Abstract
Pure calcium oxalate is the most frequent type of idiopathic kidney stone composition. Fourier transform infrared spectroscopy (FT-IR) allows to detect the ratio of calcium oxalate dihydrate (COD) and monohydrate (COM) crystals in stones, but the clinical significance of this parameter remains uncertain. The objective of this observational study was to verify the association of clinical and laboratory parameters of kidney stone disease with COD/COM ratio in a group of 465 (322 M, age 46 ± 14) patients suffering from idiopathic calcium nephrolithiasis with pure calcium oxalate stones (≥ 97%). Each participant underwent a complete clinical examination, serum chemistry, 24-h urine collection for the determination of the profile of lithogenic risk, and had stones analyzed by FT-IR. Most (62%) of the stones had a COD/COM ratio ≤ 0.25, and the urine chemistry of the corresponding patients showed a low prevalence of urinary metabolic abnormalities. With increasing COD/COM ratio intervals (0–0.25, 0.26–0.50, 0.51–0.75, 0.76–1), a significant association was observed for the number of urological procedures, serum calcium, 24-h urinary calcium excretion, prevalence of hypercalciuria and relative calcium oxalate supersaturation, and a negative trend was detected for the age of the first stone episode (all p values < 0.05). A linear regression model showed that the only parameters significantly associated with COD/COM ratio were 24-h urinary calcium excretion (standardized β = 0.464, p < 0.001) and urine pH (standardized β = 0.103, p = 0.013). In pure calcium oxalate idiopathic stones, COD/COM ratio may reflect the presence of urinary metabolic risk factors, and represent a guide for the prescription of urinary analyses.
Similar content being viewed by others
References
Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12(2–3):e86–e96
Daudon M, Réveillaud RJ (1984) Whewellite and weddellite: toward a different etiopathogenesis. Nephrologie 5(5):195–201
Daudon M, Bader CA, Jungers P (1993) Urinary calculi: review of classification methods and correlations with etiology. Scan Microsc 7(3):1081–1106
Jiang D, Geng H (2017) Primary hyperoxaluria. N Engl J Med 376(15):e33
Daudon M, Jungers P, Bazin D (2008) Peculiar morphology of stones in primary hyperoxaluria. N Engl J Med 359(1):100–102
Sutton RA, Walker VR (1994) Enteric and mild hyperoxaluria. Miner Electrolyte Metab 20(6):352–360
Massey LK, Liebman M, Kynast-Gales SA (2005) Ascorbate increases human oxaluria and kidney stone risk. J Nutr 135(7):1673–1677
Albert A, Tiwari V, Paul E, Ponnusamy S, Ganesan D, Prabhakaran R et al (2018) Oral administration of oxalate-enriched spinach extract as an improved methodology for the induction of dietary hyperoxaluric nephrocalcinosis in experimental rats. Toxicol Mech Methods 28(3):195–204
Daudon M, Bazin D, André G, Jungers P, Cousson A, Chevallier P et al (2009) Examination of whewellite kidney stones by scanning electron microscopy and powder neutron diffraction techniques. J Appl Cryst 42:109–115
Park S, Pearle MS (2007) Pathophysiology and management of calcium stones. Urol Clin N Am 34(3):323–334
Prezioso D, Strazzullo D, Lotti T, Bianchi G, Borghi L, Caione P et al (2015) Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group. Arch Ital Urol Androl 87(2):105–120
Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E et al (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29(6):715–734
Nouvenne A, Ticinesi A, Allegri F, Guerra A, Guida L, Morelli I et al (2014) Twenty-five years of idiopathic calcium nephrolithiasis: has anything changed? Clin Chem Lab Med 52(3):337–344
Guerra A, Folesani G, Nouvenne A, Ticinesi A, Allegri F, Pinelli S et al (2016) Family history influences clinical course of idiopathic calcium nephrolithiasis: case–control study of a large cohort of Italian patients. J Nephrol 29(5):645–651
Ticinesi A, Guerra A, Allegri F, Nouvenne A, Cervellin G, Maggio M et al (2018) Determinants of calcium and oxalate excretion in subjects with calcium nephrolithiasis: the role of metabolic syndrome traits. J Nephrol 31(3):395–403
Ferraro PM, Ticinesi A, Meschi T, Rodgers A, Di Maio F, Fulignati P et al (2018) Short-term changes in urinary supersaturation predict recurrence of kidney stones: a tool to guide preventive measures in urolithiasis. J Urol 200(5):1082–1087
Werness P, Brown CM, Smith LH, Finlayson B (1985) Equil2: a basic computer program for the calculation of urinary saturation. J Urol 134:1242–1244
Maurice-Estepa L, Levillain P, Lacour B, Daudon M (2000) Advantage of zero-crossing-point first-derivative spectrophotometry for the quantification of calcium oxalate crystalline phases by infrared spectrophotometry. Clin Chim Acta 298(1–2):1–11
Castiglione V, Jouret F, Bruyère O, Dubois B, Thomas A, Waltregny D et al (2015) Epidemiology of urolithiasis in Belgium on the basis of a morpho-constitutional classification. Nephrol Ther 11(1):42–49
Daudon M, Traxer O, Lechevallier E, Saussine C (2008) Epidemiology of urolithiasis. Prog Urol 18(12):802–814
Pierratos AE, Khalaff H, Cheng PT, Psihramis K, Jewett MA (1994) Clinical and biochemical differences in patients with pure calcium oxalate monohydrate and calcium oxalate dehydrate kidney stones. J Urol 151(3):571–574
Parent X, Boess G, Brignon P (1999) Calcium oxalate lithiasis. Relationship between biochemical risk factors and crystalline phase of the stone. Prog Urol 9(6):1051–1056
Asplin JR, Lingeman J, Kahnoski R, Mardis H, Parks JH, Coe FL (1998) Metabolic urinary correlates of calcium oxalate dehydrate in renal stones. J Urol 159(3):664–668
Daudon M, Letavernier E, Frochot V, Haymann JP, Bazin D, Jungers P (2016) Respective influence of calcium and oxalate urine concentration on the formation of calcium oxalate kidney monohydrate or dehydrate crystals. C R Chim 19:1504–1513
Manissorn J, Fong-Ngern K, Peerapen P, Thongboonkerd V (2017) Systematic evaluation for effects of urine pH on calcium oxalate crystallization, crystal-cell adhesion and internalization into renal tubular cells. Sci Rep 7(1):1798
Parks JH, Coward M, Coe FL (1997) Correspondence between stone composition and urine supersaturation in nephrolithiasis. Kidney Int 51(3):894–900
Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE et al (2015) Stone composition among first-time symptomatic kidney stone formers in the community. Mayo Clin Proc 90(10):1356–1365
Vaughan LE, Enders FT, Lieske JC, Pais VM, Rivera ME, Mehta RA et al (2019) Predictors of symptomatic kidney stone recurrence after the first and subsequent episodes. Mayo Clin Proc 94(2):202–210
Ticinesi A, Nouvenne A, Borghi L, Meschi T (2017) Water and other fluids in nephrolithiasis: state of the art and future challenges. Crit Rev Food Sci Nutr 57(5):963–974
Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi T (2016) Salt and nephrolithiasis. Nephrol Dial Transplant 31(1):39–45
Guerra A, Ticinesi A, Allegri F, Nouvenne A, Prati B, Pinelli S et al (2019) Insights about urinary hippuric and citric acid as biomarkers of fruit and vegetable intake in patients with kidney stones: the role of age and gender. Nutrition 59:83–89
Meschi T, Nouvenne A, Ticinesi A, Prati B, Guerra A, Allegri F et al (2012) Dietary habits in women with recurrent idiopathic calcium nephrolithiasis. J Transl Med 10:63
Ticinesi A, Milani C, Guerra A, Allegri F, Lauretani F, Nouvenne A et al (2018) Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 67(12):2097–2106
Guerra A, Ticinesi A, Allegri F, Nouvenne A, Pinelli S, Folesani G et al (2016) The influence of maternal and paternal history on stone composition and clinical course of calcium nephrolithiasis in subjects aged between 15 and 25. Urolithiasis 44(6):521–528
Guerra A, Ticinesi A, Allegri F, Nouvenne A, Pinelli S, Lauretani F et al (2017) Calcium urolithiasis course in young stone formers is influenced by the strength of family history: results from a retrospective study. Urolithiasis 45(6):525–533
Jaggi M, Nakagawa Y, Zipperle L, Hess B (2007) Tamm-Horsfall protein in recurrent calcium kidney stone formers with positive family history: abnormalities in urinary excretion, molecular structure and function. Urol Res 35(2):55–62
Yamate T, Tsuji H, Amasaki N, Iguchi M, Kurita T, Kohri K (2000) Analysis of osteopontin DNA in patients with urolithiasis. Urol Res 28(3):159–166
Rimel JD, Kolbach-Mandel AM, Ward MD, Wesson JA (2017) The role of macromolecules in the formation of kidney stones. Urolithiasis 45(1):47–54
Wollin DA, Kaplan AG, Preminger GM, Ferraro PM, Nouvenne A, Tasca A et al (2018) Defining metabolic activity of nephrolithiasis—appropriate evaluation and follow-up of stone formers. Asian J Urol 5(4):235–242
Daudon M, Jungers P, Bazin D, Williams JC Jr. (2018) Recurrence rates of urinary calculi according to stone composition and morphology. Urolithiasis 46(5):459–470
Acknowledgements
The authors wish to thank Antonio Nouvenne, for important assistance in study design and manuscript drafting, Maurizio Rossi, for the precious statistical consult, and Michele Zenna, for assistance in database management and support in manuscript drafting.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have nothing to disclose.
Ethical standards
The study protocol was approved by the local Ethics Committee as part of a larger project on the clinical and nutritional correlates of urinary parameters in nephrolithiasis. The study was carried out according to the principles of the Declaration of Helsinki. Informed consent was obtained according to Italian law for retrospective studies.
Informed consent
Informed consent was obtained according to Italian law for retrospective studies.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Guerra, A., Ticinesi, A., Allegri, F. et al. Idiopathic calcium nephrolithiasis with pure calcium oxalate composition: clinical correlates of the calcium oxalate dihydrate/monohydrate (COD/COM) stone ratio. Urolithiasis 48, 271–279 (2020). https://doi.org/10.1007/s00240-019-01156-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-019-01156-8