components were well resolved and detected at 210 nm. The recovery for oxalic and citric acids was 97% and 102%, respectively. The method presented here was applied to urine specimens of a large number of urolithic patients and control subjects. Because of the simplicity of the method its application provides better means of monitoring the concentration of oxalic and citric acids in the formation of renal calculi.

Topics: Chromatography, High Pressure Liquid; Citrates; Citric Acid; Humans; Oxalates; Oxalic Acid; Reproducibility of Results; Spectrophotometry, Ultraviolet; Urinary Calculi

Urinary oxalate may contribute far more than urinary calcium to the pathogenesis of urinary calculi. Urinary oxalate may be reduced by restricting the intake of foods high in oxalate. The oxalate content foods might be reduced by oxalate-degrading bacteria. The purpose of this experiment was to reduce the oxalate content of foods with an oxalate-degrading bacterium which was isolated from the feces of Japanese male.. An artificial intestinal juice was prepared by modifying Rogosa medium. An infusion of black tea was prepared from a commercial tea bag. The oxalate-degrading bacteria used were Eubacterium lentum WYH-1 which were have isolated. To 5 ml of the above oxalate-containing artificial intestinal juice and infusion of black tea, 0.5 ml of the bacterial culture was added and incubated anaerobically at 37 degrees C. Oxalic acid in the supernatant of the culture medium was assayed by high-performance liquid chromatography.. In 24 hours, 1 x 10(6) cells/ml of Eubacterium lentum WYH-1 decomposed 100% of 1 mg/ml oxalate in the artificial intestinal juice. The oxalate in the black tea infusion (1 mg/mL) was also decomposed completely within 48 hours by 1 x 10(7) cells/mL of bacteria.. Eubacterium lentum WYH-1 was able to efficiently decompose the oxalate in foods.

Topics: Chromatography, High Pressure Liquid; Eubacterium; Feces; Food Analysis; Food Microbiology; Humans; Intestinal Secretions; Male; Oxalates; Urinary Calculi

The urinary citrate/creatinine ratio was evaluated in 25 children with idiopathic calcium urolithiasis and 24 controls. The mean (SD) urinary citrate/creatinine ratio in controls and patients was 0.510 (0.205) and 0.181 (0.076), respectively, a statistically significant difference. In neither group was there a relation between age and urinary citrate excretion.

Topics: Calcium; Case-Control Studies; Child; Child, Preschool; Citrates; Citric Acid; Creatinine; Female; Humans; Magnesium; Male; Oxalates; Oxalic Acid; Urinary Calculi

Increased oxalate binding with negative correlation with reduced glutathione content was observed during lipid peroxidation in rat kidney mitochondria. In presence of oxidized glutathione (GSSG), peroxidized mitochondria lost 48% of protein-SH with concomitant 3-fold increase in oxalate binding activity while control mitochondria lost only 20% protein-SH with only 0.8 fold increase in oxalate binding activity. The GSSG-induced oxalate binding was apparently due to two-fold increased affinity of oxalate to the protein. Reduced glutathione (GSH) inhibited oxalate binding competitively with Ki, 1.4 x 10(-3) M. Urolithic rat kidney mitochondria showed 30-50% increase in oxalate binding activity along with depletion of GSH and protein-SH. These studies suggest that oxalate binding is regulated by thiol status of mitochondria.

Topics: Animals; Glutathione; Glutathione Disulfide; Kidney; Male; Mitochondria; Oxalates; Rats; Rats, Wistar; Urinary Calculi

Oxalic acid-degrading bacteria have been isolated from human faces. Therefore, the possibility exists that oxalic acid in food is degraded in human intestine by such bacteria, and absorption and excretion of oxalic acid is reduced. It may be possible that patients who form idiopathic stones have fewer oxalic acid-degrading bacteria than healthy controls. The purpose of this study is to examine the possibility that oxalic acid in food is degraded in the human intestine.. Nineteen patients with calcium stones and 13 healthy subjects were included in the study. Samples of feces were diluted with Barber medium containing 1 g/L of oxalic acid dihydrate, and 1%, 0.1% and 0.01% suspensions were prepared. These solutions were incubated under anaerobic conditions at 37 degrees C for seven days. The degradation of oxalic acid was estimated by the decrease of oxalic acid in the medium.. The feces of almost all persons with or without calculi degraded oxalic acid to some degree. Incomplete or no oxalic acid degradation was found in 15 of the 19 stone-forming patients and in five of the 13 stone-free controls.. Large numbers of oxalic acid-degrading bacteria were observed less often in the feces of stone-formers than in the feces of stone-free controls.

Topics: Adult; Aged; Aluminum; Bacteria, Aerobic; Bacteria, Anaerobic; Chi-Square Distribution; Chromatography; Feces; Female; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Urinary Calculi

Primary hyperoxaluria type I may initially manifest as urolithiasis, renal insufficiency, or symptoms of systemic oxalosis. This hereditary disorder was fatal until effective therapies evolved during the past two decades. Difficulty in recognizing and diagnosing this disorder in adults is illustrated in a report of a patient eventually restored to good health by high-flux dialysis and combined renal and hepatic transplantation. I explore the molecular processes of the genetic defect and discuss clinical indicators of primary hyperoxaluria type I, manifestations of oxalosis, the pathogenesis of chronic oxalate nephropathy, and the diagnosis and management of this disease.

Topics: Humans; Hyperoxaluria, Primary; Male; Middle Aged; Oxalates; Renal Insufficiency; Urinary Calculi

The aim of this investigation was to differentiate between aggregation and crystal growth by studying the structure of oxalate stones at high spatial resolution using recently developed microscopy techniques.. Sections from 6 complete human oxalate stones and 4 stone fragments were prepared by ultramicrotomy and examined by both low voltage scanning electron microscopy and atomic force microscopy.. The scanning electron microscopy showed lamellar structures up to 10 microns. in size, consistent with previous results, and provided evidence that these structures were composed of smaller particles. The atomic force microscopy clearly showed arrays of the small particles, whose size varied between 500A and 2800A.. Our images suggest that an ordered aggregation of small crystallites is responsible for oxalate stone formation.

Topics: Humans; Microscopy, Atomic Force; Microscopy, Electron, Scanning; Oxalates; Oxalic Acid; Urinary Calculi

Although nephrocalcinosis is a classical finding in primary hyperoxaluria type 1 (PH 1) associated with a poor renal survival it is exceptional in patients with PH type 2 (PH 2), characterized by a more favorable outcome. We describe an 8-month-old girl who suffered from recurrent urinary tract infections. Imaging studies revealed a profound corticomedullary nephrocalcinosis with no evidence of calculi. Urinary oxalate and D-glycerate excretion were massively elevated, while urinary glycolate or glyoxylate could not be detected, confirming the diagnosis of PH 2. Although the nephrocalcinosis progressed radiologically, renal function remained stable for over 2 years. Only further follow-up will show whether the associated nephrocalcinosis worsens the prognosis of our patient and of PH 2 in general.

Topics: Child; Female; Glyceric Acids; Glycolates; Glyoxylates; Humans; Hydrogen-Ion Concentration; Hyperoxaluria, Primary; Kidney; Nephrocalcinosis; Oxalates; Radiography; Ultrasonography; Urinary Calculi

Ethylene glycol ethers and their acetates are widely used in industry, because of their hydrophilic and simultaneously lipophilic properties. Ethylene glycol ethers and their acetates are mainly metabolised to alkoxyacetic acids, but there is also a minor pathway through ethylene glycol to oxalic acid. The main pathway of ethylene glycol ethers is associated with significant clinical or experimental health effects and the minor pathway is also interesting because formation of urinary stones depends principally upon the urinary concentration of oxalate and calcium.. Excretion of alkoxyacetic and oxalic acids was examined among silkscreen printers for an entire working week. The aim of the study was to evaluate alkoxyacetic acids as early indicators of exposure to glycol ethers and to evaluate their toxicity to kidneys. The load of alkoxyacetic and oxalic acids was compared with the excretion of calcium, chloride, ammonia, and glycosaminoglycans (GAG). Morning urine was chosen for the main analysis, as the overall metabolite, ethoxyacetic acid (EAA), has a long elimination time from the body.. The excretion of calcium increased according to the urinary alkoxyacetic acid load. The excretion of ammonia and chloride was higher among the exposed workers than among the controls. The highest urinary alkoxyacetic acid load was also associated with increased excretion of GAG, which may reflect the toxicity of metabolites of ethylene glycol ether. The excretion of GAG correlated positively with that of calcium in the printers with highest exposure. The tendency to form urinary stones was 2.4-fold higher among silkscreen printers than among office workers.. On the basis of renal effects our study indicates the need for establishing a new biological exposure limit before a workshift that is clearly below 100 mmol ethoxyacetic acids per mol creatinine in morning urine of people occupationally exposed to ethylene glycol ethers.

Topics: Acetic Acid; Adult; Ammonia; Calcium; Chlorides; Ethers; Ethylene Glycols; Glycosaminoglycans; Humans; Kidney; Occupational Diseases; Occupational Exposure; Oxalates; Oxalic Acid; Printing; Urinary Calculi

Calculogenic potential of refined sugars galactose and fructose was examined in vitamin B6 deficient and control rats in terms of their capacity to increase urinary excretion of lithogens.. Male albino rats were fed vitamin B6 deficient diet with 51.7% sucrose+ starch or galactose or fructose as the source of carbohydrate. Pair-fed controls were maintained for all the groups for a period of four weeks. Twenty-four hour urine samples obtained at weekly intervals were analyzed for creatinine, calcium, oxalate, phosphate and uric acid. Microscopic urinalysis was performed at the end of the study.. Urinary calcium excretion increased with respect to baseline in all groups except vitamin B6 control group. On day 28, galactose and fructose-fed rats demonstrated significant hypercalciuria as compared to the sucrose + starch fed group. Vitamin B6 deficient rats (irrespective of the sugar fed) excreted significantly greater urinary calcium compared to pair-fed controls. Oxalate excretion was significantly increased in rats fed galactose compared to those fed fructose or sucrose + starch. Vitamin B6 deficiency further increased oxalate excretion by 1.5, 1.9 and 1.7 fold in sucrose + starch, fructose or galactose fed animals, respectively. Urinary uric acid excretion was enhanced only in fructose-fed rats. There was no change in urinary excretion of creatinine and phosphate in different experimental and control groups. Increased urinary saturation with lithogens caused pronounced crystalluria in all the vitamin B6 deficient groups as well as galactose control group.. The results suggest galactose ingestion is associated with a greater propensity to form calcium oxalate kidney stones than fructose. Calculogenic potential of galactose and fructose is further enhanced in vitamin B6 deficiency.

Topics: Animals; Calcium; Dietary Carbohydrates; Fructose; Galactose; Male; Oxalates; Phosphates; Photomicrography; Random Allocation; Rats; Rats, Wistar; Time Factors; Uric Acid; Urinary Calculi; Vitamin B Deficiency

The precise relationship between urine composition and stone formation has not yet been completely understood. The object of this work is to study some constituents of the urine in stone formers and normal subjects in a trial to correlate stone formation with urine composition. Urinary levels of oxalic acid, uric acid and phosphate were elevated in oxalate, urate and phosphate stone formers, respectively, while in the urine of mixed stone formers both oxalic and uric acids were increased. Urinary levels of ascorbic acid, citric acid and mucopolysaccharides in all groups of patients were significantly higher than the corresponding control levels. Although oxalic acid, uric acid and phosphate concentrations were high in their respective stones, the concentrations of these constituents were nearly the same in the mixed stones. Also Ca2+ concentration was higher in stones of oxalate and mixed stone formers than in stones of urate and phosphate formers. Exceptionally, magnesium was high in stones of phosphate stone formers. It is recommended that urinary contents of oxalate, urate and phosphate have to be minimized to overcome stone recurrence.

Topics: Adult; Child; Female; Glycosaminoglycans; Humans; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urine

Urinary macromolecules have attracted great interest because of their possible role as both promoters and inhibitors of calcium oxalate (CaOx) crystallization and it remains unclear whether there is any difference, in their nucleating activity, between stone formers and controls. We selected 9 male idiopathic CaOx stone formers whose 24-h urines presented no evidence of common urinary stone risk factors such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, hypomagnesiuria or low glycosaminoglycans excretion and 12 male controls (matched for age and body weight) whose 24-h urines did not differ from those of stone formers. The study of urinary CaOx nucleation was made in freshly voided overnight urines whose biochemical composition was almost identical in the two groups. In filtered (0.22 micron) and ultrafiltered (10 kDa) urine we performed an oxalate tolerance test to determine the permissible increment of oxalate, the oxalate level for nucleation and the permissible increment of CaOx relative supersaturation (CaOx RS). In filtered urine from stone formers the permissible increment of oxalate was lower than controls (30 +/- 10.2 vs. 46.7 +/- 9.7 mg/l, P = 0.001), the oxalate level for nucleation was lower (64.4 +/- 14.2 vs. 79.5 +/- 15.6 mg/l, P = 0.035) and the permissible increment of CaOx RS was also lower (9.71 +/- 2.59 vs. 13.39 +/- 3.62, P = 0.018). In ultrafiltered urine these differences disappeared because the removal of macromolecules in stone formers significantly enhanced the oxalate-tolerance values. The difference between the change of the oxalate permissible increment of filtered and ultrafiltered urine allowed a distinction to be made between stone formers and controls that was not feasible in other ways (7.6 +/- 5.3 vs. 3.3 +/- 5.9 mg/l, P < 0.0001). The study suggests that, in idiopathic CaOx stone formers free from common urinary risk factors of CaOx crystallization, there is an increased tendency for CaOx nucleation in urine, which is mediated by macromolecular components.

Topics: Adult; Calcium Oxalate; Colloids; Glycoproteins; Glycosaminoglycans; Humans; Male; Middle Aged; Mucoproteins; Oxalates; Oxalic Acid; Peptides; Risk Factors; RNA; Ultrafiltration; Urinary Calculi; Uromodulin

Glycolate and glyoxylate, documented lithogenic precursors of oxalate, were administered acutely and chronically to Wistar-strain rats in order to study their effects on oxalate excretion and subsequent stone formation. Urinary oxalate increased significantly within 4 hours, with a maximum being reached between 4-8 hours after a single administration of glycolic acid (200 mg) or glyoxylic acid (200mg). The 24-hour increase in urinary oxalate was about 3% of each amount given. Hyperoxaluria developed immediately and persisted throughout the experimental period in all the rats, which were fed on a diet containing glycolic acid or glyoxylic acid at a 3% level. Microscopically amorphous substances accumulated in the renal tubules at one week. Significant crystal formation appeared in the tubules after two weeks in both experimental groups and consistently increased both in number and in volume until the 4th week. Therefore, the oral administration of either glycolate or glyoxylate increased urinary oxalate comparably much within a few hours, but a few weeks of hyperoxaluria may be necessary to develop crystals in the convoluted tubules.

Topics: Administration, Oral; Animals; Calcium Oxalate; Glycolates; Glyoxylates; Male; Oxalates; Rats; Rats, Wistar; Urinary Calculi

Topics: Beverages; Calcium Oxalate; Coffee; Humans; Oxalates; Tea; Urinary Calculi

Our own studies and those of others have shown that the incidence of calcium oxalate stones and plaques is markedly increased by nephrotoxins. The possible role of oxalate as a nephrotoxin has not been fully appreciated. However, recent studies in experimental animals and in cultured cells support this possibility. The results of these studies led us to hypothesize that hyperoxaluria promotes stone formation in several ways: by providing a substrate for the formation of the most common form of renal stones, calcium oxalate stones, and by inducing damage to renal epithelial cells. Damaged cells in turn would produce an environment favorable for crystal retention and provide membranous debris that promotes crystal nucleation, aggregation and adherence. The present report summarizes evidence for oxalate nephrotoxicity and discusses the potential importance of oxalate toxicity in the pathogenesis of stone disease.

Topics: Animals; Cell Membrane Permeability; Cells, Cultured; Crystallization; Epithelium; Free Radicals; Kidney Tubules; Oxalates; Swine; Urinary Calculi

Forty adult male Wistar rats were placed in metabolic cages on a Ca-deficient diet (0.1%) for 7 days and then on a Ca-deficient, Na-oxalate (NaOx) enriched diet (20 mg/100 g) for another 14 days. The animals were subdivided into three groups receiving three different types of mineral water: group I (n = 13), Badoit (Ca 222 mg/l); group II (n = 14), Contrexéville (Ca 467 mg/l); and group III (n = 13), Evian (Ca 78 mg/l). Another series of 25 rats (group I, n = 9; group II, n = 8; group III, n = 8) underwent the same study protocol, except that they received a normal Ca diet (1%). On the low-Ca diet, urinary Ca-Ox monohydrate (COM) crystals were observed only under the Na-Ox diet, with a mean crystal number significantly greater in group III (16.7 +/- 4.5 crystals/mm3) than in group I or II rats (2.5 +/- 1.5 or 4.1 +/- 1.5 crystals/mm3, respectively). Urinary Ca concentrations decreased in all groups (P < 0.001) under the Na-Ox diet, while urinary oxalate concentrations increased in all groups (P < 0.001). On the normal Ca diet, COM crystal excretion was observed only with the Na-Ox-enriched diet, but in this case feeding the Na-Ox diet did not modify urinary oxalate excretion. Ca/Ox ratio was significantly lower under 0.1% Ca diet than under normal Ca diet, related with the type and the number of crystals observed, demonstrating that assessment of crystalluria can provide an index of disease severity. Moreover, the hardness of the drinking water influences urinary COM crystal excretion only under a low-Ca, oxalate-rich diet, suggesting that the total calcium intake rather than the water calcium content is an important factor in the occurrence of Ca-Ox nephrolithiasis.

Topics: Animals; Calcium; Calcium Oxalate; Calcium, Dietary; Crystallization; Diet; Disease Models, Animal; Magnesium; Male; Oxalates; Rats; Rats, Wistar; Urinary Calculi

A combined supplement of magnesium oxide (300 mg/day) and pyridoxine.HCl (10 mg/day) was given p.o. to 16 recurrent calcium oxalate (CaOx) stone formers, and its therapeutic efficacy was biochemically evaluated by measuring various parameters of blood (Na, K, Mg, urea, creatinine, calcium, phosphate, uric acid, alanine transaminase, aspartate transaminase and alkaline phosphatase) and urine (volume, pH, creatinine, Na, K, Mg, uric acid, calcium, phosphate, oxalate and citrate) at 0, 30, 60, 90 and 120 days of treatment. Serum Mg significantly (P < 0.01) increased after 30 days of treatment and remained constant thereafter while other blood parameters were unaltered. Combined treatment led to a significant increase in the urinary excretion of Mg and citrate over pretreatment values while oxalate excretion showed a gradual and significant decline during the therapy. The results confirmed the efficacy of MgO-pyridoxine supplementation in terms of changes in urinary excretion of lithogenic and inhibitory components, leading to a significant (P < 0.01) decrease in CaOx risk index from 0.09 +/- 0.04 at 0 day to 0.05 +/- 0.02 after 120 days of treatment.

Topics: Adult; Calcium; Calcium Oxalate; Drug Therapy, Combination; Female; Humans; Magnesium; Magnesium Oxide; Male; Middle Aged; Oxalates; Pyridoxine; Urinary Calculi

Effect of uric acid on sodium oxalate-induced biochemical and histological changes were studied in rats. Rats injected with sodium oxalate (0.7 mg/100 g body wt, ip) show calcium deposits in the lumen of kidney tubules. Uric acid administration was found to potentiate calcium oxalate calculi formation. Lipid peroxide formation was increased up to 100% in kidney and 28% in liver by sodium, oxalate treatment. Uric acid administration was found to reduce lipid peroxide level up to 12% in liver and 20% in kidney. From this study it is concluded that lipid peroxidation may not be the cause of sodium oxalate-induced urolithiasis and the results are discussed with reference to the epitaxic nature of uric acid on kidney stone formation.

Topics: Animals; Drug Synergism; Lipid Peroxidation; Male; Oxalates; Rats; Rats, Wistar; Uric Acid; Urinary Calculi

Two patients with atypical manifestations of aberrant peroxisomal biogenesis are described. Contrary to previous studies, which had shown that Zellweger syndrome patients usually have normal levels of urinary oxalate excretion, the patients in the present study had evidence of abnormal oxalate metabolism in the form of hyperoxaluria and, in one of the patients, calcium oxalate urolithiasis. Activity of the liver-specific peroxisomal enzyme alanine:-glyoxylate aminotransferase (AGT), which is a major determinant of the level of endogenous oxalate synthesis in humans, was normal in one patient and markedly supranormal in the other. Using the technique of post-embedding protein A-colloidal gold immunoelectron microscopy, AGT was found to be mainly cytosolic in the livers of both patients, with significant amounts also localized in the nuclei. In a small minority of the hepatocytes of one patient, who was homozygous for the more common (major) AGT allele, large numbers of unidentified fibrillar arrays were found in the cytosol, which labelled heavily for immunoreactive AGT. The background cytosolic AGT labelling was markedly reduced in such cells when compared to the majority of cells that did not contain fibrils. In the other patient, who was heterozygous for the major and minor AGT alleles, there appeared to be low levels of mitochondrial AGT labelling. In the light of these data, the possible metabolic function of cytosolic AGT in the livers of panperoxisomal disease patients is discussed.

Topics: Alanine Transaminase; Base Sequence; Child; Cytosol; Humans; Hyperoxaluria; Immunoblotting; Immunohistochemistry; Liver; Male; Microbodies; Microscopy, Immunoelectron; Molecular Sequence Data; Oxalates; Polymerase Chain Reaction; Urinary Calculi; Zellweger Syndrome

Evidence for the suitability of spot urines for selective screening in children was obtained by comparing the 24-hour urinary oxalate excretion with the ratio of urinary oxalate to creatinine [mmol/mol] in spontaneously voided urine samples. Spot urines of 169 healthy children aged 1 day to 13 years were analysed in order to establish reference values for the urinary oxalate/creatinine ratio in relation to age and body surface area. Oxalate was measured by automated ion chromatography. Results showed an inverse relationship between the oxalate/creatinine ratio and age. The highest ratios, 131 +/- 57 mmol/mol (mean +/- 2 SD), were found in infants. At age two years, the ratio was 84 +/- 55, at age five years 56 +/- 35, and for children older than ten years 42 +/- 31. This finding can be explained by the gain of muscle mass and hence increased creatinine production with increasing age. Data for the urinary oxalate/creatinine ratio are presented according to body surface area for the assessment of children with abnormal growth. In 19 urine samples from nine patients with primary hyperoxaluria, the oxalate/creatinine ratio greatly exceeded (286-2022 mmol/mol) the above reference ranges. We therefore propose the determination of the oxalate/creatinine ratio in spot urines for the selective screening for hyperoxaluria in children with nephrocalcinosis or urolithiasis.

Topics: Adolescent; Aging; Body Surface Area; Child; Child, Preschool; Creatinine; Female; Humans; Hyperoxaluria; Infant; Infant, Newborn; Male; Nephrocalcinosis; Oxalates; Reference Values; Urinary Calculi

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.

Topics: Antacids; Australia; Calcium Carbonate; Calcium Oxalate; Child; Child, Preschool; Citrates; Citric Acid; Female; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Oxalates; Retrospective Studies; Sodium Bicarbonate; Uric Acid; Urinary Calculi

In order to better understand the role of diet in etiology of urolithiasis, 84 oxalo-phospho-calcic-lithiasic patients (52 men, 32 women) have been studied by a nutritional week-interview and by urinary and blood testing. Diet data were compared to an ideal standard. Total caloric intake was 2428 +/- 651 calories/d; this intake is high in 7% women and 40% men. 79% out of patients are fat. Protidic intake is 87 +/- 21 g/d higher than 1 g/kg/d in 84.5% of patients. Lipids are high in 38.9 +/- 7%, glucid are low in 45.3 +/- 7%. Calcium intake is 934 +/- 406 mg/d, sodium intake is 12.9 + 3 g/d. Water intake is 2305 +/- 759 ml/d. Different groups of patients are studied: a) 21 patients with mean age of 43 +/- 12 years have recurrent lithiasis (R). This group is compared to 48 patients with 37 +/- 44 years who have a single lithiasis. Half of (R) patients have hypercalciuria, hyperphosphaturia and hyperoxaluria. Diet study is no different between these two groups. b) Other groups are studied: 21 have hyperophosphaturia (HPU) without hypophosphoremia and they have hypercalciuria, hyperuraturia and high urinary urea; diet shows higher glucicid and potassium intake than group with normal phosphaturia; 23 have hypercalciuria (HCU) and high uraturia and phosphaturia: diet study shows no difference with a group with normal calciuria. 21 have hyperoxaluria (HOU): diet study of a normal oxaluric group shows higher lipid intake, lower glucidic and calcium intake; 22 have hyperuraturia (HAU) and higher urinary urea, sodium and potassium than normouraturia group: in this group potassium intake is higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Calcium; Calcium Oxalate; Calcium Phosphates; Diet; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Energy Intake; Female; Humans; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi

The action of various beverages and foods on the composition of the urine in the circadian rhythm and in the 24-hour urine has been investigated under standardized conditions. Orange juice leads to a significant increase of urinary pH and citric acid excretion. Black tea leads to a raised excretion of oxalic acid by only 7.9%. In the short term, beer increases diuresis, but afterwards leads to a compensatory antidiuresis with increased risk of stone formation. Depending on their composition, mineral waters have very different effects on the urinary constituents. Milk as well as cocoa beverage significantly increase calcium excretion; moreover, cocoa causes an increase in the oxalic acid excretion. The leafy vegetable foods containing oxalate, e.g., spinach and rhubarb, lead to peaks of oxalate excretion of 300-400% in the circadian excretion curve. Cheese leads to a significant rise of calcium excretion with acidification of the urine and lowering of citrate excretion. Calcium excretion is increased by 30% by sodium chloride. Foods containing purine result in an increased uric acid excretion over several days. Depending on their phytic acid content, brans bind calcium, but lead to an increased oxalic acid excretion. Analysis of the urine indicates that average diet in Germany entails a high risk of urinary stone formation. As a result of the change to a balanced mixed or vegetarian diet, according to the requirements, significant alterations in urinary pH, calcium, magnesium, uric acid, citric acid, cystine, and glycosaminoglycan excretion are measured, resulting in a drastic reduction in the risk of urinary stone formation.

Topics: Adult; Beverages; Calcium; Calcium, Dietary; Cheese; Circadian Rhythm; Citrates; Citric Acid; Diet; Female; Humans; Hydrogen-Ion Concentration; Male; Meat; Nutritional Physiological Phenomena; Oxalates; Oxalic Acid; Risk Factors; Sodium, Dietary; Urinary Calculi; Vegetables

In addition to standard quantitative wet chemical and inductively coupled plasma atomic-emission spectrometric stone analytic techniques, elemental analysis for the determination of nitrogen, carbon and hydrogen was utilized in this study of 460 category I (non-infection) urinary stone samples from western Saudi Arabia. They were classified according to the percentage composition of detected ions, including trace or minimum amounts. The incidence of uric acid stones (24%) is higher than that reported from western countries but similar to those reported from eastern Europe and other parts of the middle east and most are in the group with the highest uric acid content (UrI4). Oxalate stones are the most common type (61%) and phosphate stones (15%) the least common. The results confirm the reliability of elemental microanalysis and support its use for the quick identification of stones especially those that weigh < 1 mg and are too small for wet chemical analysis. Within the various stone types, however, the ionic associations shown by wet chemical analysis denoted the presence of mutual indirect associations between the characterising ion oxalate and both uric acid and phosphate ions, but no association between the characterizing ion uric acid and phosphate ions. Factors that affect these ionic correlations may influence the processes of stone initiation and type of stone formed.

Topics: Cross-Cultural Comparison; Electron Probe Microanalysis; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Saudi Arabia; Spectrometry, X-Ray Emission; Uric Acid; Urinary Calculi; Urinary Tract Infections; Xanthines

The aim of this 17-day study was to examine the influence of four different diets on urine composition and the risk of calcium oxalate stone formation in 10 healthy male subjects. In the course of phase 0, the subjects were on their individual diet for 2 days. In the following phases I, II, and III the subjects received three different standard diets for a duration of 5 days each. Whereas DIET 1 (normal mixed diet) corresponded to the dietary habits of men aged 19 to 35 years, DIET 2 (balanced mixed diet) and DIET 3 (ovo-lacto-vegetarian diet) were calculated according to the dietary recommendations of the German Society of Nutrition (DGE) for the same age-group. The risk of calcium oxalate stone formation, calculated by the computer program EQUIL of FINLAYSON, was highest on the self-selected diet and on DIET 1, but declined significantly on the intake of DIET 2 by 50% on average compared to DIET 1 and by 61% compared to phase 0. On DIET 3 no further significant decline in the risk of calcium oxalate stone formation was observed. Therefore, it can be concluded that the change of usual dietary habits into a balanced mixed diet significantly reduces the risk of calcium oxalate stone formation. With a vegetarian diet a comparable decline in urine supersaturation of calcium oxalate can be achieved with respect to a mixed diet according to requirements. Since urinary oxalic acid excretion increased significantly, a vegetarian diet is not recommend for calcium oxalate stone patients with absorptive hyperoxaluria.

Topics: Adult; Calcium; Calcium Oxalate; Citrates; Citric Acid; Diet; Diet, Vegetarian; Humans; Hydrogen-Ion Concentration; Male; Oxalates; Oxalic Acid; Risk Factors; Software; Urinary Calculi; Urine

New information is provided regarding the site and nature of intestinal oxalate absorption in man. Intestinal absorption of oxalate was assessed indirectly from the increase in renal oxalate excretion following gastric administration of 5 mmol. oxalate loads. Four different types of loads have been used: sodium oxalate, sodium oxalate plus calcium gluconate, rhubarb and spinach. Studies were performed in 6 adult patients on permanent gastric tube feeding for various reasons. Gastric emptying was blocked by an intrapyloric balloon for the duration of the experiments and the gastric oxalate load was evacuated before the balloon was deflated. Under these conditions calcium oxalate was absorbed to the same extent as soluble oxalate. With increasing gastric loading time there is a linear increase in the urinary oxalate excretion: 15 to 21% of the gastric oxalate load appeared in the urine after 2 hours of loading, 24 to 45% after 4 hours and as much as 62% after 6 hours. These absorption kinetics and our experiment suggest that the stomach is not only just another oxalate absorption site but seems to be the critical site for intestinal oxalate absorption in an intact gastrointestinal tract. This finding opens a new field for the discussion of etiology and pathogenesis of calcium oxalate stone formation.

Topics: Aged; Aged, 80 and over; Calcium Gluconate; Calcium Oxalate; Enteral Nutrition; Gastric Mucosa; Humans; Intestinal Absorption; Middle Aged; Oxalates; Plants, Medicinal; Rheum; Urinary Calculi; Vegetables

To evaluate the role of parathyroids in calculus disease, the parathyroid hormone levels were determined in 22 control subjects and 42 stone (14 with bladder stone and 28 with kidney stone) patients. Serum calcium, inorganic phosphate, alkaline phosphatase and parathyroid hormone and urinary excretion of calcium and inorganic phosphate were determined. It was found that normocalcemic and normocalciuric stone patients had slightly higher levels of parathyroid hormone (irrespective of the site of the stone) and the difference was not statistically significant as compared with control subjects although some of the patients with calculus disease were hyperparathyroid. Serum alkaline phosphatase was increased while there was an increase in urinary calcium excretion in kidney stone patients and oxalate in all patients as compared with control subjects. The increase in inorganic phosphate was, however, not different from the control subjects. The subclinical hyperparathyroidism and stone formation in these patients are not correlated.

Topics: Adult; Alkaline Phosphatase; Calcium; Female; Humans; Hyperparathyroidism; Male; Oxalates; Parathyroid Hormone; Phosphates; Urinary Calculi

Fifteen healthy women were given a standardized calcium-rich diet (1800 mg calcium/day) with or without 36 g bran for 5 days. A similar study was also carried out with rice, soy and wheat bran. Urine samples were also collected 24 h. With all brans renal calcium excretion decreased and renal oxalic acid excretion increased. However, influence of rice bran was statistically significant. After 5 days of consuming 36 g rice bran/day 14 of 15 subjects showed decreased calcium excretion, but increased oxalic acid excretion. Relative supersaturation with calcium oxalate, as a measure for the risk of calcium stone formation, increased after addition of all brans.

Topics: Adult; Calcium; Calcium Oxalate; Calcium, Dietary; Dietary Fiber; Female; Glycine max; Humans; Oryza; Oxalates; Oxalic Acid; Urinary Calculi

Red blood cell oxalate flux rates were measured in various populations of stone patients and controls. Idiopathic and normocalciuric stone patients and post-prostatectomy patients exhibited rates significantly greater than the nonstone controls. The fact that this abnormality was not limited to patients with calcium oxalate nephrolithiasis suggests that this cellular defect is not universal nor an important etiological factor for calcium oxalate nephrolithiasis.

Topics: Adult; Calcium Oxalate; Child; Erythrocyte Membrane; Humans; Male; Oxalates; Prostatectomy; Urinary Calculi

Population based data on 24-h urinary excretion of calcium, oxalate, magnesium, phosphate, uric acid and creatinine were collected from 220 children (aged 3-16 years) living in Cimitile, Campania, southern Italy. Mean excretion rates for 7 days were correlated with age, body weight, body mass index and height. The prevalence of hypercalciuria (greater than 4 mg/kg body weight) and of hyperoxaluria (greater than 60 mg/day) were 9.1% and 1.8%, respectively. The same 20 children were also identified as hypercalciuric when a calcium/creatinine ratio of greater than 0.15 was considered. No significant differences between boys and girls were found in the urinary excretion of the five constituents implicated in urolithiasis. The study data provide additional childhood reference values for urinary excretion of compounds related to stone formation.

Topics: Adolescent; Calcium; Child; Child, Preschool; Electrolytes; Female; Humans; Hyperoxaluria; Italy; Magnesium; Male; Oxalates; Phosphates; Prevalence; Reference Values; Sampling Studies; Uric Acid; Urinary Calculi

Twenty-four hour urine specimens from 5,677 stone-forming patients throughout the United States were analyzed for seasonal variations in urinary risk factors for nephrolithiasis. Determinations were performed for urine volume, pH, calcium, oxalate, phosphorus, sodium, magnesium, citrate, sulfate, uric acid, and the relative supersaturation (RS) of calcium oxalate, brushite, monosodium urate, and uric acid. Criteria for significant seasonal variation included a significant difference in monthly means of risk factors, seasonal grouping of the data by the Student-Newman-Keuls multiple range test, consistent year-to-year trends and a physiologically significant range. Minimum urine volume of 1.54 +/- 0.70 SD L/day occurred in October while a maximum urine volume of 1.76 +/- 0.78 SD L/day was observed during February. Minimum urine pH of 5.94 +/- 0.64 SD was observed during July and August while a maximum pH of 6.18 +/- 0.61 SD was observed during February. Daily urinary excretion of sodium was lowest during August, 158 +/- 74 SD mEq/day and highest during February 177 +/- 70 SD mEq/day. The RS of brushite and uric acid were found to display significant pH-dependent seasonal variation with a maximum RS of uric acid 2.26 +/- 1.98 SD in June and a low of 1.48 +/- 1.30 SD in February. Maximum RS of brushite 2.75 +/- 2.58 was observed during February. Minimum RS of brushite 1.93 +/- 1.70 SD was observed in June. Phosphorus excretion displayed seasonal variation about a spring-fall axis with a maximum value 1042 +/- 373 SD mg/day in April and a minimum value of 895 +/- 289 SD mg/day. Urine volume, sodium, and pH were significantly lower during the summer (June, July, August) than in the winter (December, January, February). The RS of uric acid was higher, but that of brushite and monosodium urate was lower in the summer than in the winter. The seasonal changes observed in urine volume, pH, sodium, and the RS of brushite and uric acid are consistent with summertime sweating and increased physical activity. Seasonal variations in phosphorus excretion are probably dietary in origin. The summertime was characterized by an increased propensity for the crystallization of uric acid but not of calcium oxalate or calcium phosphate.

