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Baumann JM, Affolter B, Caprez U, Clivaz C, Glück Z, Weber R. Stabilization of calcium oxalate suspension by urinary macromolecules, probably an efficient protection from stone formation. Urol Int 2007; 79:267-72. [PMID: 17940361 DOI: 10.1159/000107961] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 11/21/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Crystal aggregation (AGN) destabilizes crystal suspensions and during crystalluria probably favors crystal apposition to kidney calcifications and preexisting stones. We analyzed inhibition of AGN and stabilization of calcium oxalate suspensions by urinary macromolecules (UM), urine and solutions with urinary citrate concentration. MATERIALS AND METHODS Solutions of UM (UMS) were obtained by a hemofiltration procedure from urine of 6 healthy men. Calcium oxalate suspensions were prepared in all solutions and urine by adjusting Ca2+ to 1.5 mM and by an oxalate titration to 1.0 mM. Crystallization was monitored measuring optical density (OD). Stability of suspensions (SS) was defined as the time without sedimentation and zeta potential (ZP) of crystals was measured. AGN was visualized by scanning electron microscopy and quantified by maximal OD. RESULTS UMS inhibited AGN and increased ZP and SS. Most inhibitory activity of urine could be attributed to UM. 3.3-fold dilution of UM reduced SS only by 30%. CONCLUSIONS During crystalluria, UM of healthy men are supposed to protect from stone formation by inhibiting AGN and stabilizing crystal suspensions. As a probably important aspect, this protection was found to be limited in time and may favorably be influenced by an increase of diuresis.
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Affiliation(s)
- J M Baumann
- Stone Research Center Viollier, Biel, Switzerland
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2
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Straub M, Hautmann RE, Hesse A, Rinnab L. [Calcium oxalate stones and hyperoxaluria. What is certain? What is new?]. Urologe A 2005; 44:1315-23. [PMID: 16235094 DOI: 10.1007/s00120-005-0936-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Approximately 4 million Germans suffer from stone disease. In the majority of cases (70-75%) it is calcium oxalate. Its pathophysiology is complex and comprises disorders such as hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and hypomagnesuria. These biochemical changes in urine are well known as "classic" risk factors of calcium oxalate stone formation. However, studies in the last decade showed that calcium oxalate stones are strongly related with other diseases or disorders such as overweight, hypertension, or a lack of oxalate-degrading bacteria in the gut. The evidence for these "new" risk factors in the literature is very strong. It is particularly important in regard to effective treatment and aftercare of patients with calcium oxalate stones to be familiar with both the "classic" and the new risk factors.
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Affiliation(s)
- M Straub
- Arbeitsgruppe Harnsteine, Abteilung Urologie und Kinderurologie, Universitätsklinikum, Ulm.
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3
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Beshensky AM, Wesson JA, Worcester EM, Sorokina EJ, Snyder CJ, Kleinman JG. Effects of urinary macromolecules on hydroxyapatite crystal formation. J Am Soc Nephrol 2001; 12:2108-2116. [PMID: 11562409 DOI: 10.1681/asn.v12102108] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Particle size analysis was combined with titration data obtained in constant-composition, hydroxyapatite (HA)-seeded, crystal growth assays. With addition of large amounts of HA (250 microg), titration rates were linear, new crystal formation was minimal, and aggregation effