Accurate stone analysis: the impact on disease diagnosis and treatment
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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.
KeywordsKidney stone analysis Calcium oxalate Uric acid FTIR X-ray diffraction
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  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.
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Conflict of interest
None of the authors have any conflicts of interest to report.
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.
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