Topics: Calcium; Calcium Phosphates; Citric Acid; Humans; Oxalates; Phosphorus; Risk Factors; Seasons; Sodium; United States; Uric Acid; Urinalysis; Urinary Calculi

To assess the propensity for spontaneous crystallization of calcium oxalate in urine, the permissible increment in oxalate is calculated. The previous method required visual observation of crystallization with the addition of oxalate, this warranted the need for a large volume of urine and a sacrifice in accuracy in defining differences between small incremental changes of added oxalate. Therefore, this method has been miniaturized and spontaneous crystallization is detected from the depletion of radioactive oxalate. The new "micro" method demonstrated a marked decrease (p < 0.001) in the permissible increment in oxalate in urine of stone formers versus normal subjects. Moreover, crystallization inhibitors added to urine, in vitro (heparin or diphosphonate) or in vivo (potassium citrate administration), substantially increased the permissible increment in oxalate. Thus, the "micro" method has proven reliable and accurate in discriminating stone forming from control urine and in distinguishing changes of inhibitory activity.

Topics: Adult; Aged; Calcium Oxalate; Citric Acid; Crystallization; Diagnostic Techniques, Radioisotope; Diphosphonates; Female; Heparin; Humans; Male; Middle Aged; Oxalates; Urinalysis; Urinary Calculi

Three grams of calcium lactate and 3 g of uralyt U were administered to 39 calcium oxalate stone formers. Urinary oxalate level was reduced significantly without raising urinary calcium level by the administration of the two drugs for two weeks. The mechanism of action of these drugs and the diet which might produce a similar effect were discussed.

Topics: Adult; Aged; Calcium; Citrates; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

To evaluate underlying causes of calcium oxalate urolithiasis, 24-hour excretion of urine metabolites was measured in 6 Miniature Schnauzers that formed calcium oxalate (CaOx) uroliths during periods when they were fed a standard diet and during periods when food was withheld. Serum concentrations of parathyroid hormone and 1,25-dihydroxyvitamin D also were evaluated. Serum calcium concentrations were normal in all 6 affected Miniature Schnauzers; however, during diet consumption, mean 24-hour urinary excretion of calcium was significantly (P = 0.025) higher than calcium excretion when food was withheld. In 1 dog, urinary calcium excretion was lower during the period of food consumption, compared with the period when food was withheld. Compared with clinically normal Beagles, Miniature Schnauzers that formed CaOx uroliths excreted significantly greater quantities of calcium when food was consumed (P = 0.0004) and when food was withheld (P = 0.001). Miniature Schnauzers that formed CaOx uroliths excreted significantly less oxalate than clinically normal Beagles during fed (P = 0.028) and nonfed (P = 0.004) conditions. Affected Miniature Schnauzers also excreted abnormally high quantities of uric acid. Excretion of citrate was not different between Miniature Schnauzers with CaOx urolithiasis and clinically normal Beagles. In 5 of 6 Miniature Schnauzers with CaOx urolithiasis, concentrations of serum parathyroid hormone were similar to values from age- and gender-matched Miniature Schnauzers without uroliths. The concentration of serum parathyroid hormone in 1 dog was greater than 4 times the mean concentration of clinically normal Miniature Schnauzers. Mean serum concentrations of 1,25-dihydroxyvitamin D in Miniature Schnauzers with calcium oxalate urolithiasis were similar to concentrations of clinically normal Miniature Schnauzers.

Topics: Animals; Breeding; Calcitriol; Calcium; Calcium Oxalate; Dog Diseases; Dogs; Electrolytes; Female; Male; Oxalates; Parathyroid Hormone; Urinary Calculi

Topics: Adult; Female; Humans; Male; Middle Aged; Oxalates; Reproducibility of Results; Urinary Calculi

Topics: Adult; Alanine Transaminase; Algorithms; Calcium Oxalate; Child; Combined Modality Therapy; Humans; Incidence; Kidney Failure, Chronic; Kidney Transplantation; Liver; Liver Transplantation; Oxalates; Oxalic Acid; Pyridoxine; Transaminases; Urinary Calculi

Because human urine contains various substances which can affect each other, it is quite difficult to clarify the mechanism of formation of calcium oxalate (CaOx) crystal in urine. The authors recently determined CaOx crystalline content and the concentrations of other substances in urine specimens from patients with urolithiasis and healthy volunteers, and subjected the data to multi-regressive analysis for the purpose of assessing the effect of these urinary substances on CaOx crystal formation. 1. In analysis of urine from patients with urolithiasis, the partial correlation coefficients of CaOx crystal formation with oxalic acid, sodium, calcium, uric acid magnesium were 0.67, 0.28, 0.18, and -0.10, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 3.59 X 10(-2) Ox (mM/L) + 4.72 X 10(-3) Ca (mM/L) + 4.52 X 10(-3) Na (mM/L) + 2.51 X 10(-4) UA (mM/L) -2.39 X 10(-2) Mg (mM/L) -1.65. The multiple correlation coefficient was 0.759. Thus, in patients with urolithiasis, urinary crystal formation was most dependent on the oxalic acid level, sodium, calcium, and uric acid were found to promote crystal formation, while magnesium to suppress it. 2. In analysis of urine from healthy volunteers, the partial correlation coefficients of CaOx crystal formation with oxalic acid and inorganic phosphorus were 0.51 and -0.24, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 1.91 X 10(-2) Ox (mM/L) -3.43 X 10(-4) P (mM/L) +0.29 The multiple correlation coefficient was 0.525.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Calcium; Calcium Oxalate; Crystallization; Humans; Magnesium; Male; Oxalates; Oxalic Acid; Phosphorus; Regression Analysis; Sodium; Uric Acid; Urinary Calculi

Urinary lithogenic promoters and inhibitors were estimated in normal Indian men and women of young and old ages to understand the sex difference in the risk of stone disease. Young men displayed increased phosphate excretion and a higher mean calcium (both lithogenic promoters) and lower excretion of citrate (lithogenic inhibitor) compared to women of the same age indicating that young men are more at risk for calculous disease than women. In the older postmenopausal women, there was increased excretion of calcium and magnesium and a lower mean citrate than in the younger women suggesting that oestrogenic activity during reproductive years appears to offer protection against calculogenesis. This study indicates that sex differences exist in the excretion of lithogenic promoters and inhibitors which partly explain the difference in the incidence of urolithiasis between men and women.

Topics: Age Factors; Calcium; Citrates; Female; Humans; India; Magnesium; Male; Oxalates; Phosphates; Risk Factors; Sex Factors; Uric Acid; Urinary Calculi

A series of 182 calcium stone formers with idiopathic hypercalciuria underwent treatment with rice bran for 1 to 94 months. Urinary calcium excretion was considerably reduced, but there was some increase in urinary phosphate and oxalate. Urinary excretion of magnesium and uric acid, serum calcium, magnesium, phosphate, uric acid, parathyroid hormone (PTH) and ALP was unaffected. There were no obvious changes in serum iron, zinc and copper even when patients were treated for long periods. Rice bran was well tolerated in almost all cases and there were no serious side effects; 49 patients have undergone treatment for more than 3 years (average duration of administration 5.09 years). The frequency of new stone formation was drastically reduced (individual stone formation rate (no./year) from 0.720 +/- 0.533 to 0.125 +/- 0.204; group stone formation rate (no./patient-year) from 0.721 to 0.120) compared with the 3-year period before treatment. During treatment, 61.2% of patients remained in remission. Although rice bran therapy should be effective in correcting absorptive hypercalciuria, there may be limits to the overall ability of rice bran monotherapy to prevent recurrence.

Topics: Calcium; Female; Humans; Long-Term Care; Magnesium; Male; Oryza; Oxalates; Phosphorus; Recurrence; Time Factors; Uric Acid; Urinary Calculi

No information exists in the literature about the optimal time for metabolic evaluation of stone patients in relation to extracorporeal shock wave lithotripsy (ESWL) treatment. It is uncertain whether the presence of a stone, ESWL treatment itself or subsequent colic episodes influence the urinary risk factors. A prospective study was performed to determine the optimal period for metabolic evaluation. Two 24-hour urine samples were collected directly before, and 1 week, 1 month and 3 months after therapy in an outpatient setting and tested for total volume, calcium, uric acid, oxalate, citrate and creatinine levels. A total of 66 patients was available for evaluation. Comparison of the 4 subsequent collecting periods showed no statistically significant differences in the excretion values. Also, in subgroups of patients with colic (16%), on a calcium oxalate restricted diet (12%) and with repeated treatments within 3 months (33%) no differences were noted. This means that the presence of a stone, treatment itself or subsequent colic episodes have no adverse effect on the urinary risk factors. For practical reasons metabolic evaluation directly before ESWL treatment seems most attractive. In the pre-ESWL samples hypercalciuria (greater than 7.5 mmol./24 hours), hyperuricosuria (greater than 6 mmol./24 hours), hyperoxaluria (greater than 0.5 mmol./24 hours) and hypocitraturia (less than 2 mmol./24 hours) were found in 31%, 12%, 18% and 27%, respectively, of the patients. It is concluded that metabolic evaluation before ESWL is practical, applicable and reliable.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcium; Child; Citrates; Citric Acid; Creatinine; Female; Humans; Lithotripsy; Male; Middle Aged; Oxalates; Prospective Studies; Time Factors; Uric Acid; Urinary Calculi

A group of 44 patients, aged from 10 months to 14 years, underwent surgery for urinary calculi over a 7-year period (1982-1989). Eleven patients had bilateral or multiple calculi (total number of stones = 55, 20 of which were staghorn). Metabolic disorders (n = 25) and Proteus urinary infection (n = 15) were the 2 factors most often associated with lithiasis. Of the 55 stones, 51 were removed by open surgery. Complete stone clearance was achieved in 29 of 36 kidneys. Follow-up periods in the remaining 7 renal units (with small residual fragments) ranged from 3.5 to 7.5 years (mean 6.2) and revealed stone recurrence in only 2 patients. Evaluation of childhood urolithiasis should include thorough metabolic investigation and sound surgical judgment; effective management requires prolonged post-operative follow-up.

Topics: Adolescent; Bacteriuria; Calcium; Child; Child, Preschool; Female; Greece; Humans; Infant; Male; Oxalates; Proteus Infections; Recurrence; Risk Factors; Uric Acid; Urinary Calculi

Hyperoxaluria is an important risk factor in patients who form calcium oxalate stones within the urinary tract. It occurs in patients with primary hyperoxaluria, enteric hyperoxaluria, and the syndrome of idiopathic calcium oxalate urolithiasis. In the latter condition, the specific causes of the hyperoxaluria are not well defined. Diet and the availability of calcium and oxalate from the diet within the intestine are important factors in the hyperoxaluria that is present in some of these patients with idiopathic calcium oxalate urolithiasis. Other abnormalities in endogenous metabolism or transport of oxalate may play a role in the hyperoxaluria in some of these patients.

Topics: Calcium; Calcium Oxalate; Calcium, Dietary; Female; Humans; Hyperoxaluria; Male; Oxalates; Urinary Calculi

We developed 2 simple and rapid tests for measurement of constituent concentrations and the stone-forming tendency of urine in the outpatient clinic. The concentrations of urinary constituents of calcium, magnesium, phosphorus, uric acid and oxalic acid were measured using 2 types of simple colorimetric tests (vial and quantitative filter types). The intensity of the color developing after a given interval was compared with a color standard of 4 levels. The results obtained using the colorimetric test were slightly lower in value than but significantly correlated with those obtained with standard measurements. The second test measured the crystal-forming ability of urine. A 10 ml. urine sample was pipetted into 4 vials that each contained different concentrations of oxalic acid and calcium. After a given interval the turbidity in each vial was compared with a control (0 mg. oxalic acid and calcium). If turbidity occurred in urine with low concentrations of oxalic acid and calcium the sample had a large tendency for crystals to form.

Topics: Ambulatory Care; Calcium; Calcium Oxalate; Colorimetry; Crystallization; Dose-Response Relationship, Drug; Humans; Oxalates; Oxalic Acid; Risk Factors; Urinary Calculi

With the development of extracorporeal shock wave lithotripsy treatment, the duration of hospitalization for stone patients fortunately has become shorter. However, a detailed analysis of lithogenesis is not possible during such patients' short hospital stays. We prepared a standard diet to be eaten at home for investigation of lithogenesis at the out-patient clinic. This diet was nutritionally well-balanced and contained the following: energy: 2000 Kcal, total protein: 70-75 g, animal protein: 30-35 g, carbohydrate: 510 g, fat and oil: 50-60 g, calcium: 600-630 mg and magnesium: 320 mg. The urine of 24 male patients with stones on a free diet and the same patients after 3 days on the standard diet was analyzed for urea-nitrogen, uric acid, sodium, calcium, phosphorus, magnesium, citric acid and oxalic acid. The results were compared with those in 17 healthy male subjects who were eating the standard diet (controls). It was found that 66% of hypercalciuria (greater than = 300 mg/day) on a free diet became normocalciuria on the standard diet. The hypercalciuria was therefore thought to be of dietary origin. Moreover, urinary excretion of urea nitrogen, uric acid, sodium and phosphorus by patients remarkably decreased after 3 days on the standard diet, which was not different from that of controls. These results suggest that the standard diet at home is useful in the screening of hypercalciuria and also quite adequate for patients with stones.

Topics: Adult; Calcium; Diet; Humans; Male; Nitrogen; Outpatients; Oxalates; Oxalic Acid; Sodium; Uric Acid; Urinary Calculi

To compare urinary biochemical risk factors among stone-forming patients in the Southeast (SE) or "stone belt" versus four other regions of the United States.. Prospective biochemical survey for regional comparisons.. Referral-based nephrolithiasis clinics, urologists, nephrologists, and family practitioners.. Consecutive sample of 3473 stone-forming patients who submitted 24-hour urine collections for biochemical analyses of stone-forming risk factors.. None. Subjects taking medication known to interfere with stone-forming risk factors were deleted from the final data compilation.. Overall, the mean values for each urinary parameter spanned a narrow range without significant difference between the five regions. Among "metabolic" factors, 40% in the SE had hypercalciuria (> 6.25 mmol/d), compared to 35%-43% in other regions, and hyperuricosuria (> 4.2 mmol/d) was found in 16% in the SE versus 17%-19% elsewhere. Among "environmental" factors, low urine volume ( < 2 L/d) was found in 77% patients in the SE compared to 69%-78% elsewhere, and high sodium was encountered in 27% in the SE versus 24%-29% elsewhere. No differences were noted in occurrence of other abnormal risk factors: hyperoxaluria, hypocitraturia, low pH, high sulfate, high phosphorus, or low magnesium.. Despite expected regional differences in nutritional and environmental influences, the results of this study showed a striking similarity in urinary biochemical risk factor profiles of stone-formers in all five regions of the United States.

Topics: Calcium; Citrates; Humans; Magnesium; Oxalates; Phosphorus; Risk Factors; Sodium; Southeastern United States; Sulfates; United States; Uric Acid; Urinalysis; Urinary Calculi

After detailed instruction, 62 patients with urolithiasis treated at Taichung Veterans General Hospital entered this program, which ran from September 1987 to November 1988. Based on Pak's classification, there were 13 cases (21.0%) of absorptive hypercalciuria, type I (AH-I); 12 cases (19.4%) of absorptive hypercalciuria, type II (AH-II); 16 cases (25.8%) of renal hypercalciuria (RH); 3 cases (4.8%) of hyperuricosuric calcium urolithiasis (HUCU); 11 cases (17.7%) of hypocitraturia (Hypocit); 3 cases (4.8%) of hyperoxluria (HO); one case (1.6%) of primary hyperparathyroidism (PHPT) and one case (1.6%) of infectious lithiasis. Two cases (3.2%) with no metabolic abnormalities were found. Hypocitraturia, HUCU, and HO can be the primary abnormal findings, but more often coexist with various forms of hypercalciuria as a second factor. If the coexistence is considered, hypocitraturia (33 cases, 53.2%) and HUCU (24 cases, 38.7%) were the most prevalent categories. Meanwhile, 24 cases (38.7%) had only one physiological derangement, 25 cases (40.3%) had two derangements, and 13 cases (21.0%) had three. This study indicates that metabolic evaluation can elucidate the physiological derangements of urolithiasis, so that further medical treatment can be administered selectively.

Topics: Adult; Calcium; Citrates; Female; Humans; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

The intestinal uptake of [14C]oxalate, [14C]glyoxylate, and [14C]glycolate are studied in brush border membrane vesicles (BBMV) isolated from vitamin A-deficient and pair-fed control rats. The data obtained indicate that oxalate and its precursors are transported across the BBMV by passive diffusion. The intestinal uptake of glyoxylate and glycolate remains unaltered in vitamin A deficiency, while uptake rate of oxalate was significantly increased (p less than 0.01) in vitamin A-deficient rats as compared to pair-fed controls. In conclusion, the results indicate that vitamin A deficiency leads to hyperabsorption of oxalate through the gut.

Topics: Animals; Glucose; Glycolates; Glyoxylates; Jejunum; Male; Microvilli; Organ Size; Oxalates; Oxalic Acid; Rats; Rats, Inbred Strains; Sodium; Urinary Calculi; Vitamin A Deficiency

The effect of pyridoxine hydrochloride, 200 mg/day (0.97 mmol/day) for 3 weeks, upon plasma and urinary oxalate has been determined in ten normal subjects and seven patients with idiopathic hypercalciuria while both groups were on low-oxalate diets. Patients had higher basal urinary oxalate levels than normal subjects. In normal subjects pyridoxine administration decreased plasma oxalate levels and raised urinary oxalate. The patients showed no change in either plasma or urinary oxalate.

Topics: Calcium; Female; Humans; Hyperoxaluria; Male; Oxalates; Pyridoxine; Urinary Calculi

A study was made of 819 patients attending a metabolic stone clinic. A firm diagnosis was made in 708 (86%) and in 132 of these (19%) the diagnosis was thought to be chronic dehydration. The records were available for study for 87 males and 11 females in the chronic dehydration group. The mean age at presentation was 43 years. The causes of chronic dehydration were hot climate (62%), with hot occupation and low water intake almost equal in second place. In patients with a single cause of chronic dehydration, 57% also had a dietary risk factor for urolithiasis and this was most commonly high oxalate intake. Following dietary advice, the mean urinary volume increased from 1720 to 2475 ml/24 h. This was accompanied by a rise in mean urinary calcium from 6.02 to 6.96 mmol/24 h, presumably due to the calcium in the additional water drunk. Urinary oxalate did not change significantly. The mean follow-up time was 4.85 years and the stone recurrence rate was low. It was concluded that chronic dehydration is a common cause of urolithiasis; this can be treated satisfactorily by increasing water intake plus dietary advice in certain cases.

Topics: Adult; Calcium; Chronic Disease; Dehydration; Diet; Drinking; Female; Follow-Up Studies; Hot Temperature; Humans; Male; Occupations; Osmolar Concentration; Oxalates; Risk Factors; Sports; Urinary Calculi

We have evaluated the urinary excretion of promoting (calcium, phosphorus, uric acid, oxalate) and inhibiting (citrate, magnesium, glycosaminoglycans) factors of crystallization in subjects with idiopathic hypercalciuria and calcium urolithiasis and in a control group. The examined children had a free diet and were drug free for the last 2 weeks. They were not affected by malabsorption, D-RTA, urinary tract infection, or urinary tract malformation (factors interfering with urinary excretion of citrate and oxalate). In the patients with calcium urolithiasis, the daily urinary excretion of oxalate was significantly higher (p less than 0.01), and the urinary excretion of citrate was significantly lower (p less than 0.001) than in the subjects with idiopathic hypercalciuria and in the control group. Among the subjects with idiopathic hypercalciuria, those aged 4-9 years had a significantly reduced, though in the normal range, urinary excretion of citrate as compared with those aged 10-15 years (362 +/- 189 and 503 +/- 198 mg/g creatinine/24 h, respectively; p less than 0.01). Our data show that hypocitruria may play an important role in the pathogenesis of urolithiasis in children with idiopathic hypercalciuria. In these cases, the urinary citrate excretion was not inversely related to age, as has been suggested by other authors.

Topics: Calcium; Child; Citrates; Citric Acid; Crystallization; Female; Glycosaminoglycans; Humans; Magnesium; Male; Oxalates; Oxalic Acid; Phosphorus; Uric Acid; Urinary Calculi

After 1 year of allopurinol treatment in 36 patients with a history of uric acid and/or calcium oxalate lithiasis and hyperuricosuria, we observed that in addition to the desired decreases in uric acid there were apparently significant decreases in urinary oxalate levels: 37 +/- 3 mg. per day (mean +/- standard error) before therapy and 31 +/- 4 mg. per day after a mean decrease of 16% (p less than 0.05) with an equivalent decrease in the supersaturation (calcium oxalate) of the urine. However, the decrease in oxalate could have been related to changes in dietary habits rather than to any specific effects of allopurinol on oxalate metabolism. Therefore, we recruited 26 of the patients for a study in which dietary factors were controlled. Each participant was assigned to 1 of 3 diet groups: low or high protein, or a customary diet. Each patient collected a urine specimen while on allopurinol and again after the medication was discontinued. With analytical procedures that we ascertained to be free of any significant methodological bias, we observed no significant changes in urinary oxalate excretion that could be attributed to allopurinol. There were significant differences in oxalate excretion on versus off allopurinol between the low and high protein groups, with higher oxalate levels found for the latter group. Our results indicate that allopurinol does not have a specific effect on oxalate metabolism or oxaluria.

Topics: Adult; Allopurinol; Dietary Proteins; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

The study was conducted to investigate the effect of vitamin A, B1 and B6 deficiency on oxalate metabolism in rats. A significant hyperoxaluria was the common observation in all the three vitamin deficiencies (vitamin B6 greater than vitamin A greater than vitamin B1). The activities of hepatic glycolate oxidase and glycolate dehydrogenase were markedly enhanced in vitamin-A- and vitamin-B6-deficient rats. However, lactate dehydrogenase levels remained unaltered in these deficiencies as compared to their respective pair-fed controls. Vitamin B1 deficiency of 4 weeks' duration could augment the activity of glycolate oxidase only, with no alterations in the glycolate dehydrogenase and lactate dehydrogenase levels. Intestinal oxalate uptake studies revealed increased bio-availability of oxalate from the gut in vitamin-A- and vitamin-B6-deficient rats. Thus, the results suggest the relative contribution of both exogenous as well as endogenous oxalate in the process of calculogenesis under various nutritional stress conditions in rat.

Topics: Animals; Male; Oxalates; Rats; Rats, Inbred Strains; Urinary Calculi; Vitamin A Deficiency; Vitamin B 6 Deficiency; Vitamin B Deficiency

Hypocitraturia, hypercalciuria, hypokalaemia, and some form of acidosis are often characteristic accompanying symptoms of calcium containing urinary stone formation. These alterations may be controlled or normalized with the administration of alkaline citrates which slow the relative growth rate of calcium oxalate crystals down. In response to the administration of a single 2-g dose of Magurlit granulate, also regarded as alkaline citrate, citrate excretion increases, urinary Ca/citrate, Ca/creatinine, and Ca.P/creatinine quotients decrease. Since these changes of the urinary constituents are advantageous as far as the prophylaxis of stone formation is considered and may be observed following the administration of other citrate mixtures as well the application of Magurlit is recommended for the prevention of calcium oxalate stones and for the treatment of distal renal tubular acidosis.

Topics: Citrates; Drug Combinations; Female; Humans; Male; Oxalates; Pyridoxine; Urinary Calculi

Search is under way to develop reliable tests for the prediction of stone risk. Several indices and ratios on the basis of urinary excretions have been suggested. In the present study the applicability of some risk indices and ratios in slum dwellers of Dharavi area of Bombay was examined. No significant difference was observed in IAP (ionic activity product) and CORI (calcium oxalate risk index) between stone formers (SF) and normal subjects (NS). We have suggested two more adjuncts, PIR (promoter/inhibitor ratio) and COQ (calcium oxalate quotient), and found them to be quite useful in the detection of risk. Pre-existence of risk factor(s) in the majority of the normal population suggests that triggering of stone formation should be a transient phenomenon in this population. No consistent pattern of relationship between various urinary parameters was observed.

Topics: Calcium; Calcium Oxalate; Citrates; Citric Acid; Creatinine; Humans; Magnesium; Oxalates; Risk Factors; Urinary Calculi

The aim of this work is to evaluate citrate in a group of patients with calcium oxalate urolithiasis and in a control group for detecting possible differences between the two groups. The mean urinary concentration in the stone-formers was found significantly lower than in the controls. Particularly interesting was the correlation study between citrate and calcium. It was found that patients with hypocitraturia have hypercalciuria. Thus, it is particularly interesting to point out the importance of citrate in preventing the risk of lithiasis in the group of stone-formers studied by us.

Topics: Adult; Aged; Calcium; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

Uric acid is implicated in calcium oxalate kidney stone formation. Conspicuously so far, two hypotheses have been proposed: direct induction of calcium oxalate precipitation by uric acid, and uric acid as anti-inhibitor by binding urinary glycosaminoglycans (GAGS). The aim of this work is to evaluate uric acid and the relationship with GAGS in a group of patients with calcium oxalate lithiasis, and in a control group for detecting possible differences between the two groups. It was found that the lower concentration of GAGS in stone formers could impede their inhibitory activity on the heterogeneous nucleation of uric acid in calcium stone formation.

Topics: Biomarkers; Calcium; Calcium Oxalate; Chondroitin Sulfates; Female; Glycosaminoglycans; Humans; Male; Oxalates; Reference Values; Uric Acid; Urinary Calculi

The binding properties of raw vegetable fiber towards bivalent cations suggested the prescription of brain as a dietary supplement to limit intestinal calcium absorption in hypercalciuric patients. A group of 18 patients with a specific diagnosis of absorptive hypercalciuria received a dietary supplement of 14 gm. wheat bran at the 2 principal meals for 90 days. A complete assessment of mineral metabolism was performed after 45 and 90 days. Mean basal calciuria was 357 mg. per 24 hours and a significant decrease was noted after 45 days (245 mg. per 24 hours) and 90 days (240 mg. per 24 hours), with a p value of less than 0.01. Urinary oxalate did not vary significantly (0.34 to 0.38 to 0.31 mMol. per 24 hours) and neither did phosphate levels (1,020 to 900 to 893 mg. per 24 hours). A slight and pathologically insignificant decrease was noted in serum iron and urinary magnesium; this fact could be considered a side effect owing to the nonselective binding properties of fiber. Therefore, the positive results achieved confirm the effective action of wheat bran in the treatment of correctly diagnosed absorptive hypercalciuria.

Topics: Absorption; Adolescent; Adult; Calcium; Dietary Fiber; Female; Humans; Male; Middle Aged; Oxalates; Phosphates; Time Factors; Uric Acid; Urinary Calculi

Male Sprague-Dawley rats were challenged with various hyperoxaluric agents including ammonium oxalate, hydroxy-L-proline, and ethylene glycol. All treatments resulted in increased urinary oxalate. Associated with hyperoxaluria was an increase in urinary levels of renal enzymes, gamma-glutamyl transpeptidase, N-acetyl-beta-glucosaminidase, and alkaline phosphatase. Most of the rats did not demonstrate any significant change in urinary levels of beta-galactosidase. There was a highly significant positive correlation between urinary oxalate and N-acetyl-beta-glucosaminidase.

Topics: Acetylglucosaminidase; Alkaline Phosphatase; Animals; Calcium Oxalate; Crystallization; Enzymes; Ethylene Glycol; Ethylene Glycols; gamma-Glutamyltransferase; Hydroxyproline; Male; Oxalates; Oxalic Acid; Rats; Rats, Inbred Strains; Urinary Calculi

Jejunoileal bypass (JIB) has been widely performed for treatment of excessive obesity. Formation of calcium oxalate stones is a common side effect. Since, under physiological conditions, the intestinal absorption of calcium and that of oxalate are interrelated, intestinal oxalate and calcium absorption were measured in the present study by isotope techniques in 19 JIB patients and 20 healthy controls. The JIB patients showed pronounced hyperoxaluria and markedly increased absorption of oxalate, with a urinary excretion of 14C-oxalate of 29 +/- 19% (controls 6.2 +/- 3.7%; p less than 0.001). There was a strong correlation between the intestinal absorption and urinary excretion of oxalate in the JIB patients (r = 0.72; p less than 0.001). Furthermore, their oxalate kinetics was altered, with continued urinary excretion of 14C-oxalate for up to 48 hours. The JIB patients also had reduced calcium absorption (36 +/- 9.1% vs. 47 +/- 9.0%; p less than 0.001) and patients with malabsorption of calcium and low urinary calcium had the highest intestinal absorption and urinary excretion of oxalate. It is concluded that hyperoxaluria in JIB patients is due to a significant extent to hyperabsorption of oxalate.

Topics: Adult; Calcium; Calcium Oxalate; Female; Humans; Hyperoxaluria; Intestinal Absorption; Jejunoileal Bypass; Male; Oxalates; Oxalic Acid; Urinary Calculi

Oxalic acid seems to be more important for the formation of calcium oxalate stone than calcium. Three grams of calcium lactate and 3 g of uraly U were administered to 35 urolithiasis patients, whose stones were mainly composed of calcium oxalate. Urinary oxalate level was reduced significantly without raising urinary calcium level by the administration of the two drugs for two weeks. The reduction of oxalic acid was particularly remarkable in patients without hypercalciuria. The mechanism of action of these drugs and the relation to dietary management were discussed.

Topics: Adult; Aged; Calcium; Citrates; Drug Combinations; Female; Humans; Lactates; Lactic Acid; Male; Middle Aged; Oxalates; Urinary Calculi

Oxalate excretion was measured in healthy subjects and idiopathic calcium stone-formers on dietary regimens which differed in the type and amount of protein allowed; 24-h urine collections were obtained from 41 practising vegetarians and 40 normal persons on a free, mixed, "mediterranean" diet. Twenty idiopathic calcium stone-formers were also studied while on two low calcium, low oxalate diets which differed in that animal protein was high in one and restricted in the other. Vegetarians had higher urinary oxalate levels than controls and although the calcium levels were markedly lower, urinary saturation with calcium/oxalate was significantly higher. This mild hypercalciuria was interpreted as being secondary to both a higher intake and increased fractional intestinal absorption of oxalate. Changing calcium stone-formers from a high to a low animal protein intake produced a significant decrease in calcium excretion but there was no variation in urinary oxalate. As a result, the decrease in calcium oxalate saturation was only marginal and not significant. It was concluded that dietary animal protein has a minimal effect on oxalate excretion. Mild hyperoxaluria of idiopathic calcium stone disease is likely to be intestinal in origin. Calcium stone-formers should be advised to avoid an excess of animal protein but the risks of a vegetable-rich diet should also be borne in mind.

Topics: Adult; Calcium; Diet, Vegetarian; Dietary Proteins; Female; Humans; Male; Oxalates; Plant Proteins, Dietary; Urinary Calculi

A retrospective estimate of the annual rate of stone formation (fSF) was obtained in only 154 (35%) of 438 patients without medical treatment at our out-patient stone clinic. Eighty-three of these patients had never been on any prophylactic treatment and were only given advice concerning drinking and dietary habits. There was a high calcium excretion in 46%, high oxalate in 17%, low citrate in 11%, low magnesium in 17%, and increased urate in 16% of the patients. As much as 25% had a 24-hour urine volume below 1,000 ml. There was a good correspondence between stone formation during the follow-up period (tT) and a period of the same length following diagnosis (tA). The mean (+/- SD) tT was 3.2 +/- 1.9 years, with an fSF of 0.19 +/- 0.43. During the tA period fSF was 0.13 +/- 0.31. The number of patients who formed new stones during these periods were 21 and 22, respectively. It is suggested that stone formation during tT and tA advantageously might be used for preliminary evaluation of the therapeutic response. The risk of forming a urine highly supersaturated with calcium oxalate was expressed in terms of a standardized AP(CaOx) index calculated for a 24-hour urine volume of 1,500 ml. There was no relationship between this AP(CaOx) index and fSF. When only those patients were considered who formed new stones during the first 10 years after diagnosis, slightly higher values of the standardized AP(CaOx) index were recorded than in the recurrence-free group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Calcium; Citrates; Citric Acid; Female; Follow-Up Studies; Humans; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Recurrence; Time Factors; Uric Acid; Urinary Calculi

Oxalate was measured by ion chromatography in the ultrafiltrate of heparinized plasma from peripheral venous blood, using a membrane with a cut-off molecular weight (Mr). The following criteria were established: sensitivity 0.7 mumol.l-1; intra- and inter-assay coefficients of variation 4% and 12%, respectively; precision of duplicate determinations (expressed as standard deviation) 0.08 mumol.l-1; overall recovery (oxalate added and diluted, respectively) 100.7%. These qualified the method for assessment of plasma oxalate in healthy human controls (males: n = 12) as well as patients with idiopathic renal calcium urolithiasis (males: n = 22; females: n = 16). Renal calcium urolithiasis patients were subclassified into those with normocalciuria and idiopathic hypercalciuria. In male and female controls the mean values (and range) of plasma oxalate were 1.98 (1.4-2.5) and 1.78 (0.7-2.9) mumol.l-1, respectively. In male controls ultrafiltration (membrane cut off Mr 10,000) revealed that 11-16% plasma oxalate was bound to constituents having an apparent Mr above 10,000, and that with use of membranes with smaller pore size, the ultrafilterability of oxalate decreases further. In renal calcium urolithiasis the following values were elicited (mumol.l-1): male normocalciuria 1.78 (0.8-4.0), idiopathic hypercalciuria 1.58 (1.2-2.2); female normocalciuria 1.69 (0.8-3.6), idiopathic hypercalciuria 1.21 (0.8-2.1). The difference from controls is significant in idiopathic hypercalciuria (males and females). In contrast, in fasting urine of renal calcium urolithiasis the oxalate excretion rate (5-45 mumol per 120 min) and oxalate clearance (21-328 ml per min) resemble those in controls, whereas in renal calcium urolithiasis the fractional oxalate clearance (30-357% of creatinine clearance) tended to higher values (p less than 0.01, in male idiopathic hypercalciuria versus controls). It is suggested that 1) ion chromatography allows the reliable assessment of ultrafiltrable plasma oxalate in health and disease states, 2) in renal calcium urolithiasis this technique may help to elucidate oxalate pathophysiology, especially the mode of renal handling of oxalate.

Topics: Adult; Aged; Calcium; Chromatography, Liquid; Fasting; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

Relationship between urinary sodium excretion and urinary excretion of calcium, uric acid, oxalate, phosphate and magnesium was analyzed in 93 ambulatory patients with urolithiasis. There was a significant correlationship between urinary sodium excretion and urinary excretion of calcium, uric acid, oxalate (only in male stone formers), phosphate and magnesium, respectively. Under a salt restricted diet (NaCl 3-5 gm/day) for 3 days, urinary sodium excretion of 16 inpatients with urolithiasis was reduced remarkably together with significant reduction of urinary excretion of calcium, uric acid and oxalate. Urinary excretion of phosphate and magnesium showed no change. From these findings we conclude that restriction of sodium intake is an effective treatment for prevention of stone recurrence.

Topics: Calcium; Diet, Sodium-Restricted; Female; Humans; Magnesium; Male; Natriuresis; Oxalates; Phosphates; Recurrence; Sodium, Dietary; Uric Acid; Urinary Calculi

An acute acid load was used to evaluate potential chemical differences of urinary composition in recurrent oxalate stone formers and healthy controls. After intake of ammonium chloride, total calcium, ionized calcium and magnesium increased and citrate decreased significantly in both groups. Differences between stone formers and controls could be demonstrated from the excretion of total calcium, citrate, oxalate and uric acid only after acute acid load, whereas ionized calcium did not improve discrimination. These findings support the stone-promoting role of high acid food as well as the possibility of discriminating recurrent oxalate stone formers from controls by an acute acid-loading test.

Topics: Acid-Base Equilibrium; Ammonium Chloride; Calcium; Citrates; Citric Acid; Humans; Kidney Function Tests; Oxalates; Oxalic Acid; Recurrence; Uric Acid; Urinary Calculi

Urinary oxalate is one of the most important constituents of urolithiasis, but the determination of oxalate in urine has not been performed as a routine laboratory examination. We tried to measure oxalate in urine by the enzymatic method with oxalate oxidase. The linearity of the standard curve and reproducibility of this method were confirmed. (Linearity: r = 0.996, S.D./mean: 0.5-3.6%, recovery rate: 99.5 +/- 3.3 (mean +/- S.D.)%) The correlation between this method and gas-chromatographic method was 0.926. The enzymatic method with oxalate oxidase can be utilized for determining the urinary oxalate as a routine laboratory examination.

