Mineralogical composition of urinary stones, risk factors and metabolic disturbances in patients with calcium-oxalate urolithiasis


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Abstract

Aim To identify the most likely metabolic disturbances and risk factors for stone formation in a group of patients with calcium oxalate urolithiasis, and to establish the relationship between the mineralogical composition of calculi and impaired excretion of inhibitors and promoters of stone formation. Materials and methods Fifty patients with calcium oxalate urolithiasis were tested using a complex of physicochemical methods. Patients’ assessment included evaluation of quantitative mineralogical composition of calculi, daily urine pH profile and daily urinary excretion of urates, calcium, magnesium, oxalate, phosphate and citrate ions. Results The main mineralogical phase of the stones in over 80% of patients was calcium oxalate monohydrate; none of the patients had pure dihydrate stones. The most frequent metabolic disorders were hypocitraturia, hypercalciuria and hyperuricosuria. Predominant risk factors were excessive body weight and insufficient fluid intake. Only one patient had an idiopathic stone formation. It was established for the first time that patients with calcium oxalate stones, containing 10 or more mass percent of apatites had statistically significantly lower daily urinary calcium and oxalate excretion and simultaneously increased phosphate excretion. Conclusions The study findings showed that patients with calculi based on calcium oxalate dihydrate should undergo testing for daily urinary excretion of calcium and citrate while patients with calcium oxalate stones containing 10 or more mass percent of apatites should also be tested for daily phosphate excretion and urine pH-profile. Daily urinary citrate excretion was reduced in all study patients, and urate excretion was significantly increased, apparently due to an imbalanced diet and excessive intake of animal protein. Menopausal and postmenopausal women are at a particular risk due to low urinary citrate excretion and high urinary calcium excretion regardless of stone composition.

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About the authors

A. V Kustov

United Physico-Chemical Center of Solutions, G.A. Krestov Institute of Solution Chemistry of Russian Academy of Sciences and Ivanovo State University of Chemical Technology; Ivanovo State Medical Academy

Email: kustov@isuct.ru
Dr.Chem.Sci., Leading Researcher

A. I Strel’nikov

IvSMA of Minzdrav of Russia; Ivanovo State Medical Academy

Dr.Med.Sci., Prof., Head of the Department of Surgery and Urology

M. A Moryganov

Institute of Solution Chemistry of the RAS; Ivanovo Regional Clinical Hospital

A. O Airapetyan

Institute of Solution Chemistry of the RAS; Ivanovo State Medical Academy

P. R Smirnov

United Physico-Chemical Center of Solutions, G.A. Krestov Institute of Solution Chemistry of Russian Academy of Sciences and Ivanovo State University of Chemical Technology

E. V Lyalyakina

Institute of Solution Chemistry of the RAS; Ivanovo Regional Clinical Hospital

S. R Toms

Institute of Solution Chemistry of the RAS; Ivanovo Regional Clinical Hospital

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