Advertisement

Urolithiasis

, Volume 45, Issue 1, pp 3–9 | Cite as

Accurate stone analysis: the impact on disease diagnosis and treatment

  • Neil S. Mandel
  • Ian C. Mandel
  • Ann M. Kolbach-Mandel
Invited Review

Abstract

This manuscript reviews the requirements for acceptable compositional analysis of kidney stones using various biophysical methods. High-resolution X-ray powder diffraction crystallography and Fourier transform infrared spectroscopy (FTIR) are the only acceptable methods in our labs for kidney stone analysis. The use of well-constructed spectral reference libraries is the basis for accurate and complete stone analysis. The literature included in this manuscript identify errors in most commercial laboratories and in some academic centers. We provide personal comments on why such errors are occurring at such high rates, and although the work load is rather large, it is very worthwhile in providing accurate stone compositions. We also provide the results of our almost 90,000 stone analyses and a breakdown of the number of components we have observed in the various stones. We also offer advice on determining the method used by the various FTIR equipment manufacturers who also provide a stone analysis library so that the FTIR users can feel comfortable in the accuracy of their reported results. Such an analysis on the accuracy of the individual reference libraries could positively influence the reduction in their respective error rates.

Keywords

Kidney stone analysis Calcium oxalate Uric acid FTIR X-ray diffraction 

Notes

Acknowledgements

We gratefully acknowledge the financial support provided by the Department of Veterans Affairs for NM through their PhD Research Career Scientist Program as a Senior Research Career Scientist. The VA Merit Review Programs for NM 5453-02P, 5455-01P, and 5455-12P, and in part with resources and the use of facilities at the Clement J. Zablocki Department of Veterans Affairs Medical Center, Milwaukee, WI. We also thank the long-term support of our National VA Crystal Identification first by VA Central Office Department of Pathology, Washington DC and later by our local VA Medical Center with payback dollars per sample analysis from the referring VAMC. Funding was also obtained through parts of several grants (NM) from the National Institutes of Health/National Institute for Diabetes, Digestive, and Kidney, RO1 DK30579, DK064616, and R21 DK062739. The Mandel International Stone and Molecular Analysis Center, MIS.MAC is administered by the Medical College of Wisconsin, Milwaukee, WI with Dr. Mandel as the Director. MIS.MAC continues to operate even though the VA Crystal ID Center closed down due to local financial shortfalls for the Medical Center. I would especially like to acknowledge the valuable contributions by my son, Ian Mandel, in the design and development of the FTIR spectral reference library. Ian did all of the needed synthesis of components that were not commercially available. He also constructed the computer algorithm for admixing the spectra for the various admixtures. The manuscript for the polyisobutylene stone [12] was only possible due to Ian’s persistence in unraveling polymer spectra from the Aldrich reference library and his background in polymer research conducted at the University of Wisconsin, Madison, WI, USA.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to report.

Human studies

The summary data for stone analyses reported in this manuscript was approved by the Clement J. Zablocki IRB as protocol 5455-09 approved through 2016. No informed consents were necessary for the epidemiologic computer review surveys as all patient identifiers were expunged from the reviews.

References

  1. 1.
    Zisman AL, Evan AP, Coe FL, Worcester EM (2015) Do kidney stone formers have a kidney disease? Kidney Int 88:1240–1249. doi: 10.1038/ki.2015.254 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC, Consensus Conference Group (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29:715–734CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Krambeck AE, Lingeman JE, McAteer JA, Williams Jr JC (2010) Analysis of mixed stones is prone to error: a study with US laboratories using micro CT for verification of sample content. Urol Res 38:469–475. doi: 10.1007/s00240-010-0317-y CrossRefPubMedGoogle Scholar
  4. 4.
    Hesse A, Kruse R, Geilenkeuser W, Schmidt M (2005) Quality control in urinary stone analysis: results of 44 ring trials (1980–2001). Clin Chem Lab Med 43:298–303CrossRefPubMedGoogle Scholar
  5. 5.
    Siener R, Buchholz N, Daudon M, Hess B, Knoll T, Osther PJ, Reis-Santos J, Sarica K, Traxer O, Trinchieri A, EAU Section of Urolithiasis (EULIS) (2016) Quality assessment of urinary stone analysis: results of a multicenter study of laboratories in Europe. PLoS One 11:e0156606. doi: 10.1371/journal.pone.0156606 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mandel IC, Mandel NS (2007) Structural and compositional analysis of kidney stones Chapter 5: (eISBN 978-1-59259-972-1). In: Stoller ML, Meng MV (eds) Urinary stone disease: the practical guide to medical and surgical management. Humana Press, New York, pp 69–81CrossRefGoogle Scholar
  7. 7.
    Wirth GJ, Teuscher J, Graf JD, Iselin CE (2006) Efavirenz-induced urolithiasis. Urol Res 34:288–289CrossRefPubMedGoogle Scholar
  8. 8.
    Ghousheh AI, Groth TW, Fryjoff KM, Wille DF, Mandel NS, Roddy JT, Durkee CT (2013) Urolithiasis in patients on high dose felbamate. J Urol 189:1865–1869. doi: 10.1016/j.juro.2012.12.032 CrossRefPubMedGoogle Scholar
  9. 9.
    Ettinger B, Weil E, Mandel NS, Darling S (1979) Triamterene-induced nephrolithiasis. Ann Intern Med 91:745–746CrossRefPubMedGoogle Scholar
  10. 10.
    Assimos DG, Langenstroer P, Leinbach RF, Mandel NS, Stern JM, Holmes RP (1999) Guaifenesin- and ephedrine-induced stones. J Endourol 13:665–667CrossRefPubMedGoogle Scholar
  11. 11.
    Kolbach-Mandel AM, Mandel NS, Cohen SR, Kleinman JG, Ahmed F, Mandel IC, Wesson JA (2016) Guaifenesin stone matrix proteomics: a protocol for identifying proteins critical to stone formation. Urolithiasis. doi: 10.1007/s00240-016-0907-4 Google Scholar
  12. 12.
    Avallone M, Kolbach-Mandel A, Mandel I, Mandel N, Dietrich P, Wesson J, Davis C (2015) Polyisobutylene urolithiasis due to ileal conduit urostomy appliance: An index case. J Endourol Case Rep 1(1):41–43CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Boyce WH, Garvey FK (1956) The amount and nature of the organic matrix in urinary calculi: a review. J Urol 76:213–227PubMedGoogle Scholar
  14. 14.
    Khan SR, Atmani F, Glenton P, Hou Z, Talham DR, Khurshid M (1996) Lipids and membranes in the organic matrix of urinary calcific crystals and stones. Calcif Tissue Int 59:357–365CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2016

Authors and Affiliations

  1. 1.Division of Nephrology, Mandel International Stone and Molecular Analysis CenterMedical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical CenterMilwaukeeUSA

Personalised recommendations