Topics: Chromatography, Gas; Humans; Methods; Oxalates; Oxidoreductases; Urinary Calculi

Magnesium and tartrate each reduce calcium oxalate crystal formation in urine. Since the effects are additive, a palatable mixture of magnesium and tartrate salts was devised and fed to 6 healthy volunteers. There were no side effects. There was a moderate fall in urinary calcium, moderate rises in urinary magnesium, tartrate and citrate, and no change in urinary oxalate. Hence there are good grounds for supposing that this mixture could be used to prevent urinary stone recurrence.

Topics: Calcium; Carbonates; Citrates; Citric Acid; Drug Combinations; Humans; Magnesium; Oxalates; Oxalic Acid; Potassium; Tartrates; Urinary Calculi

The daily excretion of calcium, oxalate, uric acid and glycosaminoglycans, the 24-h urinary pH and volume, and the inhibitory effects of the urines on calcium oxalate crystal growth and aggregation, were measured in 44 normal women, 41 normal men, 32 female stone formers and 63 male stone formers. No significant differences could be found between the normal men and women, the male and female stone formers, or between the patients and their normal controls with regard to the excretion of oxalate and glycosaminoglycans, and the urinary pH. The normal women exhibited significantly lower urinary volumes and excreted less calcium per day than did the other subject groups. The excretion of calcium by the female stone formers was indistinguishable from that of both groups of men. The male and female stone formers did not differ from their corresponding control groups with regard to the excretion of urate, but both groups of male subjects had significantly higher daily urate excretions than did either female category. This was attributed to the greater body weights of the men. There were no discernible differences between any of the subject groups with regard to the inhibitory effects of their urines on calcium oxalate crystal growth, but urines from both groups of female subjects demonstrated a significantly greater inhibitory influence on crystal aggregation than did those of the men. It would appear that the relatively low incidence of uninfected calcium oxalate urolithiasis in women compared with men may be attributable to (a) a lower daily calcium excretion and (b) a higher inhibitory activity of their urines towards crystal aggregation.

Topics: Adult; Age Factors; Body Weight; Calcium; Female; Glycosaminoglycans; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Risk Factors; Sex Factors; Time Factors; Uric Acid; Urinary Calculi

Twenty-four hour urinary excretion of the stone forming constituents, calcium, oxalate, uric acid, phosphate and magnesium were assayed either under the restricted diet (190 stone formers and 52 non-stone formers) or under the ambulatory free diet (93 stone formers and 14 non-stone formers). Under the ambulatory free diet, urinary excretion of calcium, uric acid and magnesium in the male stone formers, and urinary excretion of calcium and magnesium in the female stone formers was significantly higher than that under the restricted diet. Under the restricted diet, no difference in urinary excretion of calcium, oxalate, uric acid or phosphate was noted between the stone formers and non-stone formers. However, urinary magnesium excretion of the stone formers under the restricted diet was significantly lower than that of the non-stone formers. Under the free diet, no difference in urinary excretion of calcium, oxalate, uric acid, phosphate or magnesium was observed between the stone formers and non-stone formers. Also, there was no significant difference in urinary excretion of calcium, oxalate, uric acid, phosphate or magnesium between the unilateral urolithiasis patients without previous stone history and that of the bilateral or recurrent stone formers. We conclude that urinary excretion of calcium, oxalate, uric acid, phosphate and magnesium have no major role in the stone producing mechanism. However, reduction of urinary excretion of calcium, oxalate, uric acid and phosphate and augmentation of urinary excretion of magnesium are mandatory in preventing stone recurrence until a better understanding of the cause of urolithiasis is obtained.

Topics: Calcium; Diet; Female; Food Service, Hospital; Food, Formulated; Humans; Magnesium; Male; Oxalates; Phosphates; Recurrence; Uric Acid; Urinary Calculi

The diurnal variations in the plasma oxalate concentration and oxalate clearance were examined at the state of oxalate restriction and loading on 6 normal subjects and 11 calcium oxalate stone formers. The oxalate-restricted diet contained 44.5 mg of total oxalate, 32.2 mg of soluble oxalate, and for oxalate loading, spinach (100 g: total oxalate 429 mg, soluble oxalate 156 mg) was added to the oxalate-restricted diet at breakfast. Normal subjects showed a diurnal variation in plasma oxalate at oxalate restriction and loading. The plasma oxalate concentration showed the highest level under the fasting condition, gradually dropped and was then fixed at the lower level during the day. The oxalate clearance during the day was significantly higher (p less than 0.05) than that during the night in normal subjects taking the oxalate restricted diet, and after they were oxalate loaded, it increased significantly (p less than 0.05) for 6 hours, but returned to the level at oxalate restriction during the night. Meanwhile, there was no significant difference in oxalate clearance between day and night in calcium oxalate stone formers. As compared with the control group, there were no significant differences in the diurnal variation in the plasma oxalate concentration, oxalate clearance at oxalate restriction, or in the diurnal variation of the plasma oxalate concentration at oxalate loading. However, the oxalate clearance during the night after oxalate loading increased significantly (p less than 0.05) compared with the control group. Based on the pattern of urinary oxalate excretion during the night compared with the control group, the stone formers were divided into two groups. The first group showed significantly (p less than 0.01) higher oxalate clearance during the night both during oxalate restriction and loading. The oxalate clearance increased significantly up to 8 hours after oxalate loading (p less than 0.01) and during the night (p less than 0.05) compared with the level during oxalate restriction. The plasma oxalate concentration did not increase after loading. The second group showed a significantly (p less than 0.05) lower oxalate clearance during the day after oxalate loading. The oxalate clearance (p less than 0.05) was significantly increased for 4 hours after the loading compared to the during oxalate restriction. The plasma oxalate concentration increased at 6 hours after oxalate loading. There was no significant difference in oxalate clearance dur

Topics: Adult; Calcium Oxalate; Circadian Rhythm; Humans; Male; Metabolic Clearance Rate; Middle Aged; Oxalates; Urinary Calculi

Topics: Humans; Hydrogen-Ion Concentration; Oxalates; Oxalic Acid; Uric Acid; Urinary Calculi

The principle of this kit method is that urinary oxalate is extracted and subsequently assayed by measuring the amount of hydrogen peroxide produced in an oxidation reaction catalyzed by oxalate oxidase. The reproducibility and accuracy of the method were tested: the within-run and day-to-day coefficients of variation were 5.4-20.0% and 16.1-18.0%, respectively, and the overall recovery rate of the added oxalate (5-25 mg/l) was 40-50%. These abnormally low recovery rates may be related to the presence of sulfate and phosphate in the extracted fluid. Therefore, the above method was modified by performing a recovery test by adding 25 mg/l oxalate to all urine samples. By the modified method, the correlation coefficient obtained between this method and the ion-chromatographic method was 0.851 (p less than 0.01). Urinary pretreatment with either acid ferric chloride or EDTA yields a higher recovery than with HCl. However, a good correlation of oxalate values is consistently observed for HCl-processed urine as measured by the above two methods. If the interference of ascorbic acid is negligible, no special urinary treatment except for HCl is necessary. The 24-hour urinary oxalate excretions were 24.4 +/- 9.1 mg (mean +/- SD) in 8 healthy males and 19.9 +/- 10.3 mg in 24 calcium-stone formers (21 males and 3 females).

Topics: Adult; Chromatography, Ion Exchange; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Oxalates; Oxidoreductases; Reagent Kits, Diagnostic; Spectrophotometry; Urinary Calculi

Topics: Adult; Animals; Calcium; Circadian Rhythm; Fabaceae; Humans; Oxalates; Plants, Medicinal; Urinary Calculi

The effect of changes in urinary sodium, induced by dietary manipulation in normal subjects (NS) and in stone formers (SF) was studied by observing crytalluria qualitatively and by determining calcium, oxalate and phosphate crystallization quantitatively in an experimental model. In SF the calcium crystallization was significantly higher than in NS at all the three levels of urinary sodium studied. However, no difference was observed in oxalate and phosphate crystallization rates between these two groups. Calcium and oxalate (p less than 0.05) and oxalate and phosphate (p less than 0.001) were found to be correlated in NS but were non-significant in SF. The wide changes in the urinary sodium induced by dietary changes did not influence the crystallization rate of calcium, nor of oxalate and phosphate in NS as well as in SF. The results suggested that a sodium intake with lower and upper limits of 124 mg and 6,009 mg respectively did not act as "inhibitor" of crystallization rate nor did it induce hypercalciuria severe enough to pose a "risk" of stone formation. The results did not suggest that a high urinary sodium increases the solubility of calcium phosphate.

Topics: Calcium; Calcium, Dietary; Crystallization; Humans; Oxalates; Phosphates; Risk; Sodium; Sodium Chloride; Urinary Calculi

Topics: Humans; Oxalates; Oxalic Acid; Phosphates; Spectrophotometry, Infrared; Urinary Calculi

The urinary excretion levels of oxalic acid, calcium, kynurenic, and xanthurenic acids and serum pyridoxal and pyridoxal phosphate concentrations were determined for nonbilharzial and bilharzial hyperoxaluric patients with or without urinary stones. The effects of pyridoxine and allopurinol treatment were also studied. The different groups studied showed elevated levels of urinary oxalic acid, calcium, kynurenic, and xanthurenic acids as well as decreases in serum pyridoxal and pyridoxal phosphate concentrations. These data indicate that nonbilharzial hyperoxaluric patients suffer from dietary B6 deficiency, whereas bilharzial hyperoxaluric patients may suffer from impaired pyridoxine phosphokinase activity. Pyridoxine supplementation is recommended for the treatment of nonbilharzial hyperoxaluric patients. Allopurinol may be the proper drug in the treatment of oxaluria and stone formation or of bilharzial patients.

Topics: Adult; Alanine Transaminase; Alkaline Phosphatase; Allopurinol; Aspartate Aminotransferases; Calcium; Creatinine; Humans; Male; Middle Aged; Oxalates; Pyridoxine; Reference Values; Schistosomiasis; Urea; Urinary Calculi

The increasing incidence of urolithiasis makes it important to report about 34 children with urolithiasis seen between 1976 and 1986 at the Department of Pediatrics, University Medical School Vienna. At the time of the first diagnosis 59 percent of the patients were less than 7 years of age; 62 percent of our patients were males. Recurrent chronic urinary tract infection in 32 percent, metabolic disorder (secondary hyperoxaluria 5, idiopathic hypercalciuria 3, cystinuria 2, hyperuricuria 2) in 27 percent were evaluated; in 13 patients the origin of calculi was idiopathic. Most infectious stones contained magnesium ammonium phosphate, most idiopathic stones calcium oxalate. In 21 patients (62%) surgical treatment, in one patient extracorporal shock wave lithotripsie was realized. Adequate metaphylaxis (general, dietetic, medicementous) can lower the rate of occurrence of stone formation.

Topics: Adolescent; Child; Child, Preschool; Cystinuria; Diagnosis, Differential; Female; Humans; Male; Oxalates; Phosphates; Risk Factors; Uric Acid; Urinary Calculi

We showed previously that ingestion of a non-specific high purine diet by healthy subjects increased not only urinary uric acid levels but urinary oxalate as well. Both increments were reduced significantly during concomitant allopurinol therapy. The present study was undertaken to investigate these findings in more detail under carefully controlled dietary conditions where a single specific purine, guanosine, was used as an additive and several different methods for oxalate determination (GLC, HPLC, isotacophoresis) were compared with the enzymatic method used previously. Results obtained by two direct techniques of oxalate determination showed no significant alteration in oxalate levels during any dietary regime, suggesting that the earlier results derived from problems inherent in the experimental design and methodology employed. The study confirmed that one of the beneficial effects of allopurinol was to reduce dietary purine absorption. The results may thus provide a logical explanation for the reduced incidence of urolithiasis during allopurinol therapy in some idiopathic oxalate stone formers addicted to purine-rich foods and beverages.

Topics: Adult; Allopurinol; Chromatography, Gas; Diet; Female; Guanosine; Humans; Male; Oxalates; Oxalic Acid; Urinary Calculi

Urine collected during a 24-h period between 06.00 and 10.00 h from 25 patients with recurrent CaOx stone disease was analysed with respect to calcium, oxalate, magnesium, citrate and creatinine. Urinary excretion of oxalate in relation to creatinine was slightly higher in 24-h urine but the correlation between 24-h and 4-h values was good. Good correlations were also recorded for calcium and citrate, whereas a more variable result was obtained for magnesium. In terms of the risk of forming a supersaturated urine (CaOx risk index), a good correlation was observed between 24-h and 4-h urine samples, although the highest values were found in 24-h urine. As a result of a low mean urine flow between 06.00 and 10.00 h, the highest supersaturation in terms of the AP (CaOx) index was observed in these samples. When the risk of calcium oxalate crystallisation (CaOx-CR) was determined by means of the increment in oxalate concentration required for precipitation of CaOx, 7 of 11 samples had the highest values in the 4-h urine. Samples collected during a 4-h period might thus be useful in the evaluation and follow-up of CaOx stone formers and further studies will show to what extent they can replace 24-h urine collections.

Topics: Calcium; Calcium Oxalate; Citrates; Citric Acid; Creatinine; Humans; Magnesium; Oxalates; Oxalic Acid; Risk Factors; Specimen Handling; Time Factors; Urinary Calculi

Topics: Calcium; Calcium Oxalate; Crystallization; In Vitro Techniques; Models, Biological; Oxalates; Urinary Calculi

Topics: Adult; Calcium; Calcium Oxalate; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Recurrence; Retrospective Studies; Urinary Calculi

Topics: Carboxy-Lyases; Chromatography, Ion Exchange; Formate Dehydrogenases; Humans; Oxalates; Oxalic Acid; Reagent Kits, Diagnostic; Urinary Calculi

Sodium pyruvate, potassium pyruvate, pyruvic acid, sodium bicarbonate and potassium bicarbonate were added to a calcium-oxalate lithogenic diet (a glycolic-acid diet) in order to determine their effects in preventing lithogenicity. Male Wistar-strain rats who had been fed the glycolic-acid diet developed marked urinary calculi within four weeks. Rats in the sodium and potassium pyruvate groups had, however, almost no stones in the urinary system. Rats in the bicarbonate and pyruvic-acid groups showed slightly less effect than those in the pyruvate groups. Urinary oxalate excretion was high in all the groups during the experiment. The urinary oxalate concentration was relatively higher in the sodium-pyruvate group, and significantly higher in the potassium-pyruvate group, than in the glycolic-acid group. Urinary citrate excretion was high both in the pyruvate and bicarbonate groups; the urinary citrate concentration was, however, significantly higher in the pyruvate groups than in the bicarbonate groups at the fourth experimental week. The urinary calcium and magnesium concentrations were irrelevant to the diets administered. Therefore, it can be concluded that pyruvate salts inhibit urinary calculi formation, not by decreasing oxalate synthesis, but by increasing the urinary citrate concentration; bicarbonate salts work in the same manner, but a little less effectively.

Topics: Animals; Bicarbonates; Calcium; Citrates; Diet; Glycolates; Hydrogen-Ion Concentration; Kidney; Kidney Calculi; Magnesium; Male; Oxalates; Potassium Compounds; Pyruvates; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Urinary Calculi

This article contains an analysis of data compiled from 813 specimens of canine uroliths submitted to the Urinary Stone Analysis Laboratory at University of California School of Veterinary Medicine.

Topics: Animals; Apatites; Calcium Phosphates; Cystine; Cystinuria; Dog Diseases; Dogs; Magnesium; Magnesium Compounds; Minerals; Oxalates; Phosphates; Silicon Dioxide; Struvite; Uric Acid; Urinary Calculi

An assay system for the measurement of the rate of Calcium Oxalate Monohydrate (COM) seed crystal growth in a metastable solution of calcium chloride and sodium oxalate containing traces of 14C-oxalic acid was used to assess the inhibitory activity of pyrophosphate (10(-5) M-10(-4) M), citrate (10(-4) M-10(-3) M) and urines of normal and pyridoxine deficient rats. Both pyrophosphate and citrate were strong inhibitors of COM crystal growth and caused a 50% decrease in crystal growth rate at 1.50 X 10(-5) M and 2.85 X 10(-4) M respectively. Normal rat urine strongly inhibited the COM crystal growth, while pyridoxine deficient animals showed a significant (p less than 0.01) decrease in mean inhibitory activity as compared to pair-fed controls. A lowered urinary inhibitory potential accompanied with hyperoxaluria and hypercalciuria, which is known to be associated with pyridoxine deficiency, may be a contributory risk of calcium oxalate crystallization and stone formation.

Topics: Animals; Calcium Chloride; Calcium Oxalate; Citrates; Citric Acid; Crystallization; Diphosphates; Male; Oxalates; Oxalic Acid; Rats; Rats, Inbred Strains; Solutions; Urinary Calculi; Urine; Vitamin B 6 Deficiency

A method is described for the determination of oxalate in urine using flow injection analysis and fluorimetry. Oxalate is precipitated with calcium chloride at pH 4.5, redissolved in H2SO4 and measured by flow injection analysis. The minimum detection limit is 6 mumol/l. The coefficient of variation is 7%. Results are in good accordance with normal values found with traditional oxalate analysis.

Topics: Adult; Calcium Chloride; Calcium Oxalate; Chemical Precipitation; Female; Fluorometry; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Oxalic Acid; Urinary Calculi

Photon induced X-ray fluorescence has been employed to determine trace elements in urinary calculi. Twenty-one urinary stones, classified in four groups, have been analysed. Besides Ca, elements Fe, Zn and Pb were detected, and Cr and Mn were also detected in some cases. No clear differences were found between the four groups.

Topics: Cystine; Humans; Oxalates; Phosphates; Spectrometry, X-Ray Emission; Trace Elements; Uric Acid; Urinary Calculi

In the last two decades, intensive research work has been done in the field of urolithiasis. Due to improved and extended diagnostic methods, it has been recognized that metabolic disturbances play an important role in stone disease.

Topics: Acidosis, Renal Tubular; Calcium; Humans; Hyperparathyroidism; Oxalates; Urinary Calculi

Fifty-two cases of urinary tract calculus disease were investigated for dietary habits, routine chemical and microscopic urinalysis, bacterial culture, quantitative analysis of 24 h urine sample and qualitative analysis of the stones. 54 out of the 56 stones analysed were of mixed type. Magnesium ammonium phosphate was present in 78.2% stones. Dietary habits revealed principal dependence on cereals, lack of animal proteins, consumption of oxalate rich vegetables and widespread consumption of tea. Urinary tract infection was present in 63.7% of the cases. Significant calcium oxalate crystalluria (2+ to 4+) was present in 34.6% of the cases. Hyperoxaluria, hypercalciuria associated with hyperoxaluria-lower excretion of magnesium and citric acid were important urinary risk factors in the local population. These observations strongly suggest the multifactorial etiology of stone disease in this region. Imbalanced nutrition and urinary tract infection were the principal risk factors for urolithiasis in this study.

Topics: Calcium; Citrates; Citric Acid; Diet; Electrolytes; Humans; Hydrogen-Ion Concentration; India; Oxalates; Oxalic Acid; Urinary Calculi

Various risk factors and inhibitors of the stone formation of the upper urinary tract have been pointed out in urine. We examined the amount of daily excretion of several important risk factors (calcium, phosphorus, urate and oxalate) and inhibitors (magnesium and citrate) in the urine of 21 healthy males, 13 male single stone formeks and recurrent and/or multiple stone formers before and after taking the regular diet which contains 500 mg of calcium and 1,000 mg of phosphorus a day. The daily excretion of calcium, phosphorus and magnesium indicated no significant differences among the 3 groups. The excretion of oxalate in urine for 24 hours was significantly decreased in the stone formers after taking the regular diet. The urinary excretion of the urate per body surface area in the stone formers was significantly higher than that in the healthy control. The amount of the excretion of the citrate in urine in the recurrent and/or multiple stone formers was significantly lower than that in the other 2 groups. Many patients of the recurrent and/or multiple urinary stones had more than two abnormal values of above-mentioned risk factors and inhibitors. These results suggest that the causes of the formation of the upper urinary stone were not single but multiple and that the dietary advice to these patients was important against the recurrence of the urolithiasis.

Topics: Adult; Aged; Calcium; Citrates; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphorus; Uric Acid; Urinary Calculi

A spinach loading experiment was performed on 9 normal subjects, 25 outpatients who were single calcium oxalate stone formers and 25 recurrent calcium oxalate stone formers. The experimental diet contained 445 mg of total oxalate, 163 mg of soluble oxalate and 115 mg of calcium. Urinary oxalate excretion was observed 2 hrs before and 6 hrs after the experimental diet was consumed. There was no significant difference in urinary oxalate excretion in preloading urine of normal subjects and stone formers. However, urinary oxalate excretion in postloading urine was significantly elevated in stone formers. This loading test is recommended as a simple and valuable screening method of hyperabsorption of oxalate on outpatients with calcium oxalate stones.

Topics: Adult; Calcium; Calcium Oxalate; Diet; Humans; Male; Oxalates; Urinary Calculi

Calcium oxalate is the most important constituent of urinary calculi and the excretion pattern of calcium and oxalate is not consistent with stone formation. The increase in urinary calcium and oxalate in calcium oxalate stone formers has been found to be associated with the increase in uric acid and uromucoids along with the increase in inorganic phosphate and magnesium (in adults only) whilst citrate was decreased (in children only). The role of uric acid and uromucoids in the genesis of calcium oxalate stone is indicated.

Topics: Adolescent; Adult; Calcium; Calcium Oxalate; Child; Citrates; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Middle Aged; Mucoproteins; Oxalates; Phosphates; Reference Values; Uric Acid; Urinary Calculi

In two test series additional oxalic acid excretion in urine was induced in healthy test persons by administering a spinach diet. This additional excretion could be markedly reduced by magnesium administration. Calcium and citrate excretions are largely unaffected by magnesium administration. Magnesium excretions, however, are clearly increased. The calcium oxalate crystallization rates in the 5-or 7-hour urines reveal a behavior parallel to that of the oxalic acid excretion profile. In the control urines, the crystal picture is characterized by numerous medium-sized whewellite crystals. In contrast, in the test series weddellite crystals are reduced in size and frequency after magnesium administration. New aspects of magnesium effects must be discussed; above all the possible absorption changes resulting from gastrointestinal diseases.

Topics: Administration, Oral; Calcium; Calcium Oxalate; Citrates; Crystallization; Humans; Intestinal Absorption; Magnesium; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Adult; Ascorbic Acid; Female; Humans; Intestinal Absorption; Intestinal Diseases; Male; Middle Aged; Oxalates; Urinary Calculi

The main threads of recent research into the cause and treatment of calcium oxalate/phosphate stones are reviewed. Little progress has been made in recent years, and two main reasons can be identified. First, there has been too much emphasis upon calcium and too little emphasis upon urinary oxalate as causative factors. Second, there has been too much emphasis upon the physical chemistry of simple solutions and too little emphasis upon the study of whole urine.

Topics: Calcium; Chemical Phenomena; Chemistry, Physical; Crystallization; Humans; Mucoproteins; Oxalates; Risk; Urinary Calculi; Uromodulin

Sodium pyruvate, choreito (a herbal preparation), and urajirogashi (a herb) were added to a calcium-oxalate lithogenic diet (a glycolic-acid diet) to determine their effects in preventing lithogenicity. Male Wistar-strain rats which had been fed the glycolic-acid diet developed marked urinary calculi within 4 weeks. Rats in the groups fed a pyruvate diet had, however, almost no stones in the urinary system. The choreito and urajirogashi were slightly less effective than the pyruvate. Urinary oxalate excretion was high in all the groups during the experiment, especially in the pyruvate and the glycolic-acid groups, but, it was relatively lowered in the herb groups, especially towards the end of the experiment (p less than 0.05). Urinary citrate excretion was high in the pyruvate group, but it was significantly low in the other groups. In the choreito group, remarkable increases in urinary volume and magnesium excretion were observed; however, they were statistically non-significant and urinary calcium excretion was higher than in the glycolic-acid group during the experiment. Therefore, it can be concluded that choreito and urajirogashi may have some beneficial effect though any such effect is inferior to that of pyruvate, in preventing calculi formation, partly by decreasing the urinary oxalate excretion; increased urine volume and magnesium excretion may also have some other, additional effects in the choreito group.

Topics: Animals; Body Weight; Calcium; Citrates; Citric Acid; Male; Oxalates; Oxalic Acid; Plant Extracts; Plants, Medicinal; Pyruvates; Pyruvic Acid; Rats; Rats, Inbred Strains; Urinary Calculi

In 25% of the samples the often applied qualitative chemical analysis of urinary stones leads to entirely wrong results with severe therapeutic consequences. The appropriate techniques for stone analysis are infrared spectroscopy and X-ray powder diffraction. These techniques make also possible the identification of iatrogenic urinary calculi. Four types of such stones were detected here, caused by modern medication. N4-acetylsulfamethoxazole, N4-acetylsulfadiazine, mefenamic acid and silicon dioxide. It is only the correct preanalytical treatment of urine samples that prevents considerable impairment of analytical results. Without precautions especially, the oxalate concentration in urine may be doubled or tripled during one day of storage.

Topics: False Positive Reactions; Humans; Iatrogenic Disease; Oxalates; Oxalic Acid; Specimen Handling; Spectrophotometry, Infrared; Urinary Calculi; X-Ray Diffraction

We evaluated 113 patients with recurrent or multiple calcium urolithiasis at our outpatient stone clinic between 1980 and 1983. Diagnostic categories included hypercalciuria (36 patients), hyperoxaluria (35 patients), and hyperuricosuria (31 patients). Thiazides and/or allopurinol were administered to the hypercalciurics and hyperuricosurics, respectively for prevention of stone recurrence. Patients followed up for more than one year were 23 (male 16, female 7) in the thiazide group, and 15 (male 12, female 3) in the allopurinol group. The mean treatment interval was 2.49 years in the former, and 2.35 years in the latter. The remission rate (percentage of patients without formation of any new stones) was 82.6% in the thiazide group, and 73.3% in the allopurinol group. The group stone formation rate was reduced from 0.85 to 0.35/pt-yr in the thiazide group, and from 0.74 to 0.27/pt-yr in the allopurinol group. Efficacy of these two drugs for the prevention of calcium stone recurrence was observed in this selective therapy, but a careful double blind study should be carried out to draw a definite conclusion.

Topics: Allopurinol; Benzothiadiazines; Calcium; Diuretics; Female; Humans; Magnesium; Male; Oxalates; Oxalic Acid; Phosphates; Recurrence; Sodium Chloride Symporter Inhibitors; Urinary Calculi

Male Wistar-strain rats which had been fed a calcium-oxalate lithogenic diet (a glycolate diet) developed urinary calculi in 4 weeks. Sodium pyruvate or CG-120 (a mixture of citrate salts) had been added to this diet to determine its effect in preventing lithogenicity. Rats in the group fed a pyruvate diet had, however, almost no stones in the urinary system. Rats in the CG-120 group showed results somewhat similar to those in the pyruvate group. Increased urinary citrate excretion was observed in both groups and could be implicated as the main inhibitory factor in stone formation. Therefore, it can be concluded that CG-120 exerts a beneficial effect close to that of pyruvate in preventing calculi formation and that both substances cause a high citrate excretion in urine.

Topics: Animals; Body Weight; Calcium Oxalate; Citrates; Citric Acid; Male; Oxalates; Oxalic Acid; Pyruvates; Pyruvic Acid; Rats; Rats, Inbred Strains; Urinary Calculi

Oral oxalate loading using sodium oxalate or a vegetable juice was done to evaluate the intestinal absorption of exogenous oxalate in 30 patients with renal stones and 13 healthy controls. Fifteen calcium oxalate stone formers, 7 non-oxalate stone formers and 10 healthy volunteers were given an oral loading of sodium oxalate (500 mg). Urinary oxalate increased promptly, reaching a peak value within 4 to 8 hours after administration of a synthetic oxalate orally in a fasting state. In calcium oxalate stone formers, the mean increment of urinary oxalate and the bioavailability following oral sodium oxalate load were significantly higher than in the healthy controls and non-oxalate stone formers. Furthermore, intestinal hyperabsorption of oxalate in our criterion was defined in six patients with calcium oxalate stones (40%). On the other hand, eight calcium oxalate stone formers and three healthy controls were given vegetable juice. Urinary oxalate was increased only slightly after the ingestion, and there was no difference between calcium oxalate stone formers and normal controls. These results suggest that a certain hyperoxaluria might be induced by intestinal absorption of exogenous oxalate, and that the hyperabsorption might indicate a possible risk factor for calcium oxalate stone formation.

Topics: Administration, Oral; Adult; Biological Availability; Female; Humans; Intestinal Absorption; Male; Oxalates; Oxalic Acid; Urinary Calculi

Studies of recurrent stone formers indicated that they have significantly increased urinary oxalate and decreased ascorbate excretions. Results of oral and intravenous administration of ascorbate indicate an enhanced production of oxalate from ascorbate in recurrent calcium stone formers as compared with normal persons and that most of this oxalate is generated in the gut.

Topics: Adult; Ascorbic Acid; Calcium Oxalate; Female; Humans; Kidney Calculi; Male; Middle Aged; Oxalates; Time Factors; Urinary Calculi

The risk of calcium oxalate (CaOx) crystallization at different pH levels was determined in urine from recurrent CaOx-stone formers and normal subjects. The highest crystallization risk was observed between pH 4.5 and 5.5. In the pH range 6.5-7.5, there was a marked increase in crystallization of calcium phosphate (CaP). The results suggest the beneficial effect of moderate alkalinization in terms of a reduced CaOx crystallization. Reduced CaOx crystallization occurs at the expense of an increased formation of CaP crystals. Whether this increases the risk of CaP-stone formation is not known, but the CaP crystals were usually small, at least below pH 7.5.

Topics: Calcium; Calcium Oxalate; Calcium Phosphates; Crystallization; Humans; Hydrogen-Ion Concentration; Oxalates; Risk; Urinary Calculi

Topics: Adult; Calcium; Creatinine; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Risk; Sucrose; Uric Acid; Urinary Calculi

Rats with a portacaval anastomosis are known to be susceptible to develop uric acid stones. The present studies were undertaken to investigate urinary Mg, Ca and oxalate excretion in such rats. We found that their Mg excretion was doubled, Ca excretion tripled, and oxaluria somewhat decreased. The Ca crystallization attributed to the increased Ca2+ in the urine is, therefore, somewhat held in check by the increased presence of Mg in the urine and by decreased oxalates.

Topics: Animals; Calcium; Crystallization; Magnesium; Male; Oxalates; Portacaval Shunt, Surgical; Rats; Urinary Calculi

Topics: Calcium Metabolism Disorders; Child; Humans; Oxalates; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Carbonates; Humans; Oxalates; Phosphates; Urinary Calculi

Topics: Adult; Calcium; Citrates; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Phosphates; Sodium; Uric Acid; Urinary Calculi

Topics: Allopurinol; Benzothiadiazines; Calcium; Cellulose; Citrates; Diuretics; Humans; Ion Exchange; Oxalates; Prostaglandin Antagonists; Sodium Chloride Symporter Inhibitors; Urinary Calculi

The probability of being a stone former (PSF) was calculated in 3 groups of idiopathic calcium stone formers [with normocalciuria (NC), dietary hypercalciuria (DH) and idiopathic hypercalciuria (IH)] in 4 conditions: while on a free diet; on a calcium- and oxalate-restricted diet during 4 days; after an oxalate load, while on a 1.5-gram calcium diet, and after an oxalate load while on a calcium-restricted diet. Combined calcium and oxalate restriction significantly decreased PSF only in NC and DH whereas the decrease was not significant in IH because of a concomitant significant increase in oxalate excretion. Increase of PSF with the oxalate load was significantly greater during a calcium-restricted diet than during the 1.5-gram calcium diet in all groups of patients (4, 6 and 12 times greater in NC, DH and IH, respectively). These data show the critical role of oxalate restriction when calcium is restricted in order to decrease the PSF. This combined restriction is however not sufficient in idiopathic hypercalciuric patients to decrease their PSF.

Topics: Calcium; Calcium Metabolism Disorders; Calcium, Dietary; Humans; Oxalates; Oxalic Acid; Risk; Urinary Calculi

In order to evaluate whether therapy can reduce relapses of urinary stone formation, we have retrospectively analysed the long-term follow-up of 55 recurrent stone former patients either treated with high fluid intake and moderate low calcium and low oxalate diet alone (Group A 18 patients), or with the same dietetic advice plus hydrocholorothiazide, amiloride and allopurinol (Group B 37 patients). In group A, stone recurrence was completely abolished in 14 patients without hypercalciuria and hyperuricuria, but not in the four patients with hypercalciuria and hyperuricuria. In group B, no relapses were observed in 19 hypercalciuric and hyperuricuric patients during a cumulative follow-up of 91 years. Even if the other 18 patients had relapses during a cumulative follow-up of 89 years, they showed a significant decrease in stone/patient and stone/year rates. It is concluded that high fluid intake and diet can actually prevent stone recurrence in patients without hypercalciuria and hyperuricuria, but in hypercalciuric and hyperuricuric patients treatment with diuretic and allopurinol is better.

Topics: Allopurinol; Benzothiadiazines; Calcium, Dietary; Diuretics; Drinking; Humans; Oxalates; Oxalic Acid; Recurrence; Sodium Chloride Symporter Inhibitors; Urinary Calculi

Urinary excretions of calcium, oxalate and uric acid were estimated in 160 stone-formers (male 118, female 42) and 257 healthy controls (male 207, female 50). Stone-formers were divided into two groups according to their stone analysis: calcium containing stone-formers and non-calcium stone-formers. Calcium stone-formers were divided again into those who had a single stone episode and multiple or recurrent stone episodes. Urinary calcium and oxalate showed significant increases in calcium stone-formers, while urinary uric acid increased only in male calcium stone-formers. Recurrent calcium stone-formers demonstrated significant high levels of urinary calcium excretion especially in males, whereas no difference of urinary oxalate excretion between recurrent and single stone-formers. The frequency distributions on the excretion of three subjects were estimated respectively in patients with calcium stone and in controls. Relative risks, risk curves and stone probabilities were proposed and compared. The higher excretion values of urinary calcium and oxalate closely related to higher risks of forming calcium stones. On the other hand, urinary uric acid did not have such a relation to calcium stone formation. We defined the states which urinary excretions exceeded 95% upper confidence limits of normal controls as hyperexcretions. Hypercalciuria was more than 200 mg/day in male and female, hyperoxaluria was 50 mg/day in male and 45 mg/day in female and hyperuricosuria was 850 mg/day in male and 650 mg/day in female according to our definition. Among male calcium stone-formers, hypercalciuria was found in 45.3%, hyperoxaluria in 26.4% and hyperuricosuria in 15.1%. While in female calcium stone-formers, hypercalciuria in 23.7%, hyperoxaluria in 26.3% and hyperuricosuria in 13.2%. Of the male calcium stone-formers 57.5% showed either or both hypercalciuria and hyperoxaluria, and recurrent stone-formers also demonstrated a higher incidence among them. Excretion products of urinary calcium and oxalate were calculated and compared in each group. Calcium stone-formers showed significant high values especially in male recurrent stone-formers. The estimation by combining some risk factors will provide more useful means of assessing severity of urinary calculous diseases and therapeutic effects of their various treatments.

Topics: Calcium; Female; Humans; Male; Oxalates; Oxalic Acid; Risk; Uric Acid; Urinary Calculi

It is well known that the urinary excretion of oxalic acid is one of the main determinants for urinary stone formation. From 1950 to 1978 a saturated oxalic acid solution was used in a repainting and cleaning process for railroad cars in Norwegian railroad workshops. With the use of a questionnaire, the cumulative prevalence of urolithiasis-induced colic episodes was registered in the Sundland railroad depot. Forty-two (11.9%) out of 353 male workers not exposed to oxalic acid reported having had one or more such stone colic episodes. The corresponding figure for 15 individuals who had a very high exposure to oxalic acid was 8 (53.3%). Also workers in other departments, occasionally exposed to oxalic acid, had an increased stone colic prevalence rate, a finding suggesting a positive dose-response relationship. There was an increased frequency of stone colic episodes in the age group 40-69 years. Seven heavily exposed workers in the paint shop reported initial pollakiuria and slight dysuria during the exposure. The study indicates a causal relation between urinary stone formation in the investigated railroad shopmen and their exposure to oxalic acid at work.

Topics: Adult; Aged; Humans; Male; Middle Aged; Occupational Diseases; Oxalates; Railroads; Urinary Calculi

Oxalate is one of the most important constituents in urine of urinary stone. But the determination of oxalate in urine has not been performed as a routine laboratory examination because of difficulty or inaccuracy in measuring oxalate in urine. We tried to measure oxalate in urine by the newly developed enzymic method with oxalate oxidase. This method is not only simple but also accurate enough. The reproducibility S.D./mean was 2.3-9.0%, the recovery rate was 95.2 +/- 4.0% (mean +/- S.D.) With this method, the normal range of urine oxalate in 24 hours was determined to be 11.8 mg-39.4 mg, the upper limit was 40 mg. By taking the regular diet which contains 500 mg of calcium and 1,000 mg of phosphorus a day, the excretion of oxalate in urine was significantly decreased in the stone formers. This suggests that the influence of the diet upon the excretion of oxalate in urine for 24 hours is important especially in stone formers.

Topics: Diet; Humans; Oxalates; Oxidoreductases; Reference Values; Spectrophotometry; Urinary Calculi

Topics: Adult; Calcium; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

As calcium oxalate stones are the most important component in urolithiasis, an experimental model has to be designed to clarify the pathogenesis and aid in their prevention. Hyperoxaluria as well as hypercalciuria were produced in rats by administering ethylene glycol (0.5%, in drinking water administered ad libitum) and 1-alpha (OH) D3 (0.5 micrograms/rat given every other day), respectively, for three to four weeks. Neither drug alone produced stones efficiently as did the combination regimen of these two compounds. The occurrence of stones was 77.3%, and with only a moderate degree of renal functional impairment. Biochemical and histological data were obtained using this model.

Topics: Animals; Calcium; Calcium Oxalate; Ethylene Glycols; Hydroxycholecalciferols; Kidney; Kidney Calculi; Magnesium; Male; Oxalates; Phosphates; Rats; Rats, Inbred Strains; Ureteral Calculi; Urinary Calculi

A simple and rapid technique for the determination of oxalate in urine by ion chromatography has been described. Although there is difficulty in separating the oxalate peak from the sulfate peak on the conductivity chromatogram of unprocessed urine, it is possible to eliminate the sulfate peak by the addition of barium chloride to the urine. Using this technique, the author has estimated the urinary oxalate in 33 urolithiasis patients and in 40 non-urolithiasis patients. The means of 50 urinary oxalate determinations in 33 urolithiasis patients and of 42 urinary oxalate determinations in 40 non-urolithiasis patients were 21.5 +/- 11.4 and 19.5 +/- 13.0 mg/gCr, respectively. Of the 33 urolithiasis patients, 17 were calcium stone formers and 6 were non-calcium stone formers whose stones had been analyzed by infrared spectrometry, and the mean urinary oxalate values were 19.4 +/- 6.9 and 21.3 +/- 8.2 mg/gCr, respectively. The urinary oxalate was significantly higher in children under the age of 10 years.

Topics: Adolescent; Adult; Aged; Child; Chromatography, Ion Exchange; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

A test stick for the measurement of the SG of the urine of stoneformers was examined. In 230 spontaneously voided urines and 45 25 h-urines the SG was measured by the test stick and compared with urinometer measurements. The two methods showed a good correlation (r = 0.86). Due to the principle of reaction of the SG-teststick a direct relationship of the SG-values to the sodium concentration and to the ionic strength of urine was found. There is no correlation between the relative supersaturation of CaOx and the SG-determination (urinometer, test stick). The handling of the SG-test stick is simple and can be easily performed by the patient.

Topics: Calcium; Humans; Magnesium; Oxalates; Phosphates; Sodium; Specific Gravity; Urinary Calculi

The relationships between urinary oxalate, calcium and magnesium were investigated in 81 patients with idiopathic calcium oxalate urolithiasis on their regular diets. A significant relationship was established between calcium and oxalate excretion in the analysis of recurrent stone-formers (n = 44, P less than 0.01), though there was no significant difference between the two in the analysis of the patients overall or in single stone-formers. This suggests that recurrent stone-formers may have some abnormality of oxalate absorption in relation to calcium absorption. The role of calcium-oxalate interaction in the gut as a cause of mild hyperoxaluria is discussed.

Topics: Adult; Calcium; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Recurrence; Urinary Calculi; Urine

Pyridoxilate is a salt formed from glyoxylic acid and pyridoxine. It has been used therapeutically as an antianoxic drug in the treatment of various arterial complaints. Its use is based theoretically on its ability to block the conversion of glyoxylic acid into oxalic acid. The following cases suggest, however, that pyridoxilate can cause stones. Intraperitoneal injection of glyoxylate in doses of 130 mg/kg will cause oxalate stones in rats. The same effect results from injection of 427 mg/kg pyridoxilate (i.e. an equivalent dose of glyoxylate). In human subjects, intravenous injection of 200 mg of pyridoxilate results in a fourfold increase in the urinary oxalic acid content in the two hours following the injection. Thirteen cases of chronic progressive oxalate stone disease have recently been reported in patients receiving a prolonged course of pyridoxilate at 450 to 600 mg daily. Eight of these patients had no previous history of lithiasis. Oxaluria levels of 80 to 100 mg daily are observed in all cases of lithiasis in patients receiving pyridoxilate. The levels fell after cessation of the pyridoxilate treatment, and reverted to normal (30 mg/24 hours) in all but three patients. These three patients maintained levels of close to 50 mg and all three had a previous history of urolithiasis.

Topics: Aged; Animals; Arterial Occlusive Diseases; Calcium Oxalate; Female; Humans; Kidney Calculi; Male; Middle Aged; Oxalates; Pyridoxine; Rats; Urinary Calculi

One hundred and twenty-four male stone formers with idiopathic hypercalciuria were followed up for 4 to 27 years (mean 12.2). Twenty-eight received restricted calcium diet alone, 52 also received bendrofluazide, 11 cellulose phosphate, and 33 received mixtures of those drugs. Although urinary calcium values fell in all groups, the stone recurrence rate remained unacceptably high. Patients on cellulose phosphate fared worst and this drug seems unsatisfactory as a sole agent. Urinary calcium was highest in patients without stone recurrences, but in patients with stone activity a higher stone recurrence rate was associated with higher urinary calcium and lower urinary volume.

Topics: Bendroflumethiazide; Calcium; Calcium Metabolism Disorders; Cellulose; Follow-Up Studies; Humans; Male; Oxalates; Oxalic Acid; Recurrence; Urinary Calculi

Piridoxilate (P) is given in cases of angina pectoris or arteritis. It is an intramolecular association of glyoxylic hemiacetal salts of pyridoxine. Glyoxylate has a membranous protective action; pyridoxine is used for the theoretical purpose of preventing oxidation of glyoxylic acid to oxalic acid. We have observed 12 patients with an active calcium oxalate lithiasis who had been taking P for many years. Hyperoxaluria was present in all patients and decreased significantly when the drug was interrupted. Significant hyperoxaluria was also observed in volunteers after ingestion of P (600 mg per day) or i.v. (200 mg). We have obtained experimental calcium oxalate urinary stones after intraperitoneal injection of P to Wistar rats. Piridoxilate represents an important lithogenic factor.

Topics: Aged; Animals; Calcium Oxalate; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Oxalates; Pyridoxine; Rats; Rats, Inbred Strains; Urinary Calculi

We describe a simple method for quantitative chemical analysis of urinary calculi requiring no specialized equipment. Pulverized calculi are dried over silica gel at room temperature and dissolved in nitric acid, which was the only effective agent for complete dissolution. Calcium, magnesium, ammonium, and phosphate are then determined by conventional methods. Oxalate is determined by a method based on the quenching action of oxalate on the fluorescence of a zirconium-flavonol complex. Uric acid, when treated with nitric acid, is stoichiometrically converted to alloxan, which is determined fluorimetrically with 1,2-phenylenediamine. Similarly, cystine is oxidized by nitric acid to sulfate, which is determined turbidimetrically as barium sulfate. Protein is determined spectrophotometrically as xanthoprotein. The total mass recovery of authentic calculi was 92.2 +/- 6.7 (SD) per cent. The method permits analysis of calculi as small as 1.0 mg. Internal quality control is performed with specially designed control samples.

Topics: Cations; Chemistry Techniques, Analytical; Cystine; Desiccation; Humans; Nitrates; Nitric Acid; Oxalates; Phosphates; Proteins; Silica Gel; Silicon Dioxide; Uric Acid; Urinary Calculi

This epidemiologic study reveals that the occurrence of urolithiasis in the nineteenth century population in Europe is quite similar to that of the twentieth century in Asia. The analogy is demonstrated for age distribution, stone localization, male/female ratio, and stone composition. The distribution of urolithiasis in a low socioeconomic level population is defined by: highest frequency in childhood, more than 40% bladder stones, less than 20% female patients, less than 40% calcium-oxalate stones, and more than 30% uric acid/urate stones. Typical for a population with a high level these characteristics of urolithiasis are: highest frequency among adults, less than 10% bladder stones, more than 25% female patients, more than 60% calcium oxalate stones, and less than 20% uric acid/urate stones. In partially developed countries those values fall in between.

Topics: Age Factors; Asia; Europe; Female; History, 19th Century; History, 20th Century; Humans; Male; Oxalates; Phosphates; Sex Factors; Socioeconomic Factors; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium; Calcium Phosphates; Child; Cystinuria; Diet; Disease Susceptibility; Female; Humans; Magnesium; Magnesium Compounds; Male; Middle Aged; Oxalates; Phosphates; Risk; Struvite; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Circadian Rhythm; Female; Humans; Infant; Male; Middle Aged; Oxalates; Risk; Sex Factors; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium; Female; Humans; Male; Middle Aged; Oxalates; Risk; Urinary Calculi

Topics: 1-Carboxyglutamic Acid; Adult; Aged; Calcium; Female; Glutamates; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Uric Acid; Urinary Calculi

The daily urinary excretion of calcium, oxalate, glycosaminoglycans and uric acid, and the 24-h urinary pH and volume were measured in 61 normal men and in 81 men with a history of renal stone disease. The following features of these data were noted: No significant difference could be demonstrated between the stone-formers and normals with respect to any of the variables measured. The values of each of the urinary parameters were positively and significantly correlated with those of at least two other parameters in one or both subject groups. The probability density histograms constructed from the data for each urinary variable in each subject group were unsuitable as the basis for calculation of individual relative risk factors. Thus it was concluded that the data were inappropriate for the calculation of "overall relative probability of forming stones" (P'SF) and that such an index is unlikely to be of use in the assessment and management of stone-formers attending a general hospital out-patient clinic.

Topics: Calcium; Glycosaminoglycans; Humans; Hydrogen-Ion Concentration; Oxalates; Oxalic Acid; Probability; Risk; Uric Acid; Urinary Calculi; Urine

Topics: Animals; Humans; Oxalates; Oxalic Acid; Uric Acid; Urinary Calculi

A short historical review precedes an outline of the impact of eating habits and various nutritional factors on the pathogenesis of urinary stone formation. In the second part of the paper the place of restrictive dietary measures in prophylactic regimes is discussed. Apart from individual restrictions, the increased ingestion of certain foodstuffs may contribute to the successful prophylaxis of urolithiasis. This is documented on the basis of foodstuffs with a high content of citrate and magnesium. According to these findings an alteration of dietary and drinking habits should be a fundamental component of the management schedule of patients with urolithiasis.

Topics: Citrates; Dairy Products; Dietary Proteins; Ethanol; Feeding Behavior; Glucose; Humans; Magnesium; Nutritional Physiological Phenomena; Oxalates; Urinary Calculi

Calcium oxalate crystalluria was induced in laboratory rats by subcutaneous implantation of potassium oxalate containing mini-osmotic pumps in their intercapsular region. Concentrations of major urinary ions were measured and urinary supersaturations of various urinary salts were calculated using a computer programme. The urines of experimental animals that received oxalate had calcium oxalate crystals and higher supersaturations for calcium oxalate compared to their controls. Oxalate levels of the urines of experimental animals were higher than their controls and this increase was proportional to the increase in urinary supersaturation of calcium oxalate. No significant difference was found in the calcium levels of urines from experimental and control animals.

Topics: Animals; Calcium Oxalate; Crystallization; Male; Osmolar Concentration; Oxalates; Prostheses and Implants; Rats; Solubility; Urinary Calculi

A sensitive, simplified method for plasma oxalate determination by gas chromatography is described. After deproteinizing the plasma with 3N HC1 and 20% sulfosalicylic acid, the oxalate was methylated, extracted and analysed by gas chromatography. This method has three advantages i.e., smaller sample size (plasma 5.0 ml), rapidity (takes less than 3 hours) and accuracy. The recovery rate of oxalate added to plasma was 91.42 +/- 11.31% (SD) and the coefficient of variation of replicate determinations was 4.18%. The minimum detectable concentration of oxalate was 0.3 micrograms/ml (oxalate peak was higher than 5 mm). The mean oxalate concentration under fasting conditions from 16 healthy subjects was 1.37 +/- 0.39 micrograms/ml (SD), while that from 31 calcium oxalate stone formers was 1.45 +/- 0.39 micrograms/ml (SD). There was no significant difference in plasma oxalate concentration between the two groups. The dietary influence of oxalate on plasma and urinary oxalate was investigated in 5 healthy subjects and 5 calcium oxalate stone formers. When 100 g spinach (total oxalate 545.5 mg, soluble oxalate 381.5 mg) was given, the increase of plasma oxalate concentration was more prominent in stone formers; in stone formers it increased to 142% of control value at 2 hours (p less than 0.05) after spinach loading, to 163% at 4 hour (p less than 0.01) and to 232% at 6 hours (p less than 0.01); while in healthy subjects increased to 119% at 2 hours (ns) after loading, to 144% at 4 hours (p less than 0.05) and only to 167% at 6 hours (p less than 0.01). Urinary oxalate excretion increased promptly between 1 and 2 hours after loading in both groups, reaching peak levels between 2 and 4 hours after loading in healthy subjects and between 4 and 6 hours or later in stone formers. The mean renal clearance of oxalate was 18.0 ml/min in 6 healthy subjects and 19.0 ml/min in 4 calcium oxalate stone formers. There was no significant difference in oxalate clearance between the two groups. The mean ratio of oxalate/creatinine clearance was 0.22 for stone formers, which was equal to that for healthy subjects.

Topics: Adult; Chromatography, Gas; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

Topics: Humans; Intestinal Diseases; Intestine, Small; Oxalates; Urinary Calculi

Urine samples, collected hourly between 6.00 and 23.00 h and in one single night fraction, were analyzed for calcium (Ca) and magnesium (Mg) before and during daily administration of 5 mg bendroflumethiazide to 13 Ca-oxalate (CaOx) stone formers. In some of them urinary oxalate (Ox), citrate and sodium were analyzed as well. Bendroflumethiazide was administered in divided doses to 7 and in a single dose to 6 patients. After 4-8 weeks of treatment urinary Ca decreased by approximately 25% in both groups and the reduction was evenly distributed over the day. The reduction of the Ca/Mg quotient and the CaOx risk index was most pronounced following meals. The AP(CaOx) index, an estimate of the CaOx ion activity product, was favorably reduced. No important differences were recorded for the different types of bendroflumethiazide administration and thus one single dose might be equally as efficient as two divided doses.

Topics: Adult; Bendroflumethiazide; Calcium; Calcium Oxalate; Circadian Rhythm; Citrates; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Urinary Calculi

With the help of a computer program the influence of magnesium, citrate, sodium, potassium, chloride and sulfate on the activity product of calcium oxalate is examined in a synthetic and in physiological urine by varying the several parameters. Natural urine shows a significant decrease of the supersaturation of calcium oxalate by enhancing concentration of citrate. A physiological average magnesium concentration shows no effect in the sense of an increase of supersaturation antagonizing the citrate. An additional increase of the concentration of magnesium is barely effective. Citrate shows a greater effect on the decrease of supersaturation of calcium oxalate than comparable quantities of magnesium concentrations. Within the normal range of sodium chloride concentration only a slight change of the supersaturation of calcium oxalate can be observed. Sulfate has also a very slight influence in natural urine within the normal physiological range, whereas potassium does not show any effect at all.

Topics: Ammonia; Calcium Oxalate; Chlorides; Citrates; Computers; Electrolytes; Humans; Hydrogen-Ion Concentration; Kinetics; Oxalates; Phosphates; Software; Sulfates; Urinary Calculi

Topics: Calcium; Crystallography; Humans; Hydroxyapatites; Hyperparathyroidism; Oxalates; Urinary Calculi

Stone formers are often told to select a drinking water with low Ca content. To see whether this measure has a rational biochemical background, 4 Ca hyperabsorbers were asked to drink, first tap water ad libitum, then 2 liters/day of tap water, then 2 liters/day of a low Ca water (A) and finally 2 liters/day of a high Ca water (B). On A, subjects were normocalciuric but hyperoxaluric; whereas on B, they were markedly hypercalciuric but normooxaluric. Therefore, Ca . Ox concentration products were similar on B and A. However, on A as well as on B, Ca . Ox products were much lower than on tap water ad libitum due to the high fluid intake which had thus been imposed. It is concluded that, in the prevention of the recurrence of nephrolithiasis, 'have a high fluid intake' is probably a more relevant advice than 'select a water with a particularly low Ca content'.

Topics: Calcium; Humans; Oxalates; Urinary Calculi; Water; Water Supply

Hereford X Angus steers (10/treatment) were fed 90% concentrate diets containing 0.3%, 0.6%, 0.9%, or 1.2% of calcium for 92 days (trial 1) or 114 days (trial 2). Ground limestone was the supplemental calcium source. At slaughter, 12 of 20 steers fed 0.3% calcium had calculi in the urinary bladder or kidneys, compared with 5 of 20 fed 0.6% calcium, 5 of 20 fed 0.9% calcium, and 4 of 20 fed 1.2% calcium. Analyses of calculi indicated they were oxalate calculi. During the first 49 days of trial 2, plasma hydroxyproline concentrations were higher (P less than 0.10) for steers fed 0.3% calcium than for steers fed higher calcium concentrations. Increased bone resorption in steers fed concentrations of 0.3% calcium, resulting in increased plasma hydroxyproline, an oxalate precursor, was indicated as a source of oxalate in calculi and as an explanation of lower occurrence of calculi in steers fed higher concentrations of calcium.

Topics: Animal Feed; Animals; Calcium; Cattle; Cattle Diseases; Hydroxyproline; Male; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Adult; Aged; Epidemiologic Methods; Female; Humans; Lebanon; Magnesium; Male; Middle Aged; Oxalates; Urinary Calculi; Vegetables; Water Supply

Topics: Calcium, Dietary; Diet, Sodium-Restricted; Dietary Proteins; Drinking; Humans; Oxalates; Phosphates; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium; Female; Humans; Male; Metabolic Diseases; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

Topics: Humans; Magnesium; Metabolic Diseases; Oxalates; Uric Acid; Urinary Calculi

Calcium oxalate retention was studied in non-stone-forming volunteers. All subjects were placed on a constant diet for 5 days. After the oral administration of 10 microCi of [14C]-oxalic acid, the pattern of urinary oxalate excretion was followed for 48 h. Each subject was then given 10 microCi of [14C]-oxalic acid mixed with sufficient sodium oxalate (7.5 mg/kg body weight) to induce calcium oxalate crystalluria. Urinary oxalate excretion was then recorded for 48 h. After the administration of labeled oxalic acid (without additional sodium oxalate), 76.6 +/- 5.9% of the total recovered dose was excreted by 4 h. When the labeled oxalic acid was mixed with a sodium oxalate load, 62.4 +/- 8.8% was excreted by 4 h (p less than 0.01). Induction of calcium oxalate crystalluria results in the retention of oxalate in the kidney. The degree of retention varies among individuals. Differences in particle retention may help explain the differences between stone formers and non-stone formers.

Topics: Adult; Calcium Oxalate; Crystallization; Female; Humans; Male; Oxalates; Urinary Calculi

Topics: Adolescent; Calcium Metabolism Disorders; Child; Child, Preschool; Humans; Magnesium; Oxalates; Uric Acid; Urinary Calculi

Topics: Adult; Enteritis; Female; Humans; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Obesity; Oxalates; Urinary Calculi

Topics: Adsorption; Electrolytes; Humans; Hydrogen-Ion Concentration; Hydroxyapatites; Ions; Models, Biological; Oxalates; Urinary Calculi

The urinary excretion of calcium, oxalate, citrate and magnesium, and the relative saturation products in urine of either calcium oxalate or calcium phosphate, were determined in male duodenal ulcer (DU) patients preoperatively (n = 60), and 1 and 5 years following highly selective vagotomy (HSV), and in male healthy controls (n = 30). In DU before HSV citrate and magnesium were lowered, oxalate was in the low normal range and calcium was normal. The calcium oxalate product was lower than in controls, while the calcium phosphate product was unchanged. Within 5 years HSV normalized urinary citrate and oxalate, but not urinary magnesium, and the median urinary pH was lower than pre-operatively. There thus results a normal product for calcium oxalate, but a reduced one for calcium phosphate. It is suggested that: (1) unoperated DU patients have a urine composition similar to that exhibited in normocalciuric recurrent calcium urolithiasis; (2) this spectrum of urinary constituents may be changed by HSV.

Topics: Adult; Calcium; Calcium Oxalate; Calcium Phosphates; Citrates; Citric Acid; Duodenal Ulcer; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Phosphates; Urinary Calculi; Vagotomy; Vagotomy, Proximal Gastric

Topics: Allopurinol; Calcium Oxalate; Calcium, Dietary; Cellulose; Citrates; Citric Acid; Combined Modality Therapy; Fluid Therapy; Humans; Hydrochlorothiazide; Kidney Calculi; Magnesium; Oxalates; Phosphates; Urinary Calculi

The probability of being a stone former (PSF) was calculated according to the method of Robertson in three groups of idiopathic calcium stone formers (normocalciuria (NCa), dietary hypercalciuria (DH) and idiopathic hypercalciuria (IH] during four conditions: on a free diet; on a calcium and oxalate restricted diet for four days and after an oxalate load (200 g of spinach) while on a calcium unrestricted or calcium restricted diet. Combined calciuria (Ca) and oxaluria (Ox) restriction significantly decreased PSF only in NCa and DH whereas the decrease was not significant in IH because of a concomitant significant increase in oxalate excretion. Increase of PSF with the oxalate load was significantly greater on calcium restricted than on calcium unrestricted diets in all groups of patients (4-6-12 times greater in NCa, DH and IH respectively). This shows the critical role of oxalate restriction when calcium is restricted in order to decrease the PSF. Combined restriction is not sufficient in idiopathic hypercalciuric patients to decrease their probability of stone formation.

Topics: Calcium; Calcium, Dietary; Diet; Humans; Oxalates; Oxalic Acid; Urinary Calculi

Nine male healthy volunteers were examined during a control period, during an oral glycine load (45 g/day, 600 mmol) and oral methionine (6 g/day, 40 mmol). Glycine caused a significant increase of urinary oxalate above baseline (from 644 to 797 mumol/day) without change in calciuria (4.74 vs 4.84 mmol/day). In contrast methionine caused no change of oxaluria, but a significant increase in calciuria (from 4.74 to 6.9 mmol/day). Alterations of lithogenic ions in urine after protein ingestion are mediated by different amino acids. The particular lithogenic risk of animal protein may be related to its high methionine/cystine and glycine content.

Topics: Adult; Calcium; Dietary Proteins; Glycine; Humans; Male; Methionine; Oxalates; Oxalic Acid; Urinary Calculi

A procedure for the routine investigation of urinary calculi is described. The investigation scheme was based on existing methods in the routine laboratory for calcium(II), magnesium(II), phosphate and urate in serum. The substance content of oxalate was calculated as non-phosphate-bound calcium(II). Furthermore the test for cystine in urine was utilized. Two specially designed tests were used, one for carbonate apatite and one for verification of the presence of oxalate. The scheme was applied to 30 specimens of human origin. The sum of the mass fractions of identified and calculated components in the calculi was found to be 0.88 on the average (s = 0.05). Low values for this sum may serve as an indication of the presence of rare components that are not included in this analytical programme. A few calculi containing rare components required special methods for the investigation and are most conveniently investigated in a specialized laboratory using X-ray diffraction or infra-red spectrometry. In this paper, however, we describe wet chemistry methods, suitable for reliable cystine determinations and for oxalate in calculi containing, for example, brushite, where the calculated oxalate value is uncertain. These methods may be used as an alternative to the physical methods for many of the rare calculi.

Topics: Autoanalysis; Calcium; Chemical Precipitation; Chemistry Techniques, Analytical; Chemistry, Clinical; Cystine; Cystinuria; Humans; Indicators and Reagents; Oxalates; Phosphates; Reference Values; Spectrum Analysis; Uric Acid; Urinary Calculi

Topics: Chromatography, High Pressure Liquid; Female; Humans; Male; Oxalates; Urinary Calculi

The use of new dialythic technics has increased the survival times for patients with primary hyperoxaluria. From here the possibility of visualizing X-rays signs specific of oxalosis besides the typical bone lesions of hyperparathyroidism secondary to chronic renal failure. Recent hysto-pathological studies allowed to correlate such radiological findings to a new pathogenetical mechanism that would be responsible of the bone lesion specific for oxalosis and that might be caused by the presence of reabsorption cavities made up by macrophagic cells fagocyting cristals.

Topics: Adolescent; Bone and Bones; Bone Diseases; Cartilage, Articular; Crystallization; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Nephrocalcinosis; Oxalates; Radiography; Renal Dialysis; Urinary Calculi

The oxalate content in choreito and urocalun, both herb medicines, is minimal, and their contents of Ca, Mg, and P are also small. A rat experiment was performed to clarify their effect on oxalate excretion. They did not seem to have any adverse effect on urinary oxalate excretion. They had no diuretic effect and did not promote urinary oxalate excretion in rats. Therefore, they can be used in stone-formers for long periods.

Topics: Animals; Calcium; Drugs, Chinese Herbal; Magnesium; Male; Oxalates; Phosphorus; Plant Extracts; Plants, Medicinal; Rats; Rats, Inbred Strains; Urinary Calculi

In order to examine the effect of diet on the urinary excretion of oxalate, a spinach loading and milk loading experiment was performed in normal subjects and patients with single calcium oxalate stones and recurrent calcium oxalate stones after a rat experiment. When spinach (100 g, total oxalate 642.57 mg, insoluble oxalate 282.21 mg, taken oxalate 444.57 mg) was given with a low calcium diet to the patients, the increase of urinary oxalate was more prominent in those with recurrent stones; the mean urinary oxalate increased from 39.84 to 84.18 mg/day (P less than 0.01) in the group with recurrent stones, from 36.95 to 55.12 mg/day (P less than 0.05) in the group with single stones and from 33.99 to 42.78 mg/day in the control group. These increases in oxalate excretion could be ameliorated by the concurrent oral administration of milk (calcium 343 mg). Moreover, diurnal variation in oxalate excretion was observed. It was more evident under spinach load in the group with recurrent stones than in the control group. Urinary oxalate increased promptly, reaching peak levels between 4 and 6 hours after loading in the group with recurrent stones and single stones, and between 2 and 4 hours in the control group. The influence of the spinach load disappeared within 24 hours.

Topics: Adult; Animals; Calcium; Calcium, Dietary; Circadian Rhythm; Diet; Humans; Male; Oxalates; Rats; Urinary Calculi

The urinary excretion of oxalate, calcium, citrate, magnesium, urate and creatinine and the inhibition of calcium oxalate crystal growth were determined in 30 patients operated with three different types of jejunoileal bypass. In addition the ion-activity products of calcium oxalate and calcium oxalate saturation were calculated. 15 of the patients had formed urolithiasis postoperatively. The patients were investigated on an out-patient basis with their ordinary diet. All patients had hyperoxaluria. The oxalate excretion did not seem to decrease with time after operation. The patients operated with a biliointestinal shunt had a significantly higher excretion of oxalate than those with the other two types of operation, indicating that variations in the anatomy of the small intestine after jejunoileal bypass might result in different absorption of oxalate or oxalate precursors. Urinary oxalate, calcium oxalate saturation and ion-activity products were higher whereas the excretion of calcium, magnesium and citrate was lower in patients than in controls. The urine volumes, excretion of creatinine and urate and inhibition of calcium oxalate crystal growth were equal in patients and controls. Analogous urine composition was found in patients both with and without urolithiasis with the exception of a higher magnesium excretion observed in stone formers.

Topics: Adult; Calcium; Citrates; Creatinine; Female; Humans; Ileum; Jejunum; Magnesium; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications; Uric Acid; Urinary Calculi; Urine

In 117 male patients with proven calcium oxalate renal calculi, adults of all ages were affected. There was a low incidence of urinary tract obstruction and infection and a high incidence of recurrence and bilateral disease. The group of patients could not be characterized as to a specific abnormality of blood or urine. There were no differences between all patients, a subset with multiple stones and normals with regard to the mean urinary excretions of calcium, magnesium and oxalic acid. There were no differences between the frequency distribution of patients with high excretions of both calcium and oxalic acid or low excretions of both calcium and oxalic acid. Mean supersaturation ratios and the frequency distribution of supersaturation ratios in 31 stone patients were the same as in 32 normal men. The data suggest that the difference between calcium oxalate stone patients and normals lies in the process of initiation.

Topics: Adult; Aged; Calcium; Calcium Oxalate; Humans; Magnesium; Middle Aged; Oxalates; Phosphorus; Ureteral Calculi; Urinary Calculi

The daily urinary excretion of calcium, oxalate, uric acid and glycosaminoglycans, and 24-h urinary volume and pH, were measured in 39 normal men and 65 male patients who had formed at least one calcium oxalate stone. No significant difference could be found between the two groups of subjects with respect to any of the urinary parameters. Nonetheless, a higher proportion of stone-formers than normals had daily excretion levels of oxalate in excess of the normal 95th percentile. On the other hand, there was no difference between the proportion of stone-formers and normals who fell into this category with respect to calcium excretion. It was concluded that a single 24-h urine analysis is of limited practical value in explaining the occurrence of stones or in predicting the likelihood of further episodes in unselected stone-formers attending a general hospital outpatient clinic.

Topics: Adult; Calcium; Glycosaminoglycans; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi; Urodynamics

This paper analyzes some aspects of the pathophysiology of urolithiasis. It is emphasized that a better understanding of factors contributing to stone formation can only be gained when the primary nucleation site is identified. Three compartments are considered in which supersaturation as a precondition for stone formation could be present: urine in the urinary tract, tubular fluid from the glomerulus down to the duct of Bellini, and the interstitium of the medulla. From calculations based on micropuncture data it becomes apparent that the oxalate concentration in the tubular fluid at the bend of Henle's loop is 1 or 2 orders of magnitude lower than in the duct of Bellini and that the oxalate concentration maximum invariably must be located in the final urine. The calculation of a tubular concentration profile of oxalate shows, that the probability of intra luminal crystal formation is even less likely for plasma oxalate values of 2-3 microM as compared to 1.2 microM, which therefore should be the correct value. The time necessary for the growth of crystals up to a critical size which can obstruct tubules or ureter is not available in the urinary tract nor in the tubules. However, in the medullary interstitium, where solute concentration is highest, nearly unlimited time for crystal growth is available due to the fact, that in this compartment convective flow is very low. It is concluded that the interstitium of the inner medulla has the best chances to function as the primary nucleation site where particles can be formed of a size which subsequently can obstruct the urinary tract.

Topics: Calcium; Crystallization; Glomerular Filtration Rate; Humans; Kidney; Kidney Medulla; Kidney Tubules; Nephrons; Oxalates; Oxalic Acid; Urinary Calculi; Urodynamics

Topics: Calcium; Diet; Dietary Proteins; Humans; Oxalates; Phosphates; Purines; Urinary Calculi

A new quantitative determination method for urinary oxalate by gas chromatography has been established. This method consists of concentration of urine to dryness followed by methylation of the oxalic acid with 7 per cent hydrochloric acid-methanol, subsequent extraction with chloroform and gas chromatographic analysis. The advantages of the technique are smaller sample sizes (only 5 ml.), rapidity (within 2 to 3 hours) and accuracy (99.14 plus or minus 1.34 per cent recovery). In addition, the treatment of the sample is simple and no specialized equipment is required. Therefore, this method is recommended to clinicians for routine determination of oxalic acid in urine. Urinary oxalate content was analyzed with this method in 62 male patients with calcium oxalate stones. Urinary oxalate concentration and excretion in 33 patients with recurrent stones were significantly higher than in the 22 controls using Welch's test.

Topics: Adult; Calcium Oxalate; Chromatography, Gas; Humans; Male; Methylation; Middle Aged; Oxalates; Oxalic Acid; Recurrence; Urinary Calculi

To evaluate the incidence of heterozygous cystinuria in patients with primary and recurrent calcium oxalate stone disease 24-hour urine samples from 140 patients were examined. The frequency of heterozygous cystinuria in this study was only 1.4 per cent (2 patients). The frequency of other metabolic disorders was in accordance with other reports: hypercalciuria (32 per cent), hyperuricosuria (32 per cent) and hyperoxaluria (17 per cent).

Topics: Adult; Aged; Calcium; Calcium Oxalate; Cystinuria; Female; Heterozygote; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Uric Acid; Urinary Calculi

In a group of 112 patients with ulcerative colitis, eight patients (7.1%) developed the complication of urolithiasis. A higher incidence was found in those with total colitis (15.4%) and in postoperative patients (20%). The mean period between the onset of colitis and the initial urinary symptoms was 5.4 yr. All the analyzed stones contained oxalate and seven of eight patients had hyperoxaluria, which was believed to be one of the important lithogenic factors. Increased urinary Ca/Mg ratio, steroid, and sulfasalazine are suggested as the other lithogenic factors in patients with ulcerative colitis.

Topics: Adult; Calcium; Colitis, Ulcerative; Crystallography; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Postoperative Complications; Steroids; Sulfasalazine; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium; Dietary Carbohydrates; Female; Glucagon; Glucose; Glucose Tolerance Test; Humans; Insulin; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

The technique of ion chromatography was applied to determine oxalate concentrations in unprocessed urine. The minimal detectable limits of oxalate was 1 microgram./ml. (11 mumole/liter), the within-run imprecision (Sw) was 2.3 per cent and the total imprecision (St) was 4.9 per cent. Ion chromatography can be used for the simple, accurate and direct measurement of urinary oxalate.

Topics: Adult; Carbon Radioisotopes; Carboxy-Lyases; Chromatography, Ion Exchange; Humans; Male; Oxalates; Oxalic Acid; Urinary Calculi

Three hundred urinary calculi were collected in the Durban area during the period August 1979--August 1980. Analysis by the X-ray diffraction method showed that their composition is generally similar to that found in the USA and UK. The incidence of uric acid, present in 17% of the calculi, is higher than that found overseas. There is a significantly higher incidence of calcium oxalate in calculi from Indians (83% v. 70% in Whites) while there is a significantly higher incidence of urinary apatite in Whites (35% v. 21% in Indians).

Topics: Black or African American; Black People; Calcium; Calcium Oxalate; Cystine; Female; Humans; India; Magnesium; Male; Oxalates; Phosphates; Quaternary Ammonium Compounds; South Africa; Uric Acid; Urinary Calculi; White People; X-Ray Diffraction; Xanthine; Xanthines

Six out of seven patients with primary hyperoxaluria showed various degrees of oxalosis. The radiographic manifestations differ between patients younger than 15 years and those older than 45 years. The mild manifestations in children, only urolithiasis, can be explained by the, as yet, unimpaired renal function. The renal function in the older patients, with extensive pathologic changes like nephrocalcinosis, urolithiasis, soft-tissue calcification, and osseous changes, is very poor. The findings of extensive soft-tissue calcification and the bony changes are not in complete agreement with those in the literature.

Topics: Adolescent; Adult; Age Factors; Calcinosis; Humans; Kidney Diseases; Middle Aged; Nephrocalcinosis; Oxalates; Radiography; Urinary Calculi

Topics: Adult; Calcium; Citrates; Female; Fluid Therapy; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Plant Extracts; Plants, Medicinal; Urinary Calculi

The effect of fluoride on urinary calculi formation in young rats was investigated. Two studies, in which rats received diets that included either higher calcium (9 g/kg diet) or normal calcium (5 g/kg diet), were conducted At each level of calcium, one group of rats received a high level of fluoride and another a low level of fluoride in the diet. Rats ingesting high fluoride diets exhibited a higher incidence of crystalluria and bladder stones compared with those receiving low fluoride diets. However, compared with higher calcium diets, normal calcium diets delayed the appearance of crystalluria and produced smaller calculi. Calcium and oxalate were the major components of the calculi. Calculi of rats fed the higher calcium and high fluoride diet contained relatively less protein and more calcium compared with calculi formed in rats ingesting the higher calcium and low fluoride diet. The concentration of fluoride in calculi from rats fed high fluoride diets was significantly higher than that of calculi from rats fed low fluoride diets. A significant positive correlation between calcium and fluoride concentration of calculi was observed in rats fed the higher calcium diet only. These studies indicate that ingestion of excess fluoride facilities calcium oxalate crystalluria and promotes the formation of bladder stones in rats, under the experimental conditions used.

Topics: Animals; Body Weight; Calcium Oxalate; Calcium, Dietary; Crystallization; Dose-Response Relationship, Drug; Fluorides; Male; Oxalates; Oxalic Acid; Phosphates; Potassium; Potassium Compounds; Rats; Sodium Fluoride; Urinary Bladder Calculi; Urinary Calculi

Topics: Administration, Oral; Ascorbic Acid; Dose-Response Relationship, Drug; Humans; Oxalates; Urinary Calculi

It has been observed that the feces as well as urine of rats fed diets supplemented with 3% glycine and 5.2% hydroxyproline contain unexpectedly high amounts of endogenously formed oxalate. That intestinal microorganisms do not synthesize significant amounts of oxalate was indicated by the findings that oral tetracycline had no effect on oxalate excretion and that germ-free rats excreted more oxalate than conventional rats. Since little intraperitoneally injected [14C] oxalate appeared in the feces, and rat intestinal mucosa homogenates were found to produce oxalate from a variety of precursors of which glyoxylic acid was far the most important, it is probable that the intestinal mucosa may be an important source of fecal oxalate observed in these studies. Ninety percent of weanling rats fed complete diets supplemented with glycine and hydroxyproline developed urinary stones in 38 days. It has been concluded that in the treatment of patients with histories of calcium oxalate urolithiasis, more concern than is commonly shown should be directed towards the feeding of diets high in precursors of endogenous oxalate synthesis.

Topics: Animals; Calcium, Dietary; Feces; Glycine; Hydroxyproline; Intestinal Mucosa; Kidney; Liver; Male; Oxalates; Oxalic Acid; Rats; Rats, Inbred Strains; Urinary Calculi; Vitamin B 6 Deficiency

Twelve recurrent stone formers with hyperoxaluria were administered pyridoxine-HCl (10 mg/day) daily for a period of 180 days. The pyridoxine status of the patients, as assessed by their erythrocyte transaminase activation indexes, improved significantly (p less than 0.001) after 180 days of supplementation as compared with the basal levels. Although urinary oxalate decreased significantly (p less than 0.05) by the 90th day of pyridoxine therapy, other parameters, e.g., urinary calcium, phosphorus, and creatinine, remained unaltered. Significant correlation was observed between erythrocyte glutamate pyruvate transaminase (EGPT) or erythrocyte glutamate oxaloacetate transaminase (EGOT) activation index and urinary oxalate excretion (p less than 0.01). Pyridoxine in low doses (10 mg/day) is of therapeutic value for hyperoxaluric stone formers.

Topics: Adult; Alanine Transaminase; Aspartate Aminotransferases; Calcium; Humans; Oxalates; Phosphorus; Pyridoxine; Recurrence; Time Factors; Urinary Calculi

Topics: Calcium; Citrates; Citric Acid; Humans; Magnesium; Oxalates; Oxalic Acid; Phosphates; Uric Acid; Urinary Calculi

Topics: Adult; Allopurinol; Calcium; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Recurrence; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Adult; Female; Humans; Male; Methods; Middle Aged; Oxalates; Urinary Calculi

We report on our experience with 9 cystine-lithiasis patients who were treated with large doses of ascorbic acid (5 g/day) for periods ranging from 6-27 months. We observed recidive lithogenesis in only 3 patients during this time. The influence of ascorbic acid on the excretion of cystine and oxalate in the urine is discussed. A lack of side effects and the significantly lower frequency of recidivation justify the further use of ascorbic as an alternative medication in cystine lithiasis.

Topics: Adult; Ascorbic Acid; Cystine; Cystinuria; Dose-Response Relationship, Drug; Female; Humans; Kidney Calculi; Male; Middle Aged; Oxalates; Oxalic Acid; Recurrence; Urinary Bladder Calculi; Urinary Calculi

A new method is described for the measurement of oxalate in urine and urinary calculi using medium pressure ion-chromatography. The technique is simple, requires minimal sample preparation and only 20 min analysis time. The minimum detection limit for oxalate is 0.5 mumol/l in the diluted sample as applied to the analyser. The intra-run coefficient of variation for the chromatography stage alone is 3.8%. The overall intra-run and inter-run coefficients of variation, including the sampling and dilution of urine, are 6.5 and 8.3% respectively. The method compares well with an established colorimetric technique for the analysis of oxalate both in urine and in urinary calculi.

Topics: Chromatography, Ion Exchange; Colorimetry; Humans; Oxalates; Oxalic Acid; Urinary Calculi

Urolithiasis in children is a very important problem from the theoretical as well as from practical point of view. Better knowledge of its metabolic basis may allow to move the central treatment from surgical to prophylactic methods. The study presents modern view points on mechanisms for concrements sedimentation and actual data on metabolic disturbances in calcium, oxalates, purines, xanthines and cystine and their relations to urolithiasis and urinary tract infection.

Topics: Acidosis, Renal Tubular; Calcium; Child; Cystinuria; Humans; Hypercalcemia; Oxalates; Purine-Pyrimidine Metabolism, Inborn Errors; Uric Acid; Urinary Calculi; Urinary Tract Infections; Xanthines

The analysed material includes 100 children with urolithiasis treated in the Pediatric Clinic of the National Research Institute of Mother and Child in Warsaw between 1976 and 1978. Patients' age was from 3 months to 18 years. The analysed group included 51 boys and 49 girls. Urinary tract infection was found in 54 cases, i.e. 57,4% of the analysed material. The most common bacterial strains were those producing urease. They were detected in 48 children i.e. 88,9% of cases with urinary tract infection. Mostly these were bacteria of Proteus group--sporadically Pseudomonas aeruginosa and Staphylococcus albus. In the analysed patients urinary tract obstruction was observed in 36 children, i.e. 36% of cases. In 77% of the analysed material, localization of concrements was in upper urinary tract in 19% in the ureters and in 4% in the lover urinary tract. While in adult patients the most common compound of urinary stones was calcium oxalate, in children the most common stone compounds were phosphates (found in 38 cases i.e. 58,4% of the analysed material). The second frequent compound was oxalate found in 20 cases (30,7%). Less frequent compounds were uric acid and cystine. Performed study allowed to establish the cause of urolithiasis in 93 out of 100 examined children. Metabolic reasons of urolithiasis were found in 26 cases, i.e. 26% of the analysed material. They were as follows: idiopathic hypercalciuria--12 cases, uric acid urolithiasis--8 cases, primary hyperoxaluria--3 cases, cystinuria--2 cases, and incomplete acidosis of distal renal tubuli--1 case. Urolithiasis of probably metabolic origin was detected in 13 children (13%). Other reasons of urolithiasis in children were: infection (31%), idiopathic urolithiasis (17%) and others (6%). In 7 cases the reason of urolithiasis was not established.

Topics: Acidosis, Renal Tubular; Adolescent; Calcium; Child; Child, Preschool; Cystinuria; Female; Humans; Infant; Male; Oxalates; Uric Acid; Urinary Calculi; Urinary Tract Infections

The x-ray investigations are performed in every case of urolithiasis. The basic ones are plain films of abdomen, urography and voiding cystourethrography. These investigations do not establish the type of lithiasis, particularly in cases of mixed stones. A visualization of concrements on a plain film depends on the absorption coefficient of x-rays. There is a close connection between radiological morphology and chemical composition as well as structure of concrements. A precise determination of phase composition of stones and their structure is possible only in the indirect investigations, i.e. after concrements' extirpation. X-ray structural methods, infrared spectrometric method, thermal and optical ones in polarization light belong to indirect inquires. The diffractograms are a consequence of x-ray structural analysis. A comparison of them with specimens allows for identification of every crystallic substance. The principle of the infrared spectrometry is a selective absorption of infrared rays in substances of different chemical structures. A comparison of infrared absorption spectrum with specimens allows for identification of some substances. An advantage of this method is its high sensibility and the possibility to perform on a small quantity of substratum (1 mg). An optical method facilitates a microscopic observation of a thin plate of stone (0,02 mm) in the polarization passing light appropriate to qualify the basic optical properties of minerals. It is possible to see the inside of concrements in the relatively big magnification without destruction of its primary structure. The recognition of the main and subordinate components in renal stones is possible through the use of at least several very precise methods, from which x-ray structural analysis, optical and infrared absorption are of main importance.

Topics: Adolescent; Apatites; Child; Child, Preschool; Cystine; Female; Humans; Male; Minerals; Oxalates; Phosphates; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi; Urography

The x-ray pictures have principal significance in the clinical estimation of morphology of the skeleton. Roentgenometrical investigations of second metacarpal bone allow to assess the value of PCA (percentage cortical area), which is adequate to the mineral contents of the bone structure. PCA value of 100 equals the density of 2,3 g/cm3. The standard values of PCA and density equivalents were established in a group of 600 healthy children. The study was based on a group of 50 sick children aged from 1 to 16 years. The urolithiasis in all cases was diagnosed and all children were treated in the National Research Institute of Mother and Child in the years 1978-1979. The concrements in all cases contained the calcium salts as the main component. In 32 cases the following mixed stones: whewellite and weddellite, struvite and apatite, brushite and apatite, struvite and oxalate were found out. It was stated on the ground of mineralogical examinations that one component clearly preponderated the other ones.

Topics: Absorptiometry, Photon; Adolescent; Apatites; Bone and Bones; Calcium; Child; Child, Preschool; Female; Humans; Infant; Male; Metacarpus; Minerals; Oxalates; Reference Standards; Urinary Calculi

After determination of the lithogenic and inhibitory substances in serum and urine of 18 healthy control subjects and 20 patients with calcium oxalate urolithiasis on an uncontrolled diet, the alteration of the parameters while taking a standard diet was investigated. After attainment of a steady state, the investigations were performed over 48 h on 3-h aliquots of urine. Typical circadian rhythms were detected for all lithogenic parameters in the urine and normal ranges were established. This special investigation permits detection of "peaks" in the excretion of lithogenic substances which were masked in investigation of 24-h urine samples alone.

Topics: Adult; Calcium; Circadian Rhythm; Citrates; Citric Acid; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Oxalates; Oxalic Acid; Phosphates; Uric Acid; Urinary Calculi; Urination; Urine

The influence of calcium carbonate, aluminium oxyhydrate (Andursil) and an anion exchanger (Colestid) on the absorption of oxalate from the intestine in rats was investigated. The animals were administered daily doses of 15mg oxalate as a 14C-sodium-oxalate solution by means of a throat probe, and the substances of interest were mixed with the food. The intake of food and the 14C-activity in the urine were measured during four urine-collecting periods of 3 days each. The quantity of the enterally administered oxalate excreted with urine has a negative correlation to the amount of the investigated test substances ingested with food.

Topics: Aluminum Hydroxide; Animals; Anion Exchange Resins; Calcium Carbonate; Colestipol; Dimethylpolysiloxanes; Drug Combinations; Female; Intestinal Absorption; Ion Exchange Resins; Magnesium; Magnesium Hydroxide; Oxalates; Polyamines; Rats; Rats, Inbred Strains; Silicones; Urinary Calculi

Topics: Energy Metabolism; Glyoxylates; Humans; Oxalates; Uric Acid; Urinary Calculi

In profile urines from oxalate stone patients and normal persons the progress of concentration and excretion of 10 urine parameters was investigated. For the majority of lithogenic and litholytic urine substances, especially for oxalic acid, a day-and-night rhythm was proven. This may be transferred to a principle of zonary structure of weddellite crystals, explaining the periodically recurring change of weddellite layers of different dissolution resistances arising from different growth rates due to different concentrations of supersaturated urine.

Topics: Calcium; Circadian Rhythm; Crystallization; Crystallography; Humans; Oxalates; Urinary Calculi

While adhering to a standardized intake of food and liquids the effect of Solubitrat medicinal tea was tested under hospital conditions on the important serum parameters for urinary calculus formation and on the excretion of lithogenic and inhibitory substances in the urine. No significant differences were found in the serum parameters and in the 24 hr urine between the control group and the trial group. Observation of the day and night rhythm in the urine of the test group showed a prevention of the otherwise normal excretion peaks of most parameters at night, in particular the Ca concentration showing a significant flattening. Solubitrat medicinal tea consequently reduces the risk of urinary calculus formation and can be recommended without restriction for the fluid supply in the prophylaxis of urinary calculus.

Topics: Adult; Beverages; Calcium; Female; Humans; Male; Middle Aged; Oxalates; Plant Extracts; Plants, Medicinal; Urinary Calculi

Topics: Adult; Female; Glycolates; Humans; Male; Oxalates; Pyridoxine; Recurrence; Urinary Calculi

Topics: Calcium; Humans; Metabolic Diseases; Oxalates; Uric Acid; Urinary Calculi

Topics: Adult; Calcium; Calcium Oxalate; Circadian Rhythm; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

We examined epitactic relationships between hydroxyapatite (HAP) and the hydrates of calcium oxalate from a crystallographic point of view. We also examined the growth of HAP on the calcium oxalate surfaces at a constant supersaturation, we maintained by the controlled addition of solutions containing the lattice ions of the precipitating phase. Calcium oxalate trihydrate was the only salt that induced HAP overgrowth. The latter phase, however, was found to be a suitable substrate for the growth of calcium oxalate monohydrate.

Topics: Apatites; Calcium Oxalate; Crystallization; Humans; Hydrogen-Ion Concentration; Kinetics; Microscopy, Electron, Scanning; Oxalates; Phosphates; Thermodynamics; Urinary Calculi

The prevalence of urinary stone disease in 426 patients who had undergone bowel surgery at the General Infirmary at Leeds from 1958 to 1978 was found by postal questionnaire to be 9.4%. The risk of urinary stone formation was determined from the composition of 24 hour urines from 61 unselected patients, in whom intestinal resections had been performed. There were 27 patients with an ileostomy, 17 patients with an ileostomy and a small bowel resection, and 17 patients with a small bowel resection, or bypass, and an intact colon. Of this group of 61 patients, 9.8% gave a history of urinary stones after surgery. Compared with normal control subjects ileostomy patients had significantly lower urinary pH and volume, higher concentrations of calcium, oxalate, and uric acid, and increased risk of forming uric acid and calcium stones: a small bowel resection combined with an ileostomy increased the ileostomy output, lowered the urinary volume further, and reduced urinary calcium excretion. The concentration of urinary oxalate increased and the risk of both uric acid and calcium stones was high. Patients with small bowel resection and intact colon had hyperoxaluria and an increased risk of calcium stones despite a low urinary calcium. There was no increased risk of uric acid stones in this sub-group. It is concluded that the risk of forming urinary stones after this type of surgery is considerable. The follow-up of patients with ileostomies and with small bowel resections should include an assessment of faecal losses and urinary composition to identify the patients who have a high risk of forming urinary stones.

Topics: Adult; Calcium; Female; Follow-Up Studies; Humans; Hydrogen-Ion Concentration; Ileostomy; Intestine, Small; Male; Methods; Middle Aged; Oxalates; Postoperative Complications; Risk; Uric Acid; Urinary Calculi

The effects of standard mineral, free, and low calcium -- low oxalate diets on the urinary excretion of phosphate and magnesium were studied in 153 consecutive patients with single or recurrent renal or ureteric stones. The patients were divided in to four groups: 78 men with single stones (MS), 40 men with recurrent stones (MR), 30 women with single stones (WS) and five women with recurrent stones (WR). Men excreted significantly more phosphate and magnesium in the urine than women. The excretion of urinary phosphate and magnesium varied most for MS and least for WS. The high excretion of urinary phosphate on free diet together with infected urine probably accounted for the formation of stone in women with recurrent stones. The role of the dietary prevention of calcium urolithiasis was discussed.

Topics: Adolescent; Adult; Aged; Calcium, Dietary; Diet; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Sex Factors; Urinary Calculi

Topics: Animals; Biological Transport; Intestinal Absorption; Kinetics; Male; Nutritional Physiological Phenomena; Oxalates; Rats; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Ascorbic Acid; Dose-Response Relationship, Drug; Humans; Oxalates; Oxalic Acid; Urinary Calculi

In the present work the influence of stress situations on the concentrations and excretions of lithogenous urinary substances (calcium, oxalic acid, uric acid) has been studied in defined urine portions of 10 calcium oxalate stone patients and 10 normal subjects and the results compared to those of 20 stone patients and 10 normal subjects without stress. Stress may be objectified in the given task. The increase of concentrations and excretions of lithogenous urinary substances indicates an enhanced risk of stone formation. Uric acid is discussed as an agent promoting the calcium oxalate crystallization. New insights on the calcium oxalate stone genesis are gained from the results.

Topics: Adult; Calcium; Calcium Oxalate; Female; Humans; Male; Oxalates; Oxalic Acid; Stress, Physiological; Uric Acid; Urinary Calculi

Intestinal absorption of oxalate can be judged from the urinary excretion of orally administered [14C]oxalate. Fifteen normal subjects, 21 patients with "idiopathic" calcium oxalate stone disease and a high oxalate excretion, four patients operated with ileocecal resection, and seven patients operated with jejunoileal bypass were so investigated. We saw no significant difference in the amount of isotope excreted by normal subjects and idiopathic stone formers; 13.6% (SD 5.9%) and 14.4% (SD 6.5%), respectively, of the administered dose was accounted for in the urine. The patients with resection or bypass showed a quite different pattern of isotope excretion, and 18.3% (SD 7.0%) and 36.8% (SD 14.0%), respectively, of the isotope was accounted for in the urine.

Topics: Calcium Oxalate; Cecum; Female; Humans; Ileum; Intestinal Absorption; Intestines; Jejunum; Male; Obesity; Oxalates; Oxalic Acid; Urinary Calculi

Base of real metaphylaxis in the renal stone disease are the analysis of stone and the research of the metabolism in blood plasma and urine. The greatest part of the happened stones is classifying in the four groups: oxalate, phosphate, uric acid and cystine. The metaphylaxis by whewellite and weddellite is the same for both species, but there is a distinction in growth and recurrence. In the phosphate stones, the section with the most different composition, a therapy postoperatively is only possible with the distinction in "acid" and "alkaline" stones. The uric acid and cystine stones need a tight supervision and metaphylaxis for all the life. On the basis of 1200 analyses with X-ray diffraction the difference of the renal stones is discussed and the deduction for a real metaphylaxis is shown.

Topics: Humans; Oxalates; Purines; Urinary Calculi

Topics: Adult; Aged; Female; Humans; Male; Methods; Middle Aged; Oxalates; Oxalic Acid; Urinary Calculi

Two groups of patients with urolithiasis were treated with 2.5 mg. (group A) and 5.0 mg. (group B) bendroflumethiazide daily. There were 14 men and 3 women in group A, and 14 men and 2 women in group B in whom metabolic effects were followed during 1 year of treatment. Serum calcium was significantly increased in group B after 1 month but later returned to the pretreatment level. A significant decrease in serum magnesium was recorded in group B after 6 and 10 months. No significant effect on serum calcium or magnesium was observed in group A. Serum potassium decreased in both groups but serum urate remained at the pre-treatment level. An increased alkalinity was noted in both groups. Urinary calcium was decreased significantly only in group B. Although significantly increased excretion of magnesium was observed after 1 and 6 months in group A this was not encountered in group B, and after 12 months urinary magnesium was at the pre-treatment level in both groups. Urinary excretion of oxalate, urate and citrate appeared to be unaffected by the treatment. The inhibition of calcium oxalate crystal growth and urine volume did not change. The calcium/magnesium quotient decreased in both groups as did the calcium times oxalate/ magnesium quotient. The main metabolic effect of bendroflumethiazide, with respect to its stone prophylactic property, appears to be a decrease in the calcium/magnesium quotient and a dose of 5 mg. per day probably is more satisfactory than a 2.5 mg. dose.

Topics: Adult; Bendroflumethiazide; Calcium; Calcium Oxalate; Citrates; Citric Acid; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Recurrence; Uric Acid; Urinary Calculi

The urinary excretion of oxalate, calcium, magnesium and creatinine was investigated in 21 outpatients who underwent jejunoileal bypass operation 6-9 years previously. Furthermore, a urinary stone index expressed as the quotient (calcium X oxalate)/(magnesium X creatinine) (mmol/mol) was calculated. The oxalate excretion exceeded normal ranges in 20 patients (1.20 +/- 0.55 mmol/24 h), and the stone index was found critically high in all. Daily administration of 1,100 mg ionized calcium in 17 of these patients die not change the urinary excretion of oxalate, calcium and magnesium separately, but the stone index was reduced significantly suggesting some preventive effect of calcium on the tendency of stone formation after jejunoileal bypass.

Topics: Adult; Calcium; Creatinine; Female; Humans; Ileum; Jejunum; Magnesium; Male; Obesity; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Acidosis, Renal Tubular; Adult; Aged; Child; Female; Humans; Hyperparathyroidism; Male; Medullary Sponge Kidney; Middle Aged; Oxalates; Risk; Urinary Calculi; Urinary Tract Infections

Results of the first Nordic quality control programme on urinary calculi are described. The programme included nine specimens, nine components and 57 laboratories participated. Most of the specimens were mixtures of selected human calculi. Of the laboratories, 67% used a binary scale for the results("qualitative"); 80% of the laboratories were unable to carry out the analysis on 10 mg material or less. For most components false positive results were rare. Oxalate and calcium (II), however, were exceptions. Results on "mixed stones" were unsatisfactory; frequently 20% of the results were wrong. The fraction of false negative results is 0.10 for cystine and urate, and is generally higher for other components. No difference between the reliability of infrared spectrometry and of wet chemistry is observed. An ordinary internal quality control scheme is suggested to facilitate improvements of the routine analytical performance. Some ideas of the analytical strategy are discussed. The drawbacks of results from a binary scale are stressed, and it is suggested that the examination of urinary calculi be carried out using techniques which give results on continuous scales. At the same time the number of components for analysis in the routine programme may be reduced.

Topics: Ammonia; Calcium; Carbonates; False Negative Reactions; Humans; Magnesium; Methods; Oxalates; Oxalic Acid; Phosphates; Quality Control; Reagent Kits, Diagnostic; Urinary Calculi

There are numerous reports dealing with the significantly reduced citrate secretion in (recurrent) tone formers. The critical values of the Ca/citrate ratio in the nocturnal urine of (oxalate) stone formers has also been reported, emphasizing the need of medicaments being capable to increase the citrate secretion and to raise the basal citrate level of the nocturnal urine in these patients. In our in vitro experiments, we tested quantitatively the inhibitory activity of some new substances on crystal growth. In Wistar rats we measured the Ca2+-binding capacity as well as the citrate and oxalate excretion before and after oral application of a great number of new compounds. Some of them were highly efficacious in the reduction of the Ca-oxalate activity product, as can be derived from the increased Ca2+-binding capacity and/or the decreased oxalate secretion in urine.

Topics: Acetates; Animals; Calcium; Citrates; Malonates; Oxalates; Oxaloacetates; Rats; Rats, Inbred Strains; Tricarboxylic Acids; Urinary Calculi

The present study describes the mode of prophylactic management of urinary stone disease as carried out at the Department of Urology. University of Vienna Medical School. A carefully directed prophylactic regimen results in a significant decrease in the recurrence rate of stone formation.

Topics: Acidosis, Renal Tubular; Calcium; Cystinuria; Humans; Hydrogen-Ion Concentration; Oxalates; Recurrence; Uric Acid; Urinary Calculi

Topics: Acidosis, Renal Tubular; Bicarbonates; Calcium; Child; Cystinuria; Enzymes; Humans; Oxalates; Phosphates; Purines; Urinary Calculi; Xanthines

Seasonal variations of urine volume and urinary excretion of calcium, oxalate, magnesium and phosphate were studied in 118 men with urolithiasis on a standard mineral diet and on free diet. The 24-hour urine volume did not vary by season. There was no significant seasonal variation in the excretion of urinary calcium, oxalate, magnesium or phosphate on a standard mineral diet. While on a free diet the patients' urinary excretion of calcium showed statistically significant seasonal differences between age groups. The seasonal variations in the excretion of urinary oxalate and phosphate were statistically significant on free diet, but did not differ by age. The urinary excretion of magnesium was not affected by season nor age. Dietary intake probably best explains seasonal changes in the urinary excretion of calcium, oxalate and phosphate.

Topics: Adolescent; Adult; Aged; Calcium; Humans; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Phosphates; Seasons; Urinary Calculi

Topics: Adult; Aged; Calcium Oxalate; Circadian Rhythm; Female; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Adolescent; Adult; Calcium Oxalate; Female; Humans; Male; Middle Aged; Oxalates; Oxalic Acid; Urinary Calculi; Xylitol

Topics: Ammonia; Carbonates; Child; Child, Preschool; Cystine; Female; Humans; Infant; Kidney Calculi; Male; Minerals; Oxalates; Ureteral Calculi; Uric Acid; Urinary Bladder Calculi; Urinary Calculi

In an attempt to detect genetic factors linked with urolithiasis, a study based on medical and genetic data and on several biochemical procedures was done on 50 stone formers and on 50 controls. Genetic factors likely to be related to stone forming were found in 4 patients: 2 cases of incomplete renal tubular acidosis, and 2 cases of heterozygous cystinuria. A study of the families of 3 of these individuals revealed 4 additional cases of genetically determined metabolic diseases. Despite the small number of patients for whom genetic factors were determined and the fact that the lithiasis cases with and without family recurrence showed similar behavior with respect to the different biochemical parameters studied, the presence of genetic factors is suggested by the significantly more frequent family history of lithiasis found for stone formers than for the controls. Identifying the cases with family recurrence, in which stone formation occurs earlier and is more frequently recurrent, and the stone-forming patients with genetically determined metabolic disorders, which may benefit from specific measures, will probably contribute to a better prognosis for these patients.

Topics: Acidosis, Renal Tubular; Adolescent; Adult; Blood Chemical Analysis; Child; Cystinuria; Female; Humans; Male; Metabolism, Inborn Errors; Oxalates; Urinary Calculi

Topics: Calcium; Cyclic AMP; Cystinuria; Humans; Hydrogen-Ion Concentration; Hyperparathyroidism; Oxalates; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Aged; Calcium; Citrates; Creatinine; Crystallization; Female; Humans; Magnesium; Male; Methods; Middle Aged; Oxalates; Recurrence; Specimen Handling; Uric Acid; Urinary Calculi

Topics: Calcium; Calcium Oxalate; Creatinine; Diet; Female; Humans; Male; Metabolic Diseases; Oxalates; Urinary Calculi

Topics: Calcium; Crystallization; Female; Humans; Male; Oxalates; Phosphates; Urinary Calculi

Topics: Acidosis, Renal Tubular; Asia, Western; Calcium; Cystinuria; Egypt; Europe; Female; Germany, East; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, Ancient; History, Medieval; Humans; Magnesium; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Xanthines

Fifteen patients with recurrent renal stone formation were treated with 400 mg magnesium oxide daily. Urine composition was analyzed before the start of treatment and after 6-12 months. The urinary excretion of magnesium before and during treatment was 321 +/- 120 (mean +/- SD) and 409 +/- 140 mmol per mol creatinine respectively, a difference that was not statistically significant. Urinary calcium increased from 473 +/- 186 to 662 +/- 213 mmol per mol creatinine (p less than 0.05). All patients who increased their excretion of magnesium also increased the urinary output of calcium and, as a result of this, the calcium/magnesium-quotients were unaffected by the treatment. No significant effect was observed on urine oxalate excretion. Serum concentrations of calcium, magnesium and urate all remained at the pre-treatment level. From the results obtained in this study, magnesium oxide in this dosage cannot be recommended for use in treatment of patients with urolithiasis.

Topics: Calcium; Calcium Oxalate; Creatinine; Humans; Magnesium; Magnesium Oxide; Oxalates; Recurrence; Uric Acid; Urinary Calculi

The values of 7 urinary parameters in divided urine collections were measured in 20 patients with calcium oxalate stones and ten normal persons. On this basis the thermodynamic stone formation risk was calculated for the different urine collections. Stone formation risk in the 0-6 a.m. urine fractions appeared to be the most important. The risk of stone formation is significantly increased in the time from midnight to 6 a.m. To detect the risk situation the determination of oxalic acid, calcium, potassium and inorganic sulfate in night urine is adequate.

Topics: Calcium; Calcium Oxalate; Circadian Rhythm; Female; Humans; Male; Mass Screening; Oxalates; Potassium; Risk; Sulfates; Urinary Calculi

Urinary excretion of calcium, magnesium and oxalate was studied in 38 patients with urolithiasis on two different occasions, and there appeared to be a good correlation between the biochemical findings in the two samples. All values were expressed per mole of creatinine and it was furthermore demonstrated that the variation in creatinine excretion was considerably less than the variation in urine volume. The calcium/magnesium quotients were calculated in 113 2-hour fasting urine samples and 24-hour urine samples and a good correlation was obtained. Biochemical grouping of the patients was performed by means of the two sets of values and the result obtained was approximately the same in both cases.

Topics: Calcium; Creatinine; Female; Humans; Magnesium; Male; Oxalates; Urinary Calculi

An unusually high incidence of urinary calculi in a group of feeder cattle is described. Necropsy findings in one affected animal suggested that oxalates in the feed, specifically in fescue (Festuca spp.) seed screenings, may have been the cause. Low dietary calcium and decreased water intake by the cattle appear to have been predisposing factors. Control measures are discussed.

Topics: Animal Feed; Animals; Cattle; Cattle Diseases; Oxalates; Urinary Calculi

A two-enzyme method is presented for estimating urinary oxalate by continuous-flow analysis. Oxalate is decarboxylated, yielding formate, which is subsequently oxidized in the presence of NAD+, yielding NADH. The NADH, measured colorimetrically, is proportional to the amount of oxalate originally present in the sample. Urine is pretreated by precipitation of the oxalate and extraction of the precipitate in citrate buffer. A correction factor for the extraction efficiency is given by the recovery of [U-14C]oxalic acid added to aliquots of the 24-h urine specimen. The normal range obtained by this method was 0.20 to 0.52 mmol/24h (18 to 47 mg/24h) with a mean value of 0.37 mmol/24 h (33 mg/24h). The between-assay CV was 7.6% (n = 12), within-assay CV 3.2% (N = 25). Unlabeled oxalate (0.5 and 1.0 mol/L) added to 28 urine samples gave a mean analytical recovery of 95% (SD 10%).

Topics: Autoanalysis; Carboxy-Lyases; Colorimetry; Female; Formate Dehydrogenases; Humans; Male; Oxalates; Reference Values; Urinary Calculi

Infrared analysis of urinary tract calculi using the system of interpretation of spectra of Oliver and Sweet [1] was compared with qualitative wet chemical analysis. This method of interpretation could be learned quickly and gave reproducible results, but had some limitations. Advantages of the infrared procedure include greater reproducibility. 1-mg sample size, greater sensitivity for oxalate and more uniform sensitivities. Minimum detectable amounts of reference standards varied roughly within 1 order of magnitude, compared with a range of 10(5) for wet chemical procedures. The comparable sensitivity for oxalate and phosphate permits a semi-quantitative approach for infrared. The main problems relate to the detection of magnesium ammonium phosphate and carbonate apatite, and wet chemical tests are recommended in addition, when these compounds are suggested. Calculi from 308 patients were analyzed by infrared. With this system of interpretation of spectra, infrared is considered to be a major advance in methodology for analysis of urinary tract calculi in the clinical laboratory, compared with qualitative wet chemical procedures.

Topics: Calcium; Carbonates; Humans; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi

Topics: Animals; Kidney; Male; Oxalates; Rats; Succinates; Urinary Bladder; Urinary Calculi

Topics: Adult; Calcium; Climate; Cystinuria; Female; Humans; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urinary Tract Infections; Urination Disorders

Topics: Cystine; Humans; Oxalates; Phosphates; Spectrum Analysis; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Calcium Oxalate; Food Analysis; Humans; Oxalates; Urinary Calculi

With a new enzymatic test using oxalate oxidase, serum and urinary oxalate can easily and quickly be determined. Serum oxalate in females was significantly higher than in males (39.5 mumol/l, 30.8 mumol/l). Increased serum levels were found only in male patients. Urinary excretion did not reveal sex-dependent differences in healthy persons. The normal range of oxalate excretion in 104 adult healthy persons was 83-365 mumol/day (95% quartile). In 130 stone formers (nonrecurrent and recurrent group) urinary oxalate excretion was found to be in the normal range. Evaluation of urinary oxalate concentration in morning samples showed increased levels in both groups of male stone formers. Oxalate concentration was unaltered in female patients.

Topics: Adult; Female; Humans; Male; Middle Aged; Oxalates; Sex Factors; Urinary Calculi

Topics: Cystine; Humans; Oxalates; Recurrence; Uric Acid; Urinary Calculi

Less than 3 per cent of the [1-14C]glycolate administered, orally to fasted and nonfasted male Wistar rats was excreted in the feces in 48 hr. This finding indicates that the glycolate was readily absorbed from the digestive tract. An average of 3 per cent of the administered [1-14C]glycolate was also recovered in 48 hr as urinary [14C]oxalate from fasted and nonfasted rats. Significant amounts of glycolate were found in the vegetables, fruits, and beverages analyzed, but much lower amounts were found in meats and milk. Inasmuch as glycolate is naturally present in the diet and contributes to the formation and excretion of urinary oxalate, restricting the intake of glycolate may be beneficial in treating oxalate stone-forming patients.

Topics: Animals; Beverages; Diet; Fruit; Glycolates; Intestinal Absorption; Male; Meat; Oxalates; Rats; Urinary Calculi; Vegetables

We isolated a mucoprotein from the urine of stone-formers that promotes the precipitation of oxalate. The mucoprotein has a molecular weight of 51,000 daltons and an isolectric point of 2.8. Although its hexuronic and stalic acid content is quite small, its glycine (31.3 per cent) and glutamic acid (12.2 per cent) content is high.

Topics: Amino Acids; Calcium; Chemical Precipitation; Humans; In Vitro Techniques; Mucoproteins; Oxalates; Phosphates; Protein Binding; Urinary Calculi

Hypercalciuria is common in patients who form calcium oxalate urinary stones and is considered by many to be the cause of the disorder. This review shows that there is little relationship between either the rate of stone-formation or calcium oxalate crystalluria and the urinary excretion of calcium. There is, however, a strong relationship between these parameters and the urinary excretion of oxalate which is slightly, but significantly, elevated in stone-formers compared with normals. It is concluded that this mind degree of hyperoxaluria may be much more important than hypercalciuria in the genesis of calcium oxalate stones.

Topics: Calcium; Humans; Male; Models, Biological; Oxalates; Recurrence; Urinary Calculi

Clinical and biochemical data were obtained from 50 patients in whom stones form and 20 controls to set up and test a screening procedure for detecting metabolic abnormalities related to the formation of urinary calculi and to provide a preliminary estimate of the frequency of these disorders in our area. A comparison between patients in whom stones form and controls in terms of the quantitative biochemical parameters evaluated (serum calcium, uric acid and inorganic phosphate, and urine calcium, uric acid, inorganic phosphate, oxalic acid, xanthine and alpha-amino-nitrogen) showed a significant difference only with respect to excretion of urinary oxalate by adults, which was higher in patients in whom stones form. Metabolic disorders were detected in 15 adult patients with stones. Of these patients 9 had isolated hyperoxaluria, 3 had incomplete renal tubular acidosis, 1 had idiopathic hypercalciuria, 1 had heterozygous cystinuria and 1 had idiopathic hypercalciuria associated with heterozygous cystinuria. These results suggest a high frequency of metabolic abnormalities in patients in whom stones form in our area, so that the wider use of the screening used here may benefit a large number of patients with preventive and therapeutic measures.

Topics: Adolescent; Adult; Ammonium Chloride; Brazil; Calcium; Child; Child, Preschool; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Nitrogen; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Xanthines

With a new enzymatic method, the dietary influence of oxalate, glycine, protein, and ascorbic acid on serum and urinary oxalate has been examined. Healthy and oxalate stone-forming subjects were compared. Two doses of sodium oxalate (130 and 400 mg daily) were administered. The high dose induced significant hyperoxaluria. No changes of serum oxalate were seen. Neither glycine (4.5 g daily) nor protein (50 g daily, 50% animal protein) had any effect on serum or urinary oxalate. Urinary oxalate excretion did not increase upon ingestion of large amounts of ascorbic acid (1--6 g daily), but serum oxalate levels were significantly elevated. The value of severe dietary restrictions concerning the compounds examined here seems to be questionable, as a significant increase of urinary oxalate excretion is lacking.

Topics: Ascorbic Acid; Diet; Dietary Proteins; Glycine; Humans; Male; Oxalates; Urinary Calculi

Topics: Cystine; Humans; Hyperparathyroidism; Male; Oxalates; Uric Acid; Urinary Calculi; Urinary Tract Infections

A survey shall be given of the present state of prevention and therapy of urolithiasis as well as of the up to now much restricted possibilities of the chemolitholysis. Particular attention is paid to calcium on account of its participation in the development of oxalate and phosphate calculi which together might be 70--80% of all calculi as well as to the rather limited possibilities of the reduction of the oxalate secretion in the urine. The encouragement of the oxalate lithiasis by increased uric acid in the urine as well as the reduction of the frequency of relapses not only of the concrements of the uric acid but also of the oxalate concrements by the uricostatic Allopurinol (e.g. zyloric) is dealt with.

Topics: Calcium Oxalate; Crystallization; Humans; Oxalates; Recurrence; Uric Acid; Urinary Calculi

The study reports 110 cases of urinary stones in children treated in the Paediatric Surgery Department of the City Hospital, München-Schwabing, from 1965-1976. 78 of the children had a follow-up examination at least two years after the surgical removal of the stone. The infant and toddler age-group demonstrated special features in possible genetic predisposition, and in the recurrence-rate, as opposed to the series as a whole. A "stony peak" is postulated also for urolithiasis in childhoiod. Prophylactic measures against recurrence consist mainly, in addition to careful surgical correction of urinary-flow hindrances, of plentiful fluid intake.

Topics: Adolescent; Calcium; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Oxalates; Phosphates; Recurrence; Urinary Calculi

Topics: Calcium; Cystine; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Calcium; Creatinine; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Examinations of the metabolism were carried out in 23 patients with ileal conduit and undisturbed renal function, in order to recognize the causes of stone-formation. In the infection calculi they are given with the alkaline urine, when an infection and a urinary retention is present. Perhaps the Ca-oxalate calculi develop within the hyperoxaluris in connection with a reduced citrate urine concentration. Differences in the composition of the conduit and renal pelvis urines could be proved.

Topics: Calcium; Citrates; Humans; Hydrogen-Ion Concentration; Ileum; Oxalates; Urinary Calculi; Urinary Diversion; Urine

Topics: Humans; Kidney Failure, Chronic; Oxalates; Renal Dialysis; Urinary Calculi

Topics: Adult; Barbiturates; Chemical Phenomena; Chemistry; Female; Humans; Oxalates; Phosphates; Ukraine; Uric Acid; Urinary Calculi

The clinical peculiarities, and the etiological and pathogenetic factors of urolithiasis in 296 patients suffering from spontaneous stone elimination were studied. It was established that 209 patients eliminated stones consisting of uric acid, sodium salts and ammonium salts. Moderate hypocalcemia and hyperphosphatemia and also hyperuricemia and hyperuricuria were present. There were 39 'eliminators' of calcium stones. Their blood calcium content was higher, hypercalciuria, inorganic phosphorus and normal uric acid, were noted. Compound stones were present in 48 observations. When carrying out additional biochemical tests in 57 patients with calcium and compound stones, primary hyperparathyroidism was diagnosed in 34 observations; and parathyroidectomy was successfully performed.

Topics: Adult; Calcium; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Oxalates; Phosphoric Acids; Salts; Uric Acid; Urinary Calculi

Eighty patients with proved calcium urolithiasis participated in an outpatient study designed to define the most likely metabolic problem related to the cause of the stone disease. Diagnostic categories included absorptive hypercalciuria (33 patients), renal leak hypercalciuria (20 patients), hypomagnesiumuria (27 patients), hyperuricemia and hyperuricuria (16 patients), hyperoxaluria (15 patients), normal stone-former (4 patients), renal tubular acidosis (2 patients) and suspicion of hyperparathyroidism (7 patients). Of the 80 patients 40 had more than 1 defect. Patients with a high suspicion of hyperparathyroidism were excluded from the study. Based on these criteria treatment plans incorporating medications, diet or both were instituted. Of 21 patients observed for greater than 2 years 90 per cent have shown no new stone disease.

Topics: Acidosis, Renal Tubular; Ambulatory Care; Calcium; Calcium Metabolism Disorders; Costs and Cost Analysis; Female; Humans; Hyperparathyroidism; Magnesium; Male; Outpatient Clinics, Hospital; Oxalates; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

Concentrations and excretion of ten urine parameters were recorded in defined urine portions of 20 calcium oxalate stone patients and 10 normal subjects; some of these urine constituents show a day-night rhythm thus indicating a daily risk variation. From the analysis of questionnaires on physical strain and psychonervous stress, correlations between stress and urine substances can be established. In this connection, oxalic acid concentration and excretion seem to be of special importance. The obtained results provide the basis for further complex-chemical calculations.

Topics: Adult; Calcium; Calcium Oxalate; Circadian Rhythm; Female; Humans; Male; Oxalates; Risk; Stress, Physiological; Urinary Calculi

Determining metabolic activity in urolithiasis may avoid excessive laboratory tests and unnecessary treatment. A simple regimen such as increased oral fluids is often effective therapy in metabolically inactive disease. Most cases of renal lithiasis are idiopathic, but a complete examination and laboratory work-up will usually establish an accurate etiologic diagnosis.

Topics: Aged; Calcium; Calcium Metabolism Disorders; Cystinuria; Humans; Male; Medical History Taking; Oxalates; Physical Examination; Radiography; Uric Acid; Urinary Calculi; Xanthines

Topics: Acidosis, Renal Tubular; Aged; Calcium; Calcium, Dietary; Cystinuria; Diet; Humans; Intestinal Diseases; Intestine, Small; Kidney Calculi; Male; Oxalates; Phosphorus; Uric Acid; Urinary Calculi

Some common conservative treating methods of urolithiasis are critically discussed. Based on physico-chemical relationships of solubility and cristallisation of stone-forming compounds our own methods of conservative treatment of urolithiasis is presented.

Topics: Allopurinol; Aluminum Hydroxide; Calcium; Cystine; Humans; Ion Exchange; Magnesium; Oxalates; Phosphates; Pyridoxine; Quaternary Ammonium Compounds; Succinimides; Uric Acid; Urinary Calculi

Topics: Adult; Age Factors; Body Weight; Calcium; Creatinine; Female; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Oxalates; Recurrence; Seasons; Urinary Calculi

The causes of, and physiopathological factors underlying the most common metabolic disorders implicated in the formation of renal stones are reviewed. These include hypercalciuria, hyperoxaluria, renal tubular acidosis, cystinuria and disturbances of purine metabolism. Apart from metabolic disorders the risk of stone formation is also influenced by a low inhibitor activity in urine. Though some aspects in the pathogenesis of urolithiasis remain uncertain, the exact knowlege of important aetiological factors of stone formation is the basis of correct treatment and the prevention of recurrence of urinary calculi.

Topics: Acidosis; Adult; Calcium; Cystinuria; Humans; Kidney Tubules; Male; Oxalates; Purine-Pyrimidine Metabolism, Inborn Errors; Uric Acid; Urinary Calculi; Urography

The incidence of urolithiasis was registered in 87 patients with chronic inflammatory bowel disease and compared with that of renal oxalate excretion. All patients were studied while on a standardized diet with fixed amounts of fat, calcium, and oxalate. Pyelography had been performed in all. Nine, or 35%, of 26 hyperoxaluric patients had urolithiasis, compared with 14, or 23%, of 61 patients were normal renal oxalate excretion, the difference being statistically insignificant. No significant difference in urinary oxalate or urinary calcium in stone-formers as compared with non-stone-formers could be demonstrated. Oxalate was a more frequent component of calculi in patients with normal renal oxalate excretion than in patients with hyperoxalura. Thus, we were unable to demonstrate an increased incidence of urolithiasis in patients with hyperoxaluria compared with a control group with normal renal oxalate excretion. Our results cast doubt on the concept that enteric hyperoxaluria per se is the cause of stone diathesis in chronic inflammatory bowel disease.

Topics: Adult; Calcium; Colitis, Ulcerative; Crohn Disease; Female; Humans; Kidney; Male; Middle Aged; Oxalates; Radiography; Urinary Calculi

The present paper describes a modified method of the quantitative determination of oxalic acid in the urine which is based on the reduction of oxalic acid to glycolic acid and on the transformation with chromotropic acid to a colorimetrically well measurable complex of colours. The method ascertains a good reproducibility and is simply to be performed in every clinico-chemical laboratory.

Topics: Colorimetry; Glycolates; Humans; Methods; Naphthalenesulfonates; Oxalates; Urinary Calculi

The hypothesis that the incidence of calcium stone disease is related to the consumption of animal protein has been examined. Within the male population, recurrent idiopathic stone formers consumed more animal protein than did normal subjects. Single stone formers had animal protein intakes intermediate between those of normal men and those of recurrent stone formers. A high animal protein intake caused a significant increase in the urinary excretion of calcium, oxalate and uric acid, 3 of the 6 main urinary risk factors for calcium stone formation. The overall relative probability of forming stones, calculated from the combination of the 6 main urinary risk factors, was markedly increased by a high animal protein diet. Conversely, a low animal protein intake, such as taken by vegetarians, was associated with a low excretion of calcium, oxalate and uric acid and a low relative probability of forming stones.

Topics: Calcium; Calcium Oxalate; Diet, Vegetarian; Dietary Proteins; Female; Humans; Male; Oxalates; Recurrence; Uric Acid; Urinary Calculi

Topics: Female; Humans; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urine; X-Ray Diffraction

Urolithiasis is seen in our region throughout the year as a periodic appearing disease with peaks not only in summer, but also--somewhat lower--in January, April and October. This appearance is especially caused by the calcium oxalate stones. Uric acid calculi show a rise between May and October. The magnesium ammonium phosphate stones appear almost completely irregular.

Topics: Humans; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Seasons; Uric Acid; Urinary Calculi

Topics: Calcium; Cystinuria; Diet; Humans; Hydrogen-Ion Concentration; Occupations; Oxalates; Risk; Stress, Psychological; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Adult; Aged; Electrolytes; Female; Humans; Long-Term Care; Male; Middle Aged; Oxalates; Pyridoxine; Uric Acid; Urinary Calculi

Topics: Calcium Oxalate; Calcium Phosphates; Crystallization; Diphosphates; Diphosphonates; Humans; Oxalates; Phosphates; Urinary Calculi

Topics: Allopurinol; Humans; Male; Oxalates; Urinary Calculi

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.

Topics: Crystallography; Evaluation Studies as Topic; Humans; Latex; Microspheres; Oxalates; Particle Size; Urinary Calculi

Topics: Austria; Nutritional Physiological Phenomena; Oxalates; Periodicity; Phosphates; Urea; Uric Acid; Urinary Calculi

Topics: Ascorbic Acid; Humans; Oxalates; Risk; Urinary Calculi

Topics: Calcium; Humans; Oxalates; United States; Urinary Calculi; Water Supply

There is a paucity of literature concerning the origin of urinary stone disease. This report uses information currently available to examine the likelihood of urinary stone disease starting from free or fixed crystalluric particles. We conclude that stone disease in the renal tubules and renal pelvis cannot begin on unattached (free) particles. However, in conditions associated with stone formation, initiation of bladder stone disease on free particles seems quite likely.

Topics: Humans; Kidney; Kidney Calculi; Kidney Pelvis; Kidney Tubules; Models, Biological; Oxalates; Urinary Bladder Calculi; Urinary Calculi

Twenty-four hour urine specimens from 26 active stone formers and 15 non-stone formers were passed through an ultrafilter that retained all molecules with a molecular weight greater than 50,000. Microscopic spherical bodies that laked alizarin red were observed in the urinary ultrafiltrate from 24 of 26 active stone formers. Only three of 15 non-stone-forming control urines contained these bodies. Histochemical studies showed the presence of calcium, phosphorus, and carbohydrate-protein complexes. No crystalline elements were detected.

Topics: Calcium; Carbohydrates; Colloids; Humans; Oxalates; Phosphorus; Ultrafiltration; Urinary Calculi

Male Wistar rats were fed a basal diet, Purina Laboratory Chow, and an oxalate calculi-producing diet (CPD). The CPD was the basal diet containing 3 per cent glycolic acid. Sodium pyruvate, DL-alanine, alpha-keto glutaric acid, thiamine pyrophosphate, and L-glutamic acid were added to the CPD to determine their effectiveness in preventing calculi formation. The effectiveness of methyl glyoxal was determined by adding it to the drinking water. Rats fed CPD for 4 weeks developed calculi in the ureters, bladder, renal tubules, and/or renal pelvis and papilla. Rats in groups fed alanine and/or pyruvate had no calculi in their renal tubules or ureters; additionally, these rats had a significant reduction in incidence and amount of deposits in the renal pelvis and bladder. Rats in groups fed alpha-keto glutaric acid, thiamine pyrophosphate, L-glutamic acid, and methyl glyoxal developed equally or more severe oxalate urolithiasis than those on CPD alone. Results of this study show that either pyruvate or alanine at appropriate levels may be beneficial in preventing oxalate urolith formation.

Topics: Alanine; Animals; Drug Evaluation, Preclinical; Glutamates; Glutarates; Male; Oxalates; Pyruvaldehyde; Pyruvates; Rats; Thiamine Pyrophosphate; Urinary Calculi

A single intraperitoneal injection of sodium oxalate was used to induce intrarenal tubular precipitation of calcium oxalate in rats. This experimental model was used to screen the efficacy of hydrochlorothiazide, orthophosphate, methylene blue, trypan blue, retinal folic acid, neuraminidase, and lysozyme in retarding intratubular calcium oxalate precipitation. Orthophosphate caused a 53 per cent reduction in calcium oxalate precipitation relative to the control animals.

Topics: Animals; Calcium; Disease Models, Animal; Drug Evaluation, Preclinical; Female; Folic Acid; Hydrochlorothiazide; Methylene Blue; Muramidase; Neuraminidase; Oxalates; Phosphates; Rats; Trypan Blue; Urinary Calculi; Vitamin A

Topics: Cystine; Diuresis; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

There were 22 patients in whom oxalate stones formed and who had absorptive hyperoxaluria treated with diethylaminoethanol-cellulose. In more than 2 years this form of treatment did not seem to have any serious side effects. It achieved a decrease of urinary oxalate values in all patients in whom oxalate hyperabsorption had been found. Diethylaminoethanol-cellulose is an anionic exchanger capable of retaining oxalate in vitro and in vivo.

Topics: Absorption; Adolescent; Adult; Cellulose; Child; DEAE-Cellulose; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

The urinary excretion of calcium, magnesium, oxalate, creatinine, phosphate and urate was investigated in patients with urolithiasis and in normal subjects. The excretion of oxalate and urate per mole creatinine and the quotients calcium/magnesium, calcium X oxalate/magnesium and calcium X oxalate/(magnesium X creatinine) were significantly higher in stone formers than in normal subjects. The mean creatinine-correlated urinary excretion of calcium was higher and of magnesium lower in patients with urolithiasis, but the differences were statistically not significant. The urine investigation was supplemented with analysis of calcium, magnesium, creatinine, urate, bicarbonate and chloride in serum and a qualitative analysis of stone composition. A simple schedule for a biochemical grouping of patients with urolithiasis is presented and on the basis of the analytical findings it was possible to classify 67% of patients with so-called 'idiopathic stone disease' according to these principles.

Topics: Adult; Calcium; Creatinine; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Earlier reports from our laboratories described the inhibitory effect of Mg++ and pyrophosphate on the dissolution and growth of calcium oxalate. In this report, growth of Ca oxalate in presence of very low concentration of chlorophyllin was followed by the Coulter counter and a multichannel analyser. The effect of chlorophyllin concentration on crystal formation was studied at different levels of supersaturation. A concentration of 0.1 microgram/ml produced a remarkable retardation of the induction period and the growth rate. The findings obtained in this study are discussed in the light of the crystal poisoning theory. Comparison was made between chlorophyllin and other growth inhibitors.

Topics: Calcium; Chlorophyll; Copper; Crystallization; Oxalates; Sodium; Urinary Calculi

Oxalate-urolithiasis and hyperoxalaria have been reported to be a frequent complication in patients with small bowel disease, especially in patients with ileal resection due to Crohn's disease. Hyperabsorption of oxalate seems to be the main patholgenetic factor for "enteric" hyperoxalaria. Intestinal absorption and urinary excretion of oxalate was measured in patients with various gastrointestinal diseases after oral or rectal administration of 14C-oxalate. Kinetic data suggest that 14C-oxalate is absorbed in the small, the large bowel and the rectum as well. Oxalate absorption was decreased in patients with a colectomy and in active ulcerative colitis, but increased in patients with ileal resection, chronic liver disease, and steatorrhea due to chronic pancratitis or sprue. There existed a positive correlation between 14C-oxalate absorption and the amount of fecal fat excretion. The data suggest that hyperoxaluria and hyperabsorption of oxalate are not a specific finding in patients with bile acid malabsorption, but may occur too, in steatorrhea without alteration of bile acid metabolism.

Topics: Celiac Disease; Chronic Disease; Colitis, Ulcerative; Colon; Gastrointestinal Diseases; Humans; Ileum; Intestinal Absorption; Liver Diseases; Oxalates; Pancreatitis; Postoperative Complications; Rectum; Urinary Calculi

Ruberythric acid and alizarin glucuronide, the biologic secretion product obtained from the alizarin derivative, stop the crystallization of calcium oxalate and calcium phosphate in the physiologic milieu of the urine. This effect is thought to be due to a soluble alizarin glucuronide: calcium chelate (2:1 mol). From this finding, we deduce that the solubility of calcium oxalate and calcium phosphate in the urine of humans can be increased through the oral administration of oxianthraquinone.

Topics: Anthraquinones; Calcium; Calcium Phosphates; Crystallization; Oxalates; Solubility; Urinary Calculi

The incidence of urolithiasis in Manipur is very high. From hospital records for a period of 7 years and 3 months, it was observed to be 11.6% of all general surgery cases in the General Hospital, Imphal. This is alarmingly high. The social, eating, drinking, and living habits are different among the three major populations in this state. The prevalence was minimal among Tribals. Compared to them the prevalence was about one and one half times higher among Muslims (also called Pangals) and seven times higher among Hindus. Surprisingly, the incidence of renal calcalus was higher in females. One hundred ninety-six stones were studied by wet chemical analysis. Calcium and oxalate were present in all stones. Phosphate was present in 194 stones and uric acid (including urate) was present in 146 stones.

Topics: Adolescent; Adult; Age Factors; Aged; Calcium; Child; Child, Preschool; Diet; Feeding Behavior; Female; Humans; India; Infant; Infant, Newborn; Male; Middle Aged; Oxalates; Religion; Sex Factors; Urinary Calculi

A variety of substances have been used to prevent recurrence of stone disease. Recently there has been considerable interest in the ability of allopurinol to prevent stone recurrence. This article discusses the effect of allopurinol on the urinary oxalate in a group of stone formers. A significant reduction was obtained especially in subjects in whom the blood urate levels exceeded 300 mumol./L. Possible mechanisms explaining the mode of action of the drug are discussed.

Topics: Adult; Aged; Allopurinol; Calcium; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

The prophylaxis of the urinary lithiasis by means of drugs (alkalinisants, Eisemberg's syrup, allopurinol, etc.) obtains a very good result against uric acid and urate stones. The prevention of stones of oxalates, phosphates, carbonates, etc. is possible by trichlormethiazide (if hypercalciuria is present) and especially by a new drug, the Covalitin. Naturally diet and hydrotherapy. Decalogue for the stone's prophylaxis is done.

Topics: Carbonates; Humans; Ion Exchange Resins; Oxalates; Phosphates; Urea; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium Oxalate; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Oxalates; Urinary Calculi

Reports of Melon et al. [7] and Hodgkinson [4] regarding the efficacy of succinic acid or its derivative (salt) in reducing the endogenous synthesis of oxalate are conflicting. The possible application of succinic acid as a potential inhibitor of oxalate synthesis, and the biochemical alterations resulting therein, has been studied in 10 idiopathic stone-forming patients (6 primary stone-formers and 4 recurrent stone-formers) and in 21 normal adult rats. In rats no significant changes in oxalate excretion were observed during the 4 weeks of succinic acid administration (500 mg/100 g BW/day) and 2 weeks therafter. In the clinical trial of 3 months, where stone-formers were given 20 g/day of succinic acid, the post-therapy values of urinary oxalate excretion showed a singificant drop ( less than 0.001) as compared with those of pretherapy--recurrent stone-formers showing a more marked decrease (63%) than primary stone-formers (49%).

Topics: Animals; Diet; Humans; Male; Oxalates; Rats; Succinates; Urinary Calculi

Oxalate, uric acid, and phosphate stones have been analyzed for their carbon isotope composition. The oxalate stones show delta13C values between -17.0 and -19.5%, the uric acid stones between -14.9 and -19.4%, and the phosphate stones between -13.0 and -23.9%. It is proposed that endogenic rather than exogenic sources are responsible for the 13C/12C ratios of the stones. The isotopic composition of the phosphate stones seems to be influenced primarily by bacterial activity.

Topics: Carbon Isotopes; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Crystallography; Humans; Microscopy, Electron, Scanning; Oxalates; Urinary Calculi

On the basis of to-day knowledge about metabolism and excretion of oxalic acid, the rationale of therapy of stone pathology is revieved. The problems of both primary and secondary oxaluria and of inhibiting factors of cristalisation are particolarly discussed.

Topics: Humans; Oxalates; Urinary Calculi

Numerous clinicians criticise the insufficiency and imprecision, and the incoherency of the analyses of biological calculations by the usual clinical methods and thus frequently avoid prescribing such an examination. The authors propose the application of a physical method, infrared spectrophotometry for the qualitative and semi-quantitative determination of the composition of stones of all origins. They recall the often heterogeneous structure of the stones and emphasise the importance which they attribute of differential analysis by separate zones during careful dissection, the results of which may orient the therapeutic attitude of the clinician. The differentiation of a few crystalline structures and the study of complex mixtures are dealt with in the form of characteristic infrared spectra. The advantages and limits of the method compared with other technics of analysis are discussed.

Topics: Bilirubin; Cholelithiasis; Cholesterol; Humans; Oxalates; Phosphates; Salivary Duct Calculi; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi

Topics: Animals; Calcium; Calcium Radioisotopes; Carbon Radioisotopes; Male; Oxalates; Phosphorus; Phosphorus Radioisotopes; Rats; Urinary Calculi

Allopurinol is a drug which could be valuable in the treatment of stone patients. In 29 subjects treated with 300 mg of the drug per day it has been found that there was a significant fall in urine oxalate excretion if the blood urate was above 330 mumol/l. In 10 subjects followed for 1 year the urine oxalate was significantly reduced and maintained at a lower level than the original.

Topics: Allopurinol; Female; Follow-Up Studies; Humans; Male; Oxalates; Uric Acid; Urinary Calculi

The excretion of uricine or yellowish-red pigment from uric acid stones and its binding by uric acid seems to affect the precipitation of uric acid. Uricine was determined by ion exchange chromatography followed by measurement of the alkaline fluorescence emission. The uricine urinary excretion and the uricine-uric acid potential binding were determined in 11 control subjects, 20 recurrent uric acid stone formers, seven calcium stone formers with hyperuricuria, and five gouty patients without urinary stone formation. Uricine excretion was increased in 11 uric acid stone formers, whereas it was normal in the rest of the patients. Uricine-uric acid potential binding was increased in many uric acid stone formers, despite the absence of uric acid urinary hyperexcretion, whereas it was normal in most of the calcium stone formers and was moderately increased in the gouty patients.

Topics: Adult; Aged; Binding Sites; Calcium Phosphates; Female; Gout; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxalates; Pigments, Biological; Uric Acid; Urinary Calculi

Pellets made by dispersing microcrystals of calcium oxalate monohydrate throughout an organic matrix have served as models for kidney stones in studies of factors governing their dissolution by calcium-chelating agents. These factors include pH, ionic strength, concentration of chelating agent, and addition of other acids and bases. The method shows good reproducibility. Results have been applied to improving a clinical procedure for kidney stone dissolution.

Topics: Calcium; Chelating Agents; Crystallization; Edetic Acid; Hydrogen-Ion Concentration; Models, Biological; Oxalates; Urinary Calculi

Topics: Calcium Phosphates; Humans; Oxalates; Uric Acid; Urinary Calculi

The diurnal urinary oxalate excretion has been determined in 11 patients with urolithiasis and in 7 normal subjects. Increased excretion following meals was observed. The variation from hour to hour was most pronounced in the stone patient group. The relation between oxalate concentration and urinary volume was found to follow a biphasic exponential course. Pyridoxine administration increased oxalate excretion in 9 out of 12 subjects and decreased the excretion in 3 subjects. Ascorbate administration increased oxalate excretion in all 7 subjects studied.

Topics: Ascorbic Acid; Circadian Rhythm; Humans; Oxalates; Pyridoxine; Urinary Calculi

Topics: Calcium Phosphates; Hardness; Humans; Oxalates; Urinary Calculi

Topics: Adult; Ascorbic Acid; Humans; Male; Oxalates; Stimulation, Chemical; Urinary Calculi

Topics: Allopurinol; Calcium; Humans; Oxalates; Urinary Calculi

Topics: Acidosis, Renal Tubular; Adult; Calcium; Crystallization; Cystinuria; Female; Humans; Magnesium; Male; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Xanthines

Topics: Binding Sites; Calcium; Humans; Intestinal Absorption; Oxalates; Postoperative Complications; Urinary Calculi

The composition of urinary calculi was studied by means of infrared spectroscopy. Analysis of 150 calculi has shown that their infrared spectrum offers quick and reliable results and the method helps to plan the therapy. Organization of a central laboratory for calculus analysis is recommended.

Topics: Apatites; Calcium Phosphates; Carbonates; Humans; Oxalates; Spectrophotometry, Infrared; Urinary Calculi

Mass spectrometric trace element analysis of whewellite and weddellite uroliths revealed 55 elements, from which 20 could be well assessed quantitatively. The total trace element content in weddellite increased by 77.5% with respect to whewellite, the main portion being made up from Na, P, Mg, and Cl. In physiological conditions weddellite is stabilized by trace elements. The importance of trace element analysis of Si, Al, Sr, Rb, S, F, Cl, and Br in uroliths is indicated.

Topics: Calcium; Humans; Mass Spectrometry; Oxalates; Trace Elements; Urinary Calculi

Since 1973 we have used allopurinol in the prevention and aftercare of recurrent urolithiasis. We give indications for the administration of allopurinol for patients with chronically recurring calcium oxalate lithiasis. Special attention is given to the urinary stone analysis as well as to metabolic disorders as for example hyperuricaemia, hyperuricuria or idiopathic hypercalciuria. In 15 patients with calcium oxalate lithiasis the stone/patient/year ratio could be decreased to 38%. In 19 patients with uric acid/calcium oxalate calculi or alternating stone formations from uric acid and calcium oxalate we succeeded in decreasing this ratio from 1.72 to 0.47 or 27%.

Topics: Allopurinol; Calcium; Humans; Oxalates; Recurrence; Urinary Calculi

In a retrospective analysis of 438 cases of canine urolithiasis, a total of 561 urolithic episodes were found to have occurred in a 6 1/2-year period. The hospital incidence of urolithiasis during that period, defined as the proportion of dogs hospitalized with urolithiasis to the total number of dogs hospitalized, was 2.8%. The major chemical component of the calculus in 307 dogs was phosphate; in 95 dogs, cystine; in 21 dogs, urate; in 12 dogs, oxalate; and in 3 dogs, carbonate. The Miniature Schnauzer, Dachsund, Dalmatian, Pug, Bulldog, Welsh Corgi, Beagle, and Bassett Hound were breeds that had a significantly higher (P less than 0.05) incidence of calculi than did breeds of other dogs hospitalized. Predisposition for calculi, by sex, was not found. Most dogs with calculi were between 3 and 7 years old. Most calculi were radiopaque and were located in the bladder or in the bladder and urethra. Specimens for bacteriologic culture were obtained by catheterization or by swabbing of tissue at the surgical site. Of 259 specimens obtained, 181 were culture-positive. The most common organisms isolated were Staphylococcus spp, Escherichia coli, Proteus spp, Streptococcus spp, and Klebsiella spp. Most of the bacteria were sensitive to gentamicin, chloramphenicol, nitrofurantoin, cephalothin, and methanamine mandelate.

Topics: Age Factors; Animals; Bacterial Infections; Carbonates; Cystine; Dog Diseases; Dogs; Female; Male; Oxalates; Phosphates; Sex Factors; Uric Acid; Urinary Calculi

A retrospective analysis of urolithiasis in the dog was done at the Animal Medical Center, New York, NY, and involved a review of case records from Jan 1, 1968, to June 30, 1974. The study involved a total of 438 dogs that had a total of 561 urolithic episodes. Of the 438 dogs, 111 had 155 known recurrences of calculi. The types of recurrent calculi were phosphate (54 dogs), cystine (45 dogs), urate (7 dogs), oxalate (3 dogs), and carbonate (2 dogs). Two-thirds of the recurrent cases involved only 2 episodes. One-half of the population was composed of mixed breeds, Schnauzers, and Poodles. With the exception of 25 females that had phosphate calculi, all of the dogs with recurrences were males. Sixty-six dogs were tested for urinary bacteria and of these dogs, 40 had infected urinary tracts. The infected dogs had both phosphate and cystine calculi. In addition, most dogs with phosphate calculi had Staphylococcus infections, whereas the cultures from the dogs with cystine calculi had a wide range of bacteria.

Topics: Age Factors; Animals; Carbonates; Cystine; Dog Diseases; Dogs; Female; Male; Oxalates; Phosphates; Recurrence; Sex Factors; Staphylococcal Infections; Uric Acid; Urinary Calculi

Urinary calculi, predominantly of oxalate composition, have been noted in 10 to 14% of a large series of morbidly obese patients after jejunoileal intestinal bypass at this institution. Physical and metabolic changes after bypass surgery, including the presence of hyderoxaluria, hyperuricemia, and fluid and electrolyte disturbances are reviewed in their possible relationship to this increased incidence of urolithiasis.

Topics: Adolescent; Adult; Bile Acids and Salts; Diet; Female; Humans; Ileum; Jejunum; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications; Urinary Calculi

1. Whewellite (calcium oxalate monohydrate) crystals were found to induce epitaxially the heterogeneous nucleation of brushite (calcium monohydrogen phosphate dihydrate) from its metastable supersaturated solution in approximately one-quarter of the time required for spontaneous precipitation in the absence of added nucleating agents. Scanning electron-microscope observation of the crystalline phase showed brushite crystals originating from the whewellite seed crystals. 2. Crystal growth, upon nucleation, proceeded rapidly, and the metastable solutions quickly approached saturation. 3. Brushite crystals also induced the precipitation of calcium oxalate crystals in about one-quarter of the time required for spontaneous precipitation; however, the rate of crystal growth was considerably slower. In support of the chemical data, scanning electron micrographs showed few crystals of calcium oxalate nucleated on the surface of the brushite seed. 4. The results provide some insight into the cause of stones containing calcium oxalate or calcium phosphate (or both), which form in the normally acid environment of human urine.

Topics: Calcium Phosphates; Crystallization; Hydroxyapatites; Microscopy, Electron, Scanning; Oxalates; Urinary Calculi

Ten urinary stones composed of calcium oxalate or a mixture of calcium oxalate and calcium phosphate were analyzed for trace metal content by emission spectroscopy. Trace metals found in amounts of 0.001 per cent or more were iron, copper, zinic, tin, lead, and aluminum. The inhibitory effect of each of these trace metals on the crystal growth of calcium oxalate and calcium phosphate was tested. Results indicated that none of the metal affect the crystal growth of calcium oxalate at concentrations approximating those found in normal urine. The metal ions copper (II), zinc (II), tin (II), and aluminum (III) did affect the crystal growth of calcium phosphate when present at physiologic concentrations; however, their contribution to the total calcium phosphate inhibitor activity in urine was estimated to be insufficient to have a regulatory role in urinary stone growth.

Topics: Aluminum; Calcium; Calcium Phosphates; Copper; Crystallization; Humans; Iron; Lead; Oxalates; Tin; Trace Elements; Urinary Calculi; Zinc

There have been 543 jejuno-ileal bypass patients screened for the presence of urinary calculi 1 to 6 years postoperatively. Of these patients 9 per cent have had 1 to 2 calculi during the followup and 3 per cent have had multiple calculi. Ninety-four per cent of the recovered calculi consisted entirely of calcium oxalate. Seven patients had a history of stones before the bypass, 6 of whom have had additional stones postoperatively. To define the conditions associated with stone formation in these patients measurements of serum and urinary oxalate concentration, urinary calcium oxalate saturation, urinary crystal size distribution, and the rates of intestinal oxalate absorption and urinary crystallization have been performed on patients who did and did not have stones postoperatively. On the basis of these studies it appears that the patients in whom stones formed differ from those in whom they did not form only in the rate of urinary crystallization and in the number of large crystal particles present in the urine. Evaluation of current therapeutic modalities in terms of the capability to correct these stone-forming characteristics and to reduce actual calculus formation reveals that the only successful regimen is that which includes an extreme reduction of oxalate ingestion.

Topics: Follow-Up Studies; Humans; Ileum; Intestinal Absorption; Jejunum; Obesity; Oxalates; Postoperative Complications; Urinary Calculi

Urinary excretion of 4-pyridoxic acid and oxalic acid was investigated in 75 patients with urinary calculi and in 50 normal subjects on regular diet. Mean excretion of 4-pyridoxic acid was 0.85 and 0.90 mg per day, respectively, and mean excretion of oxalic acid was 27.5 and 28.0 mg per day, respectively. Statistically there was no difference between the two groups in 4-pyridoxic acid excretion or in oxalic acid excretion. There was a weak positive correlation between the urinary excretion of 4-pyridoxic acid and oxalic acid. Patients who were on ascorbic acid supplementation during the urine collection period excreted increased amounts of oxalic acid. It was concluded from this investigation that most patients with urinary calculi had 4-pyridoxic acid excretion and oxalic acid excretion within normal limits. Low 4-pyridoxic acid values were not combined with high excretion values of oxalic acid, and the nutritional state of vitamin B6 in patients with urinary calculi was assumed to be satisfactory in order to control the endogenous oxalic acid production. The significance of high excretion values of 4-pyridoxic acid and oxalic acid is discussed.

