Urinary supersaturation as a diagnostic measure in urolithiasis

AIM To demonstrate that urinary supersaturation per se is not a reliable diagnostic measure of the risk for stone formation.METHODS Available physical and chemical data for calcium oxalate monohydrate(COM) and calcium hydrogen phosphate dihydrate(brushite, BRU), and urinary supersaturations with respect to COM and BRU in healthy individuals and stone formers, were obtained from the literature. Classical theory of nucleation was used for calculations.RESULTS It was found that the rate of homogeneous nucleation(unaided by substrates) of COM and BRU is nil at all conceivable supersaturations of urine. Consequently spontaneous formation of crystals in urine requires the presence of nucleation substrates for(heteronuclei).CONCLUSION Urinary supersaturation with respect to lithiatic compounds is a necessary, but not a sufficient condition for nephrolithiasis. The absence of crystallization inhibitors and the presence of efficient nucleation promoters(heteronuclei) in urine are further necessary conditions of urolithiasis occurrence. Urinary supersaturation per se is not a reliable diagnostic measure of the risk of kidney stone formation.

Ultrafine Structure of Calcific Deposits Developed in Calcific Tendinopathy

The ultrafine structure of tendons deposits formed in three patients, males aged 52 and 61 years and a female aged 71 years were evaluated by atomic force microscopy. Three distinctly different structures of deposit surface were identified: (i) compact, smooth and uneven surface composed of closely packed nanoparticles of diameter 30 nm;(ii) surfaces consisting of plate-like crystalline particles about 30 nm thick that formed larger entities divided by deep depressions;(iii) rough surface formed by individual or closely attached elongated needle-like particles with elliptical cross-section of diameter about 30 nm. These surface structures were developed by different formation mechanisms: (i) Aggregation of Posner’s clusters into nanoparticles formed on biological calcific able surfaces and in the bulk of body fluid surrounding the deposits that subsequently settled onto the deposit surface;(ii) Regular crystal growth on surface nuclei generated at low supersaturation of body fluid with respect to the phosphatic phase and/or in a narrow cavity containing a very limited volume of liquid;(iii) Solution mediated re-crystallization of the upper layers of a deposit or unstable crystalline growth governed by volume diffusion of building units to the particle tip. Small rods, 40 nm wide and from 100 to 300 nm long, with no apparent order were detected only on the surface of deposit formed in the female patient. These rods could be debris of collagen fibres that disintegrated into individual building units (macromolecules) with some showing breakdown into smaller fragments.

Study on the structure and composition of aortic valve calcific deposits:Etiological aspects

The structures and chemical compositions of valve calcific deposits were investigated. The deposits was chosen arbitrarily and subjected to chemical analysis, observation with scanning microscope, semi-quantitative determination of Ca, Mg, Na, K, P and C elements by energy dispersive X-ray, X-ray diffraction and Fourier transform infrared spectroscopy carried out. These deposits were found to have non-uniform internal structures composed of layers of a structureless aspidinic inorganic material, substantial amounts of voluminous organic material and in a few samples small spheres were also present. Two groups of deposits with distinctly different chemical compositions were identified: one group with a low Ca/P molar ratio (1.59) and the other group with a high (1.82) Ca/P molar ratio. The deposits belonging to the group with a low Ca/P molar ratio contain higher concentration of magnesium and consist of increased amount of amorphous calcium phosphate. The deposits with a high Ca/P molar ratio contain low concentration of magnesium and consist predominantly of carbonated hydroxyapatite. The inorganic material was identified as a poorly crystalline carbonate hydroxyapatite containing molecular water of the average formula Ca9.1Mg0.4(Na,K)(PO4)5.8(CO3)0.3(OH)2. The actual chemical composition of the apatitic solid phase varies not only from deposit to deposit but also within the same deposit. The non-uniform internal structure of the deposits, the occasional presence of spherical particles and the variable point composition of the individual deposits indicate that their formation did not proceed under more or less constant conditions.

Structure and Composition of Non-Infectious Phosphate Calculi Formed in Patients with Low and High Urinary Phosphate Concentrations

Objective: The aim of this paper was to assess the relationships among chemical, phase and structural composition and?etiopathogenic factors of non-infectious phosphate calculi formed in patients with low and high urinary phosphate concentrations, and to characterize the mechanism of their formation related on biochemical results. Material and Methods: Twelve samples of phosphate renal calculi were obtained, 4 from patients with low phosphaturia and 6 from patients with high urinary phosphate concentrations. Their chemical composition was determined qualitatively by energy dispersive X-ray analysis and quantitatively by spectrophotometric and thermal analysis;and their phase composition was determined by Fourier transform infrared transmission spectroscopy and X-ray diffraction. The structure of the calculi was assessed by scanning electron microscopy. Results: Non-infectious phosphate renal calculi of patients with low phosphaturia consist of poorly crystalline carbonate hydroxyapatite, whereas those of patients with high urinary phosphate concentrations consist of poorly crystalline hydroxyapatite with some amount of calcium oxalate crystals. Calculi of patients with high urinary phosphate concentrations are formed at urinary supersaturation with respect to hydroxyapatite and calcium oxalate about 4 times higher than in patients with low phosphaturia. Conclusion: In patients with low phosphaturia, the non-infectious phosphate renal calculi are formed in urine near pH 7 and contain only poorly crystalline carbonate hydroxyapatite. In patients with high urinary phosphate concentrations and hypercalciuria, the calculi are formed in urine near pH 6 and consist of both poorly crystalline hydroxyapatite and some amount of calcium oxalate crystals.