Topics: Ascorbic Acid; Female; Humans; Isonicotinic Acids; Male; Oxalates; Pyridoxic Acid; Pyridoxine; Urinary Calculi

In the present paper was reported on the results of the topographic crystal-optic analysis of urinary calculi of 560 concrements. 59% of all urinary calculi had a different phase content in the nucleus and in the calyx. All frequent minerals of the urinary calculi could be proved in the nucleus of the calculus. It could be shown that nucleus and calyx may have a monomineral as well as a polymineral structure. It is referred to the importance of the topographic analysis of the urinary calculi for the metaphylaxis of the urolithiasis.

Topics: Calcium; Humans; Methods; Optics and Photonics; Oxalates; Phosphates; Uric Acid; Urinary Calculi

The effect of oral administration of cholestyramine, neomycine, calcium, and bile acids on intestinal 14C-oxalate absorption and urinary oxalate excretion was assessed in patients with normal or increased ('enteric' hyperoxaluria) urinary oxalate excretion. Cholestyramine, neomycine and acute administration of chenodeoxycholic acid (2.75 g/24 h) did not affect significantly 14C-oxalate absorption or urinary oxalate excretion. Oral administration of calcium markedly reduced 14C-oxalate absorption (88.2%) and urinary oxalate excretion (46%). Calcium-induced reduction of intestinal oxalate absorption was more pronounced in patients with hyperabsorption of oxalate than in subjects with normal oxalate absorption or excretion. Patients on treatment with high doses of chenodeoxycholic acid (1.5-2.0 g/day) for dissolution of cholesterol gallstones had increased oxalate absorption and excretion, patients on long-term treatment with lower doses of chenodeoxycholic acid (0.75-1.0 g/day) exhibited normal absorption or urinary excretion of oxalate. The results do suggest that calcium and bile acids do play an important role in the pathogenesis of 'enteric' hyperoxaluria. It is suggested that the beneficial therapeutic effect of cholestyramine in hyperoxaluria due to ileal resection is rather caused by its bile acid binding property than by direct binding of oxalate within the intestinal lumen.

Topics: Bile Acids and Salts; Calcium; Carbon Radioisotopes; Cholestyramine Resin; Humans; Intestinal Absorption; Neomycin; Oxalates; Urinary Calculi

Individual urine samples from normal subjects and stone-formers with idiopathic hypercalciuria have been examined for crystals both qualitatively and quantitatively at 37 degrees C. The group as a whole showed a rise in incidence of urinary crystals in the summer months of June to August inclusive. This rise was seen most clearly in overnight urines, collected on rising in the morning, and the patients appeared to be at risk overnight during the summer. In the untreated patients the summer rise in incidence of phosphate crystals was quite dramatic but was only small in the cellulose phosphate treated group, who showed a rather constant and raised incidence of oxalate crystals right through the year. Seasonal crystal incidence has been compared with seasonal changes in urinary composition. The rise in crystal incidence during the summer was associated with increased creatinine concentration in the same urine samples and with increased oxalate concentration in 24-hour urine collections.

Topics: Crystallization; Humans; Oxalates; Phosphates; Seasons; Urinary Calculi; Urine

Topics: Calcium; Calcium Phosphates; Crystallization; Humans; Oxalates; Urinary Calculi

The present paper deals with experimental and crystaloptical studies on synthetic and native Ca-oxalate. The findings are in favour of a uniform way of formation of Ca-oxalate stones from Ca-oxalate dihydrate crystals as primary crystallization product in urine, developing into the monochydrate phase by dehydratation. Rapid growth and a sufficiently high concentration of foreign ions (Mg) in the urine support the formation and stabilisation of dihydrate stones.

Topics: Calcium; Crystallization; Crystallography; Humans; Magnesium; Oxalates; Urinary Calculi

Topics: Citrates; Female; Humans; Male; Oxalates; Phosphates; Urinary Calculi

Calcium oxalate crystals were obtained from urine specimens submitted to a hospital laboratory. The incidence of crystalluria was 4.2 per cent of 42 times the maximum reported incidence of urinary calculi. In our opinion the crystalluria was real and not artifactual. The crystalline structure was determined by polarized light, x-ray diffraction and electron microprobe analysis. Calcium oxalate occurs in several forms--the dihydrate as bipyramidal and dodecahedral prisms, the monohydrate as biconcave ovals, dumbbell shapes and intermediate forms.

Topics: Calcium; California; Humans; Hydrogen-Ion Concentration; Oxalates; Urinary Calculi

In vitro investigations of the formation of Whewellite or Weddellite are described. By means of different precipitation models the influence of cationic minerals on the formation of Weddellite could be observed. The possible conversion of Weddellite into Whewellite in vivo is demonstrated by in vitro experiments. A theory of the formation of Weddellite or Whewellite urinary calculi is developed on the basis of the results obtained.

Topics: Calcium; Crystallization; Fractional Precipitation; Humans; Hydrogen-Ion Concentration; Models, Biological; Oxalates; Urinary Calculi

The influence of magnesium in vitro on the precipitation of calcium oxalate was investigated. Even at maximum physiological magnesium concentrations a litholytic effect could not be observed, but the retardation of the calcium oxalate crystallization caused by magnesium might be decisive for a reduction in calculi formation. The enlargement of the calcium oxalate crystals and aggregates caused by the retardation of crystallization, however, should be regarded as a contraindicating factor for Mg therapy in oxalate calculous disease. It is safe to say that high magnesium concentrations prevent the conversion into Whewellite of the calcium oxalate calculi substance primarily formed as Weddellite.

Topics: Calcium; Crystallization; Fractional Precipitation; Humans; Hydrogen-Ion Concentration; Magnesium; Oxalates; Solubility; Urinary Calculi

An experimental study made on rat shows an inhibitrice activity of succinimide on formation of others kinds of urinary stones than those constituted with Ca oxalate and suggests the existence of a non specific anticrystallizing effect.

Topics: Animals; Calcium; Magnesium; Oxalates; Phosphorus; Rats; Succinimides; Urinary Calculi

Calcium, phosphate and alcaline phosphatase levels were determined in the serum of 29 patients with suspected primary hyperparathyroidism. Phosphate clearance according to Kyle, 24 hours urine hydroxyproline excretion during collagen free diet, the excretion of cAMP in the 24 h urine during calcium restricted diet were examined with regard to the diagnostic value and relevance as compared to the consumption of laboratory and staff time. The elevation of the serum calcium levels are not specific and only of minor diagnostic value. It has been found that the highest diagnostic value is given by the Kyle-test using 15 mg Ca ions/kg body weight. No false positive results were recorded. The excretion of hydroxyproline and calcium are only of limited value. Serum alcaline phosphatase and cAMP excretion have no diagnostic significance whereas concentration of serum phosphate may have some value.

Topics: Alkaline Phosphatase; Calcium; Creatinine; Cyclic AMP; Humans; Hydroxyproline; Hyperparathyroidism; Metabolic Clearance Rate; Oxalates; Phosphates; Urinary Calculi

Persorption is the excretion in urine of particles that have been absorbed (persorbed) from the gastrointestinal tract. In experiments with rats the effect of Herbst was combined with the production of renal calcium oxalate sediments by the oral administration of ethylene glycol and acidification with ammonium chloride. We used this method to investigate whether persorbed corpuscula may represent nuclei of crystallization in the formation of renal calculi. Lead sulfide, zirconium silicate and 45Ca-labeled calcium oxalate crystals were used as persorbable model bodies. It became apparent that orally supplied lead sulfide and zirconium silicate crystals could be found in the urine and the kidneys but they did not function as crystallization centers in the calcium oxalate sediments. However, radioactive labeled calcium could be demonstrated histoautoradiographically within the renal concrements. Our experiments showed that persorbed calcium oxalate crystals can work as nuclei for stone formation.

Topics: Ammonium Chloride; Animals; Crystallization; Ethylene Glycols; Histocytochemistry; Intestinal Absorption; Kidney; Male; Oxalates; Rats; Silicon Dioxide; Sulfides; Urinary Calculi

Topics: Amino Acids; Calculi; Glycine; Humans; Kidney Calculi; Oxalates; Parenteral Nutrition; Sorbitol; Urinary Calculi; Wounds and Injuries; Xylitol

The composition of 1,000 kidney stones in our area of Israel was analyzed. The predominant stones were a combination of calcium oxalate and calcium phosphate, and uric acid. We used chemical analysis to determine the relative incidence of urinary calculi in 500 patients of various ages and ethnic groups. The incidence of calcium oxalate and calcium phosphate calculi (44 per cent) in Jews born in Israel was lower than in other ethnic groups (54 to 64 per cent). The incidence of uric acid stones in Jews born in Israel, Lebanon, Iran, Iraq and Syria, and the Ashkenazim (16 to 29 per cent) was 2 to 3 times higher than in other groups. In more than 60 per cent of the patients urolithiasis developed after they were 20 years old. The age at onset was significantly younger in Jews born in Israel (25.7 per cent) and North Africa (13.8 per cent), and in Arabs (18 per cent).

Topics: Adult; Age Factors; Calcium; Calcium Phosphates; Ethnicity; Humans; Israel; Jews; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

The composition of 1,327 urinary stones by X-ray diffraction is statistically analyzed, and the exact analyses are discussed. The representative test portion of the urinary stone is important to the result. A comparison of different results of urinary stones with that of other authors is only possible when we know the exactness of the method.

Topics: Cystine; Female; Humans; Magnesium; Male; Oxalates; Phosphates; Radiography; Uric Acid; Urinary Calculi

The causes of hypercalciuria and simple diagnostic criteria for the various forms of hypercalciuria are outlined. Indications, effectiveness, limitations, and side effects of cellulose phosphate are described. Emphasis is placed on the biochemical pathogenesis and classification of hyperoxaluria. The problems of measuring and controlling oxalate excretion in patients with hyperoxaluria and calcium oxalate stones are discussed. Succinimide offers a partly successful approach to the reduction of endogenous oxalate synthesis.

Topics: Calcium; Calcium Metabolism Disorders; Cellulose; Glyoxylates; Humans; Organophosphorus Compounds; Oxalates; Phosphates; Succinimides; Urinary Calculi

Transmitted light microscope and scanning electron microscope investigations reveal various shapes of urine calcium oxalate crystals. In addition to tetragonal bipyramids, weddellite forms further crystal shapes that have been heretofore interpreted exclusively as whewellite crystals. Weddellite is stabilized by urine foreign ions. In vivo formation of whewellite crystals occurs with massive crystallization only.

Topics: Animals; Calcium; Crystallization; Crystallography; Humans; Microscopy, Electron, Scanning; Microscopy, Polarization; Oxalates; Spectrophotometry, Infrared; Surface Properties; Urinary Calculi; X-Ray Diffraction

Topics: Ammonia; Calcium; Calcium Phosphates; Computers; Cystinuria; Humans; Kinetics; Magnesium; Mathematics; Oxalates; Phosphates; Risk; Sodium; Uric Acid; Urinary Calculi

Topics: Adult; Female; Humans; Male; Middle Aged; Oxalates; Postoperative Complications; Urinary Calculi; Urinary Diversion

Urinary oxalate excretion was measured in healthy persons and patients with Crohn's disease, colitis ulcerosa, sprue and other diseases accompanied with malabsorption, and patients with insufficiency of the exocrine pancreas gland. Further measurements were made in patients after resection of parts of the small intestine or the colon. We found a clear increase of urinary oxalate excretion in patients with resected parts of the small intestine, sprue or other malabsorption syndromes. In 4 patients with resected parts of small intestine or pancreas we even found urolithiasis. Urinary oxalate excretion correlated significantly with steatorrhoea and increased if larger parts of small intestine were resected. Increased resorption of oxalate from food causes increased urinary excretion. Details about the patho-mechanism of this increased excretion are not known yet; an important factor seems to be the reduced absorption of fat in the small intestine.

Topics: Adult; Celiac Disease; Colitis, Ulcerative; Crohn Disease; Feces; Female; Humans; Intestinal Diseases; Intestine, Large; Intestine, Small; Lipids; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Pancreatic Diseases; Urinary Calculi

25 to 30% of calcium oxalate urinary calculi consist of the metastable Weddellite crystal phase. By fractionation of urine it was found that mineral substances are stabilising factors. The stability was checked in dry condition at room temperature at 38 degrees C and at 110 degrees C. These results could be confirmed by precipitation from synthetic solutions. Mg, Zn, Ni, Co, Mn and Cu individually, and above all in combination, promote the formation of Weddellite. The formation of mixed crystal phases must be considered one of the main factors for the stabilisation of Weddelite in the urinaty calculus.

Topics: Calcium; Cations, Divalent; Chemical Precipitation; Crystallization; Dialysis; Humans; Magnesium; Models, Biological; Oxalates; Urinary Calculi

Urinary oxalate excretion has been measured by a specific enzymatic method in normal subjects and stone formers with idiopathic hypercalciuria. In every group studied urinary oxalate was higher in the summer than in the winter. These differences were slight and not significant in normal subjects but were considerable and statistically significant in the stone formers both untreated and when treated with thiazide. Thiazides raise urinary oxalate only very slightly but cellulose phosphate leads to large rises in urinary oxalate both in the summer and the winter. The highest values of urinary oxalate were seen in the summer in patients treated with cellulose phosphate. The mean rise in this group was 70% above normal and this must be viewed with some anxiety.

Topics: Benzothiadiazines; Calcium; Cellulose; Diuretics; Drug Therapy, Combination; Humans; Oxalates; Seasons; Sodium Chloride Symporter Inhibitors; Urinary Calculi

Topics: Humans; In Vitro Techniques; Models, Biological; Oxalates; Phosphates; Uric Acid; Urinary Calculi

During the period 1926-1975, 94 children with urinary calculi were treated. The incidence, causation, localisation, symptomatology and diagnosis of urolithiasis in children are discussed. The therapeutic possibilities are also outlined. Particular emphasis is laid on therapeutic programmes for the prevention of recurrence in all varieties of urinary calculi, by means of which the recurrence rate in our own series was reduced to around 16%.

Topics: Adolescent; Calcium; Child; Child, Preschool; Cystine; Female; Glyoxylates; Humans; Infant; Infant, Newborn; Male; Oxalates; Phosphates; Solubility; Uric Acid; Urinary Calculi; X-Ray Diffraction

Studies were carried out on multiple urine samples from eight patients with recurrent idiopathic calcium oxalate stone formation and eight normal persons to define an index of the risk of forming calcium oxalate stones. Under the same conditions of dietary and fluid intake the urine samples of the patients with stone formation were more supersaturated with calcium oxalate (P less than 0.001) and had lower concentrations of protective inhibitors of crystallization (P less than 0.001) than those of the controls. However, the best separation between the groups was defined by a discriminant line relating inhibitory activity and urine saturation. A measure of the risk of forming large crystals, the saturation-inhibition index, was defined as the distance of each urine from the discriminant line. The patients with stone formation had a significantly higher mean saturation-inhibition index than the controls (P less than 0.001). Both the percentage of large calcium oxalate crystals excreted (P less than 0.001) and the stone episode rate (P less than 0.005) were significantly correlated with the saturation-inhibition index.

Topics: Calcium; Crystallization; Humans; Oxalates; Recurrence; Risk; Urinary Calculi

The concentrations of sodium, potassium, calcium, magnesium, phosphorus, sulfate, citrate and oxalate in the urine of normal subjects were compared to the concentrations in urine of calcium oxalate stone-forming patients. Because of the large volume excreted by stone-forming patients the urine contained less concentrations of sodium, potassium, magnesium, phosphorus, sulfate and citrate than did the urine from normal subjects. The urinary concentrations of calcium and oxalate were similar in the 2 groups and, thus, the calculated supersaturation of calcium oxalate was greater in the urine of stone-forming patients than in the urine of normal subjects. Orthophosphate therapy increased the urinary concentration of alkali ions and phosphate but reduced urinary calcium concentration, thereby causing a reduction in urine supersaturation with calcium oxalate. There was no discernible correlation between the phosphate-induced changes in urine supersaturation and the presence or absence of continued calculus formation.

Topics: Calcium; Humans; Male; Middle Aged; Oxalates; Phosphates; Urinary Calculi

Plasma and uric acid levels were measured in 132 men with calcium-containing renal stones and in 24 healthy men of similar ages. Fasting resulted in a significant fall in the mean plasma uric acid level of normal subjects. Intermittent hyperuricaemia was observed in 7% of fasting patients. Intermittent hyperuricosuria was found in 17% of non-fasting patients but in only 2 to 6% of fasting subjects. Most of the uric acid abnormalities in patients with calcium stones therefore appear to be due to diet and may be prevented by reducing the consumption of purine-rich foods. A direct relationship was observed between uric acid excretion and urine flow at normal flow rates. It is suggested that the apparent increase in stone incidence, which occurs with rising living standards, may be due partly to increased consumption of purine-rich foods.

Topics: Adult; Calcium; Creatinine; Fasting; Humans; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Adult; Child; Humans; India; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Knowledge of the crystalline structure of the calculus provides the basis of the therapeutic plan. Laboratory evaluation depends heavily upon routine urinalysis. Assessment of renal function, serum calcium, phosphorus, uric acid and, in some cases electrolytes is usually indicated, as is urography. General principles of management include maintenance of an ample urine volume, eradication of infection and correction of any obstructing lesions or metabolic abnormalities. Specific antistone regimens are indicated for patients with recurrent urolithiasis.

Topics: Anti-Bacterial Agents; Calcium; Cystinuria; Diarrhea; Female; Humans; Hydrochlorothiazide; Intestinal Diseases; Kidney Calculi; Male; Oxalates; Phosphates; Proteus Infections; Uric Acid; Urinary Calculi

1. A retrospective cross-sectional study was carried out on data derived from single 24 h urine collections from 246 male idiopathic calcium stone-formers. 2. The daily urine volume and pH and the exretions of calcium, oxalate, phosphate, creatinine and magnesium were related to the time of year when the urine was collected, and the saturation of urine with calcium oxalate and octocalcium phosphate calculated for each month. 3. There were significant seasonal variations in the urinary excretion of calcium and oxalate, each showing a maximum during the summer months and a minimum in the winter. There was no significant seasonal variation in urinary pH, volume, creatinine, phosphate or magnesium. 4. There was a significant increase in the saturation of urine with calcium oxalate and a trend towards higher saturation levels of octo-calcium phosphate in the summer. These changes were dependent only on the seasonal variation in urinary calcium and oxalate and not on urine volume. 5. A retrospective study of the seasonal incidence of stone episodes among these 246 stone-formers showed that the rate of stone passage per month was 50% higher in the summer than in the winter. There was no significant seasonal variation in the incidence of stones removed surgically.

Topics: Calcium; Creatinine; England; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Oxalates; Phosphates; Retrospective Studies; Seasons; Urinary Calculi; Urine

Topics: Calcium; Cystinuria; Glycosaminoglycans; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

A method is described for quantitatively determining the inhibitory activity of pure components, isolates, or mixtures of components (such as urine) on the growth of calcium oxalate crystals. Results with known calcium phosphate crystal growth inhibitors--magnesium, citrate, and pyrophosphate--suggest that these components contribute little to the ability to normal urine to inhibit the growth of calcium oxalate crystals. As yet unidentified urinary components seem to be responsible for most of this activity. The urinary crystal growth inhibitors appear to function by adsorbing on the surface of the growing crystals, thereby preventing the further incorporation of lattice ions. The fit of experimental data to the Langmuir absorption isotherm supports this conclusion.

Topics: Calcium; Chemical Phenomena; Chemistry, Physical; Citrates; Crystallization; Diphosphates; Humans; Ions; Magnesium; Oxalates; Urinary Calculi; Urine

Topics: Calcium; Calcium Phosphates; Female; Fluoridation; Humans; Male; Ohio; Oxalates; Retrospective Studies; Uric Acid; Urinary Calculi

Of patients with oxalate-containing calculi of the upper urinary tract who were surveyed for stone recurrences after an average of 4 years and 7 months, the relationship between the stone recurrence and the urinary excretion of stone components was studied. Seventy-one cases for urinary calcium and magnesium, 48 cases for phosphorus, 36 cases for oxalic acid, and 29 cases for uric acid were available for estimate. The urinary excretion of calcium, magnesium, phosphorus, and uric acid was the same for noncurrent patients as for recurrent patients. However, the ratio of magnesium to (calcium x oxalic acid) in the urine patients with oxalate stone recurrences was significantly lower than that in the urine of patients without recurrences.

Topics: Adult; Calcium; Female; Humans; Magnesium; Male; Oxalates; Phosphorus; Recurrence; Uric Acid; Urinary Calculi

Preoperative, operative and postoperative data from a sampling group of 435 ileal bypass patients have been tabulated and computer-analyzed. Genitourinary disorders other than stone disease have been insignificant. Patients with stones and those without stones have been compared and the significant data tabulated. The incidence of stone disease is 6 per cent. All but 1 stone consisted of calcium oxalate. Oxalate levels were normal preoperatively and elevated in 60 per cent postoperatively. The stone formers are among the heaviest members of the studied population, they have the greatest amount of ileum bypassed and the greatest amount of 1 year weight loss. Correlations between these observations and possible pathways of metabolic stone disease are made.

Topics: Body Weight; Calcium; Follow-Up Studies; Humans; Ileum; Intestine, Small; Jejunum; Obesity; Oxalates; Pyuria; Uric Acid; Urinary Calculi; Water-Electrolyte Balance

Seven hundred patients with 735 urinary calculi were studied for the compositions of calculi by infrared analysis and for stone recurrence. Of these 700 cases, 422 cases were possible to follow up, and 250 cases have had no further stone; 138 cases experience recurring stones, and 34 cases had multiple stones. The length of follow-up period was 1-19 years averaging 8 years, 8 months. 41.2% of patients with calcium oxalate-calcium phosphate calculi had stones recurrently, and although there was some variation of recurrence rates for patients with various proportions of oxalate to phosphate in the calculi, it was impossible to predict the tendency of recurrence by these proportions. The stone recurrence was noted in 38.6% of patients with magnesium ammonium phosphate calculi, in 38.9% with mixed magnesium ammonium phosphate-calcium oxalate calculi, in 55.6% with uric acid calculi, and in 50% with cystine calculi.

Topics: Adolescent; Adult; Aged; Calcium; Calcium Phosphates; Child; Child, Preschool; Female; Humans; Infrared Rays; Magnesium; Male; Middle Aged; Oxalates; Recurrence; Time Factors; Tokyo; Urinary Calculi

Five patients with jejunoileal shunt for morbid obesity in whom postshunt hyperoxaluria and recurrent urinary tract calculi developed are presented. All the stones were composed of calcium oxalate. The twenty-four hour urinary oxalic acid levels were also elevated in twenty of twenty-six patients who had had jejunoileal shunt for six months or longer. No correlation was present between urolithiasis and the degree of hyperoxaluria.

Topics: Adult; Calcium; Female; Humans; Intestine, Small; Male; Middle Aged; Obesity; Oxalates; Recurrence; Time Factors; Urinary Calculi

The kinetics of the crystal growth of calcium oxalate monohydrate has been studied using the technique of seeded crystal growth from stable supersaturated solution. The rate law takes the form minus dc/dt equals kN-2 in which the rate of loss of lattice ion from solution is proportional to the square of the supersaturation. It is proposed that the incorporation of lattice ions into the crystal is governed by a bimolecular surface-controlled reaction step. The rate is independent of the hydrodynamics of the system but is proportional to the solid to solution ratio in the supersaturated solution. The specific rate constant, k (M-minus-1 min-minus-1 [mg/dl]minus-1), is nearly independent of the solid to solution ratio, however. The rate of crystal growth was found not to vary with the calcium to oxalate molar ratio in the range 1.5 to 0.75, although the rate did increase at both higher and lower ratios. The method was found to be simple, rapid, and reproducible and lends itself to the quantitative study of inhibitors of crystal growth.

Topics: Calcium; Chemical Phenomena; Chemistry, Physical; Crystallization; Ion Exchange; Kinetics; Osmolar Concentration; Oxalates; Solubility; Urinary Calculi

Out of a group of 979 patients with urinary calculi, 175 had passed their stone(s). Comparison of data for stones which had been passed with data for the whole group shows many significant differences. Calculi composed entirely of calcium oxalate are more likely to be expelled than any other composition variety. The chance of this happening is 1 in 3 and it is even higher when the person is under 50 years of age. The probability of calculi composed of calcium oxalate+calcium phosphate being expelled is 1 in 5 and this also increases for younger patients. Infection stones consisting of calcium phosphate+struvite have only 1 in 19 chance of being passed. Many of the stones passed (130) are under 0.10 g in weight. However, there is a similar relationshp between composition and weight among both the stones that were passed and the whole group. In both groups, pure oxalate stones are the lightest, infection stones are the heaviest and stones composed of calcium phosphate and calcium phosphate+calcium oxalate are of intermediate weight.

Topics: Adolescent; Adult; Age Factors; Aged; Calcium Phosphates; Child; Child, Preschool; Female; Humans; Kidney Calculi; Male; Middle Aged; Oxalates; Sex Factors; Ureteral Calculi; Uric Acid; Urinary Calculi

On a few examples we show, which informations are given by optical investigations of microsections of calculi. Besides changes in the history of the production mainly the later changes of the already formed calculus are to be seen.

Topics: Calcium; Calcium Phosphates; Crystallization; Humans; Magnesium; Microscopy, Polarization; Oxalates; Phosphates; Quaternary Ammonium Compounds; Urinary Calculi

An analysis is made of 100 school children with recurrent urolithiasis treated during the last six years. The clinical findings and prognosis in this patient material are outlined. The incidence of recurrence was 23.7% in 421 patients.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cystine; Czechoslovakia; Female; Focal Infection; Humans; Kidney Failure, Chronic; Male; Metabolic Diseases; Oxalates; Phosphates; Recurrence; Sex Factors; Time Factors; Uric Acid; Urinary Calculi; Urinary Tract; Urinary Tract Infections

During the last six years 400 children with urolithiasis underwent a six weeks rehabilitation treatment in a specialized children's sanitorium for renal diseases. The clinical picture, course of the disease, etiology, complications and therapy are analyzed and discussed. Urolithiasis is surprisingly common in girls; it occurs commonly not until school age and recurrence occurs in one-fourth of the children. The importance of stone analysis for the therapy is outlined and the necessity of conservative renal surgery is emphasized.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cystine; Female; Focal Infection; Humans; Infant; Kidney Failure, Chronic; Male; Metabolic Diseases; Nephrectomy; Oxalates; Phosphates; Recurrence; Sex Factors; Uric Acid; Urinary Calculi; Urinary Tract; Urinary Tract Infections

Of 93 patients with small bowel bypass for massive exogenous obesity, three developed calcium oxalate urinary calculi, four stones in their gallbladder, and one developed both gallstones and urinary calculi during a mean follow-up period of 17.6 plus or minus 9.0 months. The urinary oxalate excretion increased from 21.6 to 67.8 mg/24 hours (P smaller than .001); simultaneously, the urinary output decreased from 1,775 to 1,101 ml/24 hours (P smaller than .001). Postoperatively, there was a significant increase in the rate of bile salt synthesis from 1.6 to 4.9 gm/day (P smaller than .02) and in the bile sale glycine/taurine ratio from 4.6 to 6.8 (P smaller than .05). It is suggested that the postbypass increase in the biliary glycine/taurine ratio, with its consequent decrease in the zeta potential of the micelles in bile, is at least partly responsible for the increased incidence of cholelithlasis. The pathogenic basis for the increased incidence of urinary calculi is hyperoxaluria, which is probably related to an increased bile salt and glycine synthesis.

Topics: Adult; Bile; Bile Acids and Salts; Calcium; Cholelithiasis; Follow-Up Studies; Glycine; Humans; Intestine, Small; Middle Aged; Obesity; Oxalates; Postoperative Complications; Taurine; Urinary Calculi

Topics: Bile Acids and Salts; Calcium; Crohn Disease; Glycine; Glyoxylates; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Oxalates; Urinary Calculi

Topics: Humans; Methods; Oxalates; Urinary Calculi

Topics: Acidosis, Renal Tubular; Acute Disease; Analgesics; Calcium; Chronic Disease; Cystinuria; Female; Humans; Hyperparathyroidism; Infrared Rays; Kidney Calculi; Male; Oxalates; Radiography; Spectrum Analysis; Ureteral Calculi; Urinary Calculi; Urinary Tract Infections; X-Ray Diffraction

Oxalate urolithiasis in male rats was experimentally induced by feeding a basal diet composed of Purina laboratory chow and 3 per cent glycolic acid. When this basal oxalate calculus-producing diet containing 10 per cent alanine was fed to rats, the incidence of oxalate urolithiasis was markedly reduced. Moreover, when Purina laboratory chow containing 10 per cent alanine was fed to rats which had been on the calculi-producing basal diet for 4 weeks, it appeared that most uroliths were dissolved. Excess intake of alanine increased the concentration of alanine in urine and this apparently aided in the prevention and treatment of urolithiasis.

Topics: Administration, Oral; Alanine; Animals; Calcium; Glycolates; Kidney; Male; Oxalates; Rats; Urinary Calculi

An increase in the average calcium oxalate content and decrease in average calcium phosphate content of stones received for analysis has been noted in a 9-year study. These changes appear to be due to a progressive increase in the number of patients with noninfected upper urinary tract stone and to the gradual elimination of phosphatic stones as a result of improved diagnosis and treatment. Some of the conditions associated with calcium phosphate stones are examined, particularly primary hyperparathyroidism, renal tubular acidosis, and medullary sponge kidney. These results further emphasize the importance of calcium oxalate in idiopathic stone disease and the need for a fuller understanding of the factors influencing calcium oxalate crystallization.

Topics: Acidosis, Renal Tubular; Calcium; Female; Humans; Hydroxyapatites; Hyperparathyroidism; Magnesium; Male; Medullary Sponge Kidney; Oxalates; Phosphates; Quaternary Ammonium Compounds; Retrospective Studies; Sex Factors; United Kingdom; Urinary Calculi

Chemical kinetic data, complemented with scanning electron-microscope observations of the crystalline phase, show that seed crystals of hydroxyapatite have the ability to induce the growth of calcium oxalate monohydrate crystals epitaxially from a metastable supersaturated solution of calcium oxalate. The rate of growth of calcium oxalate crystals is dependent on the surface area of the seed material and follows a second-order rate law. It is suggested that there may be a causal relationship between the occurrence of apatite crystals in the urinary tract and the formation of both 'pure' and mixed urinary stones containing calcium oxalate. Under similar experimental conditions, however, seed crystals of calcium oxalate monohydrate appeared unable to induce epitaxially the growth of calcium phosphate crystals from a supersaturated calcium phosphate solution, indicating the absence of an epitaxial relationship between calcium oxalate monohydrate and the initially precipitating calcium phosphate phase(s).

Topics: Calcium; Calcium Phosphates; Crystallization; Hydroxyapatites; In Vitro Techniques; Oxalates; Urinary Calculi

Topics: Adult; Aged; Calcium; Child; Child, Preschool; Crystallization; Female; Humans; Male; Oxalates; Urinary Calculi

Topics: Administration, Oral; Calcium; Circadian Rhythm; Humans; Magnesium; Oxalates; Urinary Calculi; Vegetables

The 'effect of Herbst' was combined with the production of renal calcium oxalate sediments by oral administration of ethyleneglycol and acidification with NH4Cl. This investigation was made to see whether persorbed bodies may form nuclei in crystallization in the genesis of stone. Lead sulphide crystals and 45Ca-labelled calcium oxalate crystals were used as persorbable model bodies. It became apparent that lead sulphide crystals given by mouth could be found both in the urine and kidneys, but these did not form nuclei in calcium oxalate sediments. Radioactive-labelled calcium, however, could be proved histoautoradiographically within the renal concretions. Our experiments showed that persorbed calcium oxalate crystals can represent nuclei for stone formation.

Topics: Ammonium Chloride; Animals; Calcium; Ethylene Glycols; Intestinal Absorption; Kidney; Lead; Male; Oxalates; Rats; Sulfides; Urinary Calculi

Topics: Adolescent; Adult; Aged; Allopurinol; Female; Humans; Male; Middle Aged; Oxalates; Recurrence; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

Topics: Allopurinol; Calcium; Humans; Kidney; Long-Term Care; Oxalates; Uric Acid; Urinary Calculi

Topics: Calcium; Crystallization; Crystallography; Diet; Ethanol; Glycosaminoglycans; Humans; Kidney Calculi; Organophosphonates; Organophosphorus Compounds; Oxalates; Urinary Calculi

Topics: Adult; Calcium; Depression, Chemical; Diphosphates; Humans; Middle Aged; Organophosphonates; Oxalates; Phosphates; Time Factors; Urinary Calculi

Topics: Animals; Australia; Calcium; Calcium Carbonate; Cattle; Cattle Diseases; Disease Outbreaks; Electron Probe Microanalysis; Magnesium; Male; Microscopy, Polarization; Oxalates; Phosphorus; Sheep; Sheep Diseases; Silicon Dioxide; Urinary Calculi

Topics: Acidosis, Renal Tubular; Adrenal Gland Diseases; Adrenal Glands; Adrenalectomy; Calcium; Female; Humans; Hyperaldosteronism; Hypokalemia; Middle Aged; Nephrocalcinosis; Oxalates; Phosphates; Potassium; Recurrence; Sodium; Urinary Calculi

Topics: Alanine; Calcium; Calcium Phosphates; Diet; Dimethyl Sulfoxide; Hydrogen-Ion Concentration; Kinetics; Magnesium; Oxalates; Phosphates; Solubility; Spectrophotometry, Atomic; Urinary Calculi

Topics: Calcium; Calcium Phosphates; Drug Therapy, Combination; Humans; Magnesium Oxide; Oxalates; Pyridoxine; Recurrence; Urinary Calculi

Topics: Adult; Calcium; Colitis, Ulcerative; Creatinine; Crohn Disease; Electrolytes; Female; Humans; Ileum; Magnesium; Male; Oxalates; Prospective Studies; Statistics as Topic; Time Factors; Uric Acid; Urinary Calculi; Urography

Topics: Adolescent; Bone Diseases; Calcinosis; Calcium; Humans; Hydroxyapatites; Hyperparathyroidism, Secondary; Kidney Diseases; Male; Metabolic Diseases; Oxalates; Urinary Calculi; Urography

Topics: Calcium; Creatinine; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Oxalates; Phosphates; Urea; Uric Acid; Urinary Calculi; Water-Electrolyte Balance

Topics: Apatites; Cystine; Humans; Microscopy, Electron, Scanning; Minerals; Oxalates; Phosphates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Adolescent; Ammonia; Calcium; Calcium Phosphates; Child; Female; Follow-Up Studies; Humans; Kidney; Magnesium; Male; Oxalates; Phosphates; Ureter; Uric Acid; Urinary Calculi

Topics: Adult; Female; Humans; Male; Oxalates; Phosphates; Urinary Calculi

Topics: Calcium; Crystallography; Cystine; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Calcium; Carbon Radioisotopes; Chemical Precipitation; Crystallization; Humans; Kinetics; Methods; Oxalates; Urinary Calculi

Topics: Adult; Aged; Calcium; Calcium Phosphates; Crystallization; Cystine; Female; Humans; Israel; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Aged; Calcium; Cystinuria; Female; Humans; Hypercalcemia; Hyperglycemia; Male; Metabolic Diseases; Middle Aged; New Zealand; Oxalates; Phosphates; Prospective Studies; Radiography; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Adolescent; Age Factors; Calcium; Calcium Phosphates; Child; Child, Preschool; Female; Humans; Infant; Male; Oxalates; Sex Factors; Urinary Calculi; Urinary Tract Infections

Topics: Adult; Age Factors; Apatites; Asia; Calcium; Carbonates; Child; Child, Preschool; England; Europe; Female; History, 18th Century; History, 19th Century; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Quaternary Ammonium Compounds; Sex Factors; United States; Uric Acid; Urinary Calculi

Topics: Alanine; Animals; Anura; Dogs; Female; Foreign-Body Reaction; Glomerular Filtration Rate; Humans; Hypoparathyroidism; Magnesium Deficiency; Nutritional Physiological Phenomena; Oxalates; Rabbits; Rats; Solvents; Ultrasonic Therapy; Urinary Calculi

Topics: Adult; Calcium; Cholestyramine Resin; Diarrhea; Diet; Diet Therapy; Diet, Reducing; Female; Humans; Intestine, Small; Kidney Calculi; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications; Radiography; Taurine; Urinary Calculi

Topics: Calcium; Diet; Female; Humans; Male; New Zealand; Oxalates; Phosphates; Urinary Calculi

Topics: Adult; Age Factors; Calcium; Child; Ethnicity; Female; Humans; Hyperparathyroidism; Magnesium; Male; Medullary Sponge Kidney; Oxalates; Phosphorus; Quaternary Ammonium Compounds; Sex Factors; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Apatites; Calcium; Carbonates; Child; Child, Preschool; England; Female; Humans; Male; Middle Aged; Naval Medicine; Oxalates; Scotland; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Bile Acids and Salts; Carbon Dioxide; Carbon Radioisotopes; Cholestyramine Resin; Female; Glycine; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Intestines; Middle Aged; Oxalates; Postoperative Complications; Syndrome; Urinary Calculi

Topics: Adult; Calcium; Citrates; Crohn Disease; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Oxalates; Solubility; Urinary Calculi

Topics: Calcium; Methods; Oxalates; Phosphates; Urinary Calculi; Urine

Topics: Administration, Oral; Alanine; Amino Acids; Animals; Body Weight; Chromatography, Gas; Female; Glycolates; Kidney; Kidney Cortex; Kidney Medulla; Kidney Pelvis; Male; Oxalates; Phosphates; Pyridoxine; Rats; Sex Factors; Time Factors; Ureter; Urinary Calculi

Topics: Adult; Apatites; Calcium; Calcium Phosphates; Cystine; Disease Reservoirs; Female; Humans; Magnesium; Male; Middle Aged; Northern Ireland; Oxalates; Sex Factors; Social Class; United Kingdom; Uric Acid; Urinary Calculi

Topics: Blood Urea Nitrogen; Calcium; Creatinine; Diet; Female; Humans; Male; Middle Aged; Oxalates; Phosphorus; Purines; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Calcium; Child; Child, Preschool; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Quaternary Ammonium Compounds; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Female; Germany, East; Humans; Infant; Male; Middle Aged; Oxalates; Phosphoric Monoester Hydrolases; Sex Factors; Urinary Calculi

Topics: Glycine; Humans; Male; Naval Medicine; Oxalates; Pyridoxine; Urinary Calculi

Topics: Adolescent; Adult; Aged; Apatites; Bacterial Infections; Bacteriological Techniques; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Klebsiella Infections; Male; Middle Aged; Oxalates; Proteus Infections; Proteus mirabilis; Pseudomonas Infections; Recurrence; Staphylococcal Infections; Urease; Urinary Calculi; Urinary Catheterization; Urinary Tract Infections

Topics: Animals; Diet; Humans; Oxalates; Rats; Tyrosine; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Adult; Aged; Cadmium; Copper; Female; Humans; Iron; Lead; Male; Middle Aged; Oxalates; Trace Elements; Urinary Calculi; Zinc

Topics: Calcium; Child; Child, Preschool; Cystine; Female; Humans; Infant; Male; Oxalates; Phosphates; Sex Factors; Urinary Calculi; Urinary Tract Infections

Topics: Adolescent; Adult; Calcium; Creatinine; Female; Humans; Male; Middle Aged; Osmolar Concentration; Oxalates; Spectrophotometry, Atomic; Urinary Calculi; Zinc

Topics: Calcium; Kinetics; Mathematics; Methods; Models, Biological; Oxalates; Solubility; Spectrophotometry, Atomic; Temperature; Urinary Calculi; X-Ray Diffraction

Topics: Administration, Oral; Adolescent; Adult; Aged; Bacteria; Bile; Bile Acids and Salts; Carbon Dioxide; Carbon Isotopes; Colon; Glycine; Glyoxylates; Humans; Ileum; Injections, Intravenous; Intestinal Absorption; Intestinal Diseases; Middle Aged; Oxalates; Respiration; Spirometry; Urinary Calculi

Topics: Gout; Humans; Oxalates; Uric Acid; Urinary Calculi

Topics: Adult; Allopurinol; Calcium; Gout; Humans; Male; Oxalates; Urinary Calculi

Topics: Cystine; Diet Therapy; Diuretics; Exercise Therapy; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Absorptiometry, Photon; Apatites; Calcium; Calcium Phosphates; Cystine; Humans; Oxalates; Physical Phenomena; Physics; Uric Acid; Urinary Calculi; Water

Topics: Adult; Humans; India; Kidney Calculi; Oxalates; Phosphates; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; X-Ray Diffraction

Topics: Cystine; Humans; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi; Water; X-Ray Diffraction; Xanthines

Topics: Apatites; Calcium; Calcium Phosphates; Chemical Phenomena; Chemistry; Cystine; Hot Temperature; Humans; Hydrogen; Magnesium; Oxalates; Phosphates; Proteins; Quaternary Ammonium Compounds; Sodium; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi; X-Ray Diffraction; Xanthines

Topics: Calcium; Calcium Chloride; Chemical Phenomena; Chemistry; Humans; Oxalates; Sodium; Sodium Chloride; Solubility; Temperature; Urinary Calculi

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Female; Hematuria; Hospitalization; Humans; Infant; Iran; Kidney Calculi; Male; Oxalates; Rectal Prolapse; Sex Factors; Socioeconomic Factors; Ureteral Calculi; Urinary Bladder Calculi; Urinary Calculi

Topics: Calcium Phosphates; Citrates; Fungi; Glucuronates; In Vitro Techniques; Methods; Oxalates; Solubility; Solutions; Urinary Calculi

Topics: Apatites; Humans; Methods; Oxalates; Phosphates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Calcium; Histocytochemistry; Humans; Methods; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Autopsy; Child; Female; Humans; Metabolism, Inborn Errors; Oxalates; Urinary Calculi

Topics: Humans; Methods; Oxalates; Phosphates; Photometry; Urinary Calculi

Topics: Animals; Calcium; Cattle; Cattle Diseases; Crystallization; Magnesium; Microscopy, Electron, Scanning; Oxalates; Phosphorus; Silicon Dioxide; Spectrophotometry, Atomic; Urinary Calculi

Topics: Adult; Age Factors; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; MMPI; Neurocognitive Disorders; Neurotic Disorders; Oxalates; Phosphates; Sex Factors; Uric Acid; Urinary Calculi

Topics: Calcium; Crystallography; Humidity; Infrared Rays; Models, Structural; Oxalates; Spectrum Analysis; Urinary Calculi; Water; X-Ray Diffraction

Topics: Adolescent; Adult; Aged; Apatites; Calcium; Carbonates; Chemistry Techniques, Analytical; Child; Cystine; Evaluation Studies as Topic; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Proteins; Quaternary Ammonium Compounds; Spectrophotometry, Infrared; Uric Acid; Urinary Calculi

Topics: Amides; Animals; Diet; Female; Humans; Ischemia; Kidney; Kidney Diseases; Magnesium; Male; Oxalates; Rabbits; Time Factors; Urinary Calculi

Topics: Calcium; Humans; Oxalates; Phosphates; Urinary Calculi

Topics: Calcium; Cyanates; Humans; Hydroxyapatites; Oxalates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Alginates; Allopurinol; Calcium; Diet Therapy; Diuretics; Female; Humans; Ion Exchange Resins; Magnesium; Male; Methylene Blue; Oxalates; Phosphates; Pyridoxine; Sodium; Urinary Calculi

Topics: Ammonia; Calcium; Carbonates; Crystallization; Humans; Hydrogen-Ion Concentration; Magnesium; Models, Chemical; Oxalates; Phosphates; Potassium; Sodium; Solubility; Specific Gravity; Urate Oxidase; Uric Acid; Urinary Calculi; Urine; Water

Topics: Calcium; Calcium Phosphates; Electron Probe Microanalysis; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Oxalates; Urinary Calculi; X-Ray Diffraction

Topics: Adolescent; Adult; Aged; Apatites; Calcium Phosphates; Child; Child, Preschool; Female; Humans; Kuwait; Male; Middle Aged; Northern Ireland; Oxalates; Quaternary Ammonium Compounds; South Africa; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Administration, Oral; Allopurinol; Cystine; Humans; Magnesium; Oxalates; Penicillamine; Phosphates; Pyridoxine; Quaternary Ammonium Compounds; Urinary Calculi

Topics: Adult; Calcium; Calcium Isotopes; Calcium, Dietary; Diet Therapy; Humans; Kidney Tubules; Male; Oxalates; Purines; Pyrazinamide; Renal Tubular Transport, Inborn Errors; Uric Acid; Urinary Calculi

Topics: Animals; Calcium; Calcium Phosphates; Chemical Precipitation; Ethanol; Female; Magnesium; Organophosphonates; Oxalates; Phosphates; Quaternary Ammonium Compounds; Rats; Urinary Bladder Calculi; Urinary Calculi; Zinc

Topics: Calcium; Crystallization; Mathematics; Methods; Models, Structural; Oxalates; Photomicrography; Urinary Calculi; Urinary Tract; Urinary Tract Physiological Phenomena

Topics: Adult; Calcium; Humans; Kidney Concentrating Ability; Magnesium; Male; Middle Aged; Osmolar Concentration; Oxalates; Urinary Calculi

Topics: Acidosis, Renal Tubular; Calcium; Child; Cystinuria; Female; Hematuria; Humans; Male; Metabolic Diseases; Oxalates; Parathyroid Neoplasms; Retrospective Studies; Ureteral Obstruction; Uric Acid; Urinary Calculi; Urinary Tract Infections; Urography

Topics: Apatites; Calcium; Calcium Phosphates; Crystallization; Cystine; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Uric Acid; Urinary Calculi; X-Ray Diffraction; Xanthines

Topics: Adult; Animals; Female; Fluorescent Antibody Technique; Glycosaminoglycans; Humans; Injections, Intramuscular; Kidney; Male; Middle Aged; Oxalates; Phosphates; Rabbits; Urinary Calculi

Topics: Imides; Oxalates; Succinates; Time Factors; Urinary Calculi

Topics: Calcium Phosphates; Calculi; Cystine; Humans; Infrared Rays; Male; Methods; Oxalates; Phosphates; Prostatic Diseases; Proteins; Spectrum Analysis; Uric Acid; Urinary Calculi; Xanthines

Topics: Adolescent; Adult; Calcium; Female; Humans; Magnesium; Male; Middle Aged; Osmotic Pressure; Oxalates; Phosphorus; Urinary Calculi

Topics: Carbonates; Humans; Kidney Tubules; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Xanthine Oxidase

Topics: Acids; Amino Acids; Animals; Calcium; Chromatography, Paper; Citrates; Coenzyme A; Folic Acid Deficiency; Hippurates; Humans; Hydroxyproline; Ketoglutaric Acids; Kynurenic Acid; Male; Oxalates; Pyridoxine; Pyruvates; Rats; Tryptophan; Tyrosine; Urinary Calculi; Vitamin B 6 Deficiency; Xanthurenates

Topics: Adult; Aged; Calcium; Diet Therapy; Female; Humans; Hydrochlorothiazide; Kidney; Male; Middle Aged; Oxalates; Time Factors; Urinary Calculi; Water-Electrolyte Balance

Topics: Adult; Calcium; Calcium Phosphates; Child; Humans; Hydrogen-Ion Concentration; Male; Mucoproteins; Nutrition Disorders; Oxalates; Pakistan; Urinary Calculi

Topics: Calcium; Calcium Phosphates; Chemical Precipitation; Crystallization; Humans; Hydrogen-Ion Concentration; Oxalates; Solubility; Urinary Calculi

Topics: Adolescent; Adult; Alcohol Oxidoreductases; Child; Glycolates; Glyoxylates; Humans; Kidney; Ligases; Liver; Metabolism, Inborn Errors; Nephrocalcinosis; Oxalates; Oxidoreductases; Urinary Calculi; Vitamin B 6 Deficiency; Xanthine Oxidase

Topics: Calcium; Humans; Oxalates; Phosphates; Solubility; Thailand; Urinary Bladder Calculi; Urinary Calculi

Topics: Calcium; Chemical Phenomena; Chemistry; Humans; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Salts; Uric Acid; Urinary Calculi

Topics: Calcium; Chromatography, Thin Layer; Colorimetry; Humans; Magnesium; Methods; Microchemistry; Oxalates; Uric Acid; Urinary Calculi

Topics: Administration, Oral; Humans; Oxalates; Phosphates; Pyrophosphatases; Urinary Calculi

Topics: Bicarbonates; Calcium; Diuresis; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Urinary Calculi; Urine

Topics: Calcium; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Calcium; Child; Female; Humans; Kidney Calculi; Male; Middle Aged; Oxalates; Pyrrolidinones; Succinimides; Time Factors; Urinary Calculi

Topics: Calcium; Humans; Kidney Calculi; Microscopy, Polarization; Oxalates; Phosphates; Pyelonephritis; Urinary Calculi

Topics: Calcium; Cystine; Humans; Magnesium; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Xanthines

Topics: Calcium; Humans; Lithium; Oxalates; Phosphates; Photometry; Urinary Calculi

Topics: Adult; Blood Proteins; Calcium; Child; Child, Preschool; Creatinine; Diet; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Male; Mucoproteins; Oxalates; Phosphates; Quaternary Ammonium Compounds; Uric Acid; Urinary Calculi; Urine; Vitamin A Deficiency

Topics: Animals; Ascorbic Acid; Chickens; Diabetes Mellitus; False Positive Reactions; Female; Fetal Death; Fetus; Glycosuria; Guinea Pigs; Humans; Oxalates; Phosphates; Pregnancy; Rats; Urinary Calculi

A better understanding of the physico-chemical principles underlying the formation of calculus has led to a need for more precise information on the chemical composition of stones. A combined qualitative and quantitative procedure for the chemical analysis of urinary calculi which is suitable for routine use is presented. The procedure involves five simple qualitative tests followed by the quantitative determination of calcium, magnesium, inorganic phosphate, and oxalate. These data are used to calculate the composition of the stone in terms of calcium oxalate, apatite, and magnesium ammonium phosphate. Analytical results and derived values for five representative types of calculi are presented.

Topics: Apatites; Calcium; Humans; Magnesium; Methods; Oxalates; Phosphates; Quaternary Ammonium Compounds; Uric Acid; Urinary Calculi

Topics: Diuresis; Humans; Oxalates; Urinary Calculi

Topics: Adult; Aged; Apatites; Calcium Phosphates; Cystine; Female; Humans; Hydroxyapatites; Kidney Calculi; Male; Middle Aged; Oxalates; Scotland; Sudan; United States; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Child; Crystallization; Cystine; Female; Humans; Male; Methods; Microscopy, Polarization; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Cholesterol; Cystine; Humans; Magnesium; Oxalates; Phosphates; Prognosis; Uric Acid; Urinary Calculi

Topics: Calcium; Carbonates; Humans; Kidney Calculi; Kidney Pelvis; Magnesium; Oxalates; Phosphates; Quaternary Ammonium Compounds; Sex Factors; Ureteral Calculi; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; X-Ray Diffraction

Topics: Animals; Apatites; Cystine; Cytoplasm; Histocytochemistry; Humans; Microscopy, Electron; Oxalates; Phosphates; Rats; Specific Gravity; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Acrylates; Azides; Benzoates; Calcium; Coloring Agents; Creatinine; Crystallization; Diphosphates; Glycolates; Hippurates; Humans; Metals; Oxalates; Phenylacetates; Urinary Calculi; Vitamins; Zinc

Topics: Adult; Aldehydes; Amino Acids; Amino Alcohols; Animals; Calcium; Carbon Isotopes; Child; Chromatography, Ion Exchange; Female; Glycolates; Glycols; Haplorhini; Humans; Hypercalcemia; Imines; L-Lactate Dehydrogenase; Male; Methylene Blue; Oxalates; Uric Acid; Urinary Calculi

Topics: Adolescent; Aged; Child, Preschool; Cystoscopy; Electric Stimulation Therapy; Electronics, Medical; Female; Humans; Male; Methods; Middle Aged; Oxalates; Phosphates; Radiography; Urea; Urinary Bladder Calculi; Urinary Calculi

Topics: Animals; Body Weight; Calcium; Castration; Citrates; Female; Kidney Calculi; Liver; Magnesium; Male; Nutritional Requirements; Oxalates; Pyridoxine; Sex Factors; Time Factors; Ureteral Calculi; Urinary Bladder Calculi; Urinary Calculi; Vitamin B 6 Deficiency; Xanthurenates

A relationship between crystallographic structure and morphological form of calcium oxalates in urinary sediments is established. The common tetragonal bipyramids have been confirmed as weddellite from their electron diffraction patterns. Other solid forms, such as needles, biconcave disks, and dumbbell forms, that can appear in hyperoxalurias, of both metabolic and alimentary origin, have been identified as whewellite. Micrographs reveal fibrous structure on those whewellite polycrystalline aggregates.

Topics: Calcium; Crystallography; Electrons; Humans; Microscopy, Electron; Oxalates; Urinary Calculi

Topics: Adult; Apatites; Calcium Phosphates; Child; Czechoslovakia; England; Female; Humans; Male; Oxalates; Thailand; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Calcium; Crystallization; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphates; Uric Acid; Urinary Calculi

Topics: Administration, Oral; Adolescent; Adult; Child; Crystallization; Female; Humans; Male; Metabolism, Inborn Errors; Methylene Blue; Oxalates; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Aged; Calcium; Feedback; Female; Homeostasis; Humans; Hypercalcemia; Hyperparathyroidism; Male; Middle Aged; Oxalates; Phosphorus; Urinary Calculi

Topics: Calcium; Disease Susceptibility; Humans; Hyperparathyroidism; Oxalates; Urinary Calculi

Topics: Acrylates; Aluminum; Chelating Agents; Chemical Phenomena; Chemistry; Coloring Agents; Crystallization; Diphosphates; Magnesium Oxide; Oxalates; Pyridoxine; Surface-Active Agents; Urinary Calculi

Topics: Calcium; Crystallization; Diphosphates; Humans; Hydrogen-Ion Concentration; Magnesium; Metabolic Clearance Rate; Oxalates; Phosphates; Secondary Prevention; Uric Acid; Urinary Calculi

Topics: Amino Acids; Calcium Phosphates; Hexosamines; Humans; Magnesium; Oxalates; Phosphates; Proteins; Urinary Calculi

Topics: Adult; Aged; Female; Fluoridation; Fluorine; Humans; Male; Middle Aged; Oxalates; Uric Acid; Urinary Calculi

Topics: Calcium Carbonate; Calcium Phosphates; Chemistry Techniques, Analytical; Citrates; Humans; Oxalates; Uric Acid; Urinary Calculi

Topics: Ambulatory Care; Diet; Germany, East; Humans; Male; Middle Aged; Mineral Waters; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urography

Topics: Body Weight; Bone Resorption; Calcium; Casts, Surgical; Diet Therapy; Feces; Humans; Immobilization; Male; Nitrogen; Oxalates; Paraplegia; Phosphates; Urinary Calculi

Topics: Adult; Apatites; Calcium; Calcium Phosphates; Female; Humans; Magnesium; Male; Oxalates; Phosphates; Quaternary Ammonium Compounds; Sex Factors; Sodium; Spectrophotometry; Urinary Calculi; Urinary Tract Infections; Water

Topics: Amino Acids; Calcium Metabolism Disorders; Carbohydrate Metabolism; Diet Therapy; Drug Therapy; Humans; Infections; Metabolic Diseases; Oxalates; Uric Acid; Urinary Calculi

Topics: Ammonium Chloride; Animals; Bicarbonates; Calcium; Diet Therapy; Glycols; Hydrogen-Ion Concentration; Kidney Calculi; Magnesium; Oxalates; Rats; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Calcium; Humans; Oxalates; Urinary Calculi

Topics: Acrylates; Adult; Arsenicals; Calcium; Calcium Phosphates; Chemical Precipitation; Chromatography, Gel; Chromatography, Ion Exchange; Conductometry; Densitometry; Dextrans; Humans; Hydrogen-Ion Concentration; Male; Medullary Sponge Kidney; Methods; Middle Aged; Oxalates; Peptides; Urinary Calculi; Urine

Topics: Adolescent; Adult; Animals; Humans; Male; Middle Aged; Oxalates; Pyridoxine; Rats; Thiamine; Urinary Calculi; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Calcium Carbonate; Calcium Phosphates; Child; Female; Humans; Infant, Newborn; Male; Middle Aged; Oxalates; Spectrophotometry; Uric Acid; Urinary Calculi

Topics: Animals; Formates; Glyoxylates; Male; Oxalates; Thiamine Deficiency; Urinary Calculi

Topics: Apatites; Calcium; Crystallography; Cystine; Humans; Magnesium; Microscopy, Polarization; Oxalates; Phosphates; Silicon Dioxide; Uric Acid; Urinary Calculi; X-Ray Diffraction; Xanthines

X-ray diffraction studies have shown that there are several different kinds of human urinary calculi, with different age, sex, period, and geographical distributions. Juvenile bladder stones are typically urate and oxalate in small boys in certain stone belts. They have disappeared in some areas, particularly in Britain, but are still common in Thailand. India. and Turkey. Their cause is unknown. Adult bladder stones, formerly common in elderly men, were largely of uric acid and were due to a faulty diet. Juvenile kidney stones are rare, except in Turkey where they are similar to juvenile bladder stones. Adult kidney stones are by far the most universally common, especially in technically developed communities. They are found in both sexes (equally at postmortem), and in the United States and in Czechoslovakia the average number of hospital entries for stones, relative to the whole population, is about 1 per 1000 per annum (increasing) although the incidence in different districts varies by 4 to 1 or more. Such stones are mainly calcium oxalates and calcium and MgNH(4) phosphates. The incidence among the administrative class is at least 20 times that among agricultural workers, relative to their numbers. Stones are reported also to be an occupational hazard for air pilots. It is probably that much more exercise and the drinking of more water to prevent kidney dehydration (spirits and coffee are not effective for this purpose) would lower the high rate of incidence. Moderate acidification would prevent phosphate supersaturation of the urine, but is not effective for oxalates. It seems certain that, once a suitable seed is formed, epitaxy is largely responsible for deposition from urines that would otherwise remain supersaturated until voided. This would explain the curioLls radial and layered texture of many stones. Laboratory experiments might suggest ways of preventing orientated overgrowth.

Topics: Calcium Phosphates; Calculi; Crystallization; Czechoslovakia; History, 18th Century; History, 19th Century; History, 20th Century; Humans; India; Italy; Kidney Calculi; Occupational Diseases; Oxalates; Spain; Thailand; Turkey; United Kingdom; Ureteral Calculi; Ureteral Obstruction; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; X-Ray Diffraction; Zimbabwe

Topics: Adult; Aged; Cystine; Electrolytes; Female; Humans; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi; Urography

Topics: Calcium; Female; Humans; Male; Oxalates; Uric Acid; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Adolescent; Adult; Aged; Child; England; Female; Humans; Male; Middle Aged; Oxalates; Phosphates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Africa; Asia; Calcium; Child; Diet; Humans; Kidney Calculi; Oxalates; Racial Groups; United Kingdom; United States; Urinary Bladder Calculi; Urinary Calculi

Topics: Adolescent; Adult; Age Factors; Aged; Apatites; Calcium Phosphates; Child; Child, Preschool; Cystine; Czechoslovakia; England; Female; Humans; Hydroxyapatites; India; Indonesia; Infant; Kidney Calculi; Male; Middle Aged; Minerals; Oxalates; Sex Factors; Spain; Thailand; Turkey; Ureteral Calculi; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; X-Ray Diffraction

Topics: Adult; Aged; Anti-Bacterial Agents; Calcium; Humans; Magnesium; Male; Middle Aged; Oxalates; Phosphates; Phosphorus; Urinary Calculi

Topics: Calcium; Humans; Hydrogen-Ion Concentration; Kidney Calculi; Oxalates; Uric Acid; Urinary Calculi

Topics: Animals; Apatites; Calcium; Crystallization; Humans; Molecular Weight; Oxalates; Phosphates; Proteinuria; Pyelonephritis; Uric Acid; Urinary Calculi

Topics: Adult; Animals; Calcium; Calcium Carbonate; Calcium Phosphates; Cattle; Chemistry Techniques, Analytical; Humans; Magnesium; Oxalates; Pancreas; Phosphates; Thermodynamics; Urinary Calculi

Topics: Gout; Humans; Hydrogen-Ion Concentration; Oxalates; Phosphorus; Urea; Uric Acid; Urinary Calculi

Topics: Calcium; Cystine; Female; Humans; Male; Methods; Oxalates; Phosphorus; Polarography; Sex Factors; Urinary Calculi

Topics: Animals; Cat Diseases; Cats; Oxalates; Urinary Calculi

Topics: Aluminum; Calcium; Copper; Humans; Iron; Oxalates; Solubility; Trace Elements; Urinary Calculi; Zinc

Topics: Cadmium; Calcium; Crystallization; Humans; Iron; Lead; Manganese; Mercury; Nickel; Oxalates; Photomicrography; Tin; Trace Elements; Urinary Calculi; Vanadium

Topics: Animals; Calcium Phosphates; Humans; Kidney; Oxalates; Rabbits; Rats; Urinary Calculi

Topics: Adult; Calcium Phosphates; Humans; Infrared Rays; Kidney Tubules; Kidneys, Artificial; Oxalates; Spectrophotometry; Uremia; Urinary Calculi

Topics: Humans; Male; Oxalates; Urinary Calculi

Topics: Cystine; Humans; Oxalates; Phosphates; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Calcium; Calcium Phosphates; Cystine; Humans; Magnesium; Methods; Oxalates; Phosphates; Phosphorus; Quaternary Ammonium Compounds; Spectrum Analysis; Sulfur; Uric Acid; Urinary Calculi

Topics: Humans; Male; Oxalates; Phosphates; Urinary Calculi

Topics: Adolescent; Disulfiram; Humans; Male; Metabolic Diseases; Oxalates; Urinary Calculi

Topics: Calcium; Calcium Carbonate; Calcium Phosphates; Cystine; Humans; Infrared Rays; Magnesium; Oxalates; Quaternary Ammonium Compounds; Spectrum Analysis; Uric Acid; Urinary Calculi; Xanthines

Topics: Acetates; Acetone; Adult; Animals; Calcium; Child, Preschool; Citrates; Citric Acid Cycle; Estrogens; Female; Humans; Infant, Newborn; Kidney Function Tests; Male; Oxalates; Rats; Solubility; Testosterone; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Female; Humans; Kidney Function Tests; Male; Oxalates; Urinary Calculi

Topics: Calcium; Calcium Phosphates; Citrates; Diphosphates; Humans; Indicators and Reagents; Magnesium; Oxalates; Phosphates; Urinary Calculi

Topics: Cystine; Female; Humans; Male; Oxalates; Urinary Calculi

Topics: Animals; Ascorbic Acid; Humans; In Vitro Techniques; Oxalates; Rats; Urinary Calculi; Urine

Topics: Calcium; Citrates; Humans; Magnesium; Metabolic Diseases; Oxalates; Pyridoxine; Urinary Calculi

Topics: Animals; Cricetinae; Crystallization; Guinea Pigs; Humans; Kidney Calculi; Oxalates; Rabbits; Urinary Calculi

Topics: Aged; Citrates; Female; Humans; Kidney; Male; Oxalates; Radiography; Solubility; Uric Acid; Urinary Calculi; Urinary Tract Infections

Topics: Amino Acids; Calcium; Calcium Oxalate; Calcium, Dietary; Oxalates; Research; Solubility; Spectrophotometry; Urinary Calculi; Urine

Topics: Calcium; Calcium, Dietary; Crystallization; Cystine; Humans; Oxalates; Pathology; Research; Uric Acid; Urinary Calculi

Topics: Acids; Ammonia; Calcium; Calcium Oxalate; Calcium, Dietary; Creatine; Creatinine; Magnesium; Oxalates; Potassium; Research; Salts; Sodium; Solubility; Urea; Urinary Calculi; Urine

Topics: Calcium Phosphates; Diphosphates; Humans; Oxalates; Urinary Calculi

Topics: Humans; Magnesium; Oxalates; Urinary Calculi

Topics: Ascorbic Acid; Child; Child, Preschool; Glycine; Glyoxylates; Humans; In Vitro Techniques; Metabolism, Inborn Errors; Oxalates; Urinary Calculi; Urine

Topics: Animals; Calcium, Dietary; Cats; Humans; Magnesium Deficiency; Oxalates; Plants, Medicinal; Pyridoxine; Rats; Rheum; Urinary Calculi; Vitamin B 6 Deficiency

Topics: Acidosis, Renal Tubular; Adolescent; Adult; Aged; Calcium; Child; Female; Humans; Hyperparathyroidism; Kidney Calculi; Male; Middle Aged; Oxalates; Phosphorus; Urinary Calculi

Topics: Crystallization; In Vitro Techniques; Oxalates; Urinary Calculi

Topics: Acid-Base Equilibrium; Crystallization; Cystine; Humans; In Vitro Techniques; Oxalates; Uric Acid; Urinary Calculi

Topics: Female; Humans; Male; Oxalates; Urinary Calculi

Topics: Humans; Oxalates; Urinary Calculi

Topics: Adult; Biopsy; Humans; Kidney Calculi; Male; Metabolism, Inborn Errors; Oxalates; Urinary Calculi

Topics: Amides; In Vitro Techniques; Oxalates; Oxamic Acid; Pharmacology; Photomicrography; Rats; Research; Surgical Procedures, Operative; Urinary Calculi; Urolithiasis; Urologic Diseases

Topics: Blood; Body Fluids; Calcium; Calcium, Dietary; Edetic Acid; Formaldehyde; Humans; Oxalates; Phosphates; Photomicrography; Proteins; Research; Uric Acid; Urinary Calculi; Urine

Topics: Calcium; Calcium, Dietary; Citrates; Humans; Oxalates; Phosphates; Urinary Calculi; Urine

Topics: Calcium; Calcium, Dietary; Carbonates; Chemistry Techniques, Analytical; Electrons; Luminescence; Magnesium; Microscopy; Microscopy, Electron; Oxalates; Phosphates; Spectrum Analysis; Uric Acid; Urinary Calculi; X-Ray Diffraction

Topics: Asia, Western; Chemistry Techniques, Analytical; Crystallography, X-Ray; Ethnology; Humans; Kidney Calculi; Oxalates; Surgical Procedures, Operative; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; X-Ray Diffraction

Topics: Calcium; Calcium, Dietary; Chemical Phenomena; Chemistry; Chlorides; Humans; In Vitro Techniques; Magnesium; Oxalates; Phosphorus; Pregnancy; Reproducibility of Results; Urinary Calculi; Urine

Topics: Agaricales; Calcium; Calcium, Dietary; Carboxy-Lyases; Chemistry Techniques, Analytical; Oxalates; Research; Urinary Calculi; Urine; Vegetables

Topics: Biliary Dyskinesia; Cholecystectomy; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Liver Diseases; Oxalates; Pancreatitis; Urinary Calculi

Topics: Animals; Calcium Carbonate; Calcium Phosphates; Chemistry Techniques, Analytical; Dogs; Fluorescence; Fluorometry; Magnesium; Oxalates; Oxytetracycline; Tetracycline; Tetracyclines; Toxicology; Ultraviolet Rays; Urinary Calculi

Topics: Chemistry Techniques, Analytical; Humans; Oxalates; Research; Uric Acid; Urinary Calculi

Topics: Calcium; Crystallization; Diphosphates; Models, Theoretical; Oxalates; Urinary Calculi

Topics: Body Fluids; Carboxy-Lyases; Humans; Oxalates; Urinary Calculi

Topics: Chemistry Techniques, Analytical; Child; Humans; Nutrition Disorders; Oxalates; Statistics as Topic; Thailand; Uric Acid; Urinary Bladder Calculi; Urinary Calculi; Urine; Vitamin A Deficiency

Topics: Calcium; Calcium, Dietary; Carbohydrate Metabolism; Glycine; Humans; Lithiasis; Mexico; Minerals; Nephrolithiasis; Oxalates; Pathology; Proteins; Serine; Uric Acid; Urinary Calculi

Topics: Calcium Oxalate; Humans; Lithiasis; Oxalates; Urinary Calculi; Vitamin B 6

Topics: Humans; Hyperoxaluria; Medical Records; Oxalates; Urinary Calculi

Topics: Animals; Calcium; Calcium, Dietary; Citrates; Citric Acid; Diet; Nutrition Assessment; Oxalates; Phosphorus; Phosphorus, Dietary; Rats; Urinary Calculi

Topics: Acute Kidney Injury; Female; Humans; Hyperoxaluria; Metabolic Diseases; Oxalates; Pregnancy; Pregnancy Complications; Urinary Calculi

Topics: Calcification, Physiologic; Calcinosis; Child; Humans; Hyperoxaluria; Infant; Kidney Diseases; Oxalates; Urinary Calculi

Topics: Animals; Biological Evolution; Glycols; Gonadal Steroid Hormones; Leadership; Lithiasis; Oxalates; Rats; Urinary Calculi

Topics: Hepatitis; Humans; Kidney; Kidney Function Tests; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Hepatitis; Hepatitis, Chronic; Humans; Hyperoxaluria; Liver Diseases; Oxalates; Urinary Calculi

Topics: Humans; Oxalates; Urinary Calculi; Urolithiasis

Topics: Antibodies; Calcium Compounds; Humans; Kidney Calculi; Oxalates; Oxides; Phosphates; Urinary Calculi

Topics: Calcium; Humans; Hypercalciuria; Lithiasis; Male; Nephrolithiasis; Oxalates; Urinary Calculi; Water-Electrolyte Balance

Topics: Diet; Dietetics; Humans; Hyperoxaluria; Nutrition Assessment; Oxalates; Urinary Calculi; Urolithiasis; Vegetables

Topics: Humans; Hyperoxaluria; Lithiasis; Oxalates; Periodicity; Urinary Calculi

Topics: Humans; Hyperoxaluria; Lithiasis; Oxalates; Urinary Calculi

Topics: Calcium Oxalate; Calculi; Humans; Magnesium; Oxalates; Urinary Calculi; Vitamin B 6; Vitamin B 6 Deficiency

Topics: Black People; Female; Humans; Hyperoxaluria; Medical Records; Oxalates; Urinary Calculi

Topics: Oxalates; Urinary Calculi

Topics: Acute Kidney Injury; Child; Humans; Hyperoxaluria; Infant; Kidney Calculi; Nephrolithiasis; Oxalates; Renal Insufficiency; Urinary Calculi

Topics: Calcium; Disease; Humans; Kidney Calculi; Oxalates; Parathyroid Diseases; Parathyroid Glands; Phosphates; Urinary Calculi

Topics: Biochemical Phenomena; Calcium Oxalate; Oxalates; Urinary Calculi

Topics: Diet; Dietetics; Humans; Lithiasis; Nutrition Assessment; Nutritional Status; Oxalates; Urinary Calculi

Topics: Cystine; Cystinuria; Humans; Lithiasis; Medical Records; Oxalates; Urinary Calculi

Topics: Cystine; Cystinuria; Humans; Lithiasis; Medical Records; Oxalates; Radiology; Urinary Calculi

Topics: Ethylene Glycol; Glycols; Humans; Lipid Metabolism; Lipids; Lithiasis; Nephrolithiasis; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Humans; Oxalates; Solubility; Urinary Calculi

Topics: Humans; Hyaluronoglucosaminidase; Kidney; Oxalates; Oxalic Acid; Urinary Calculi

Topics: Humans; Oxalates; Urinary Calculi

Topics: Humans; Hyperoxaluria; Medical Records; Metabolic Diseases; Oxalates; Urinary Calculi

Topics: Calculi; Humans; Lithiasis; Oxalates; Oxalic Acid; Urinary Calculi; Urinary Tract

Topics: Calculi; Humans; Hyperoxaluria, Primary; Oxalates; Urinary Calculi; Urinary Tract

Topics: Calculi; Humans; Kidney; Oxalates; Sulfathiazole; Sulfathiazoles; Urinary Calculi; Urinary Tract

Topics: Animals; Calculi; Oxalates; Urinary Calculi; Urinary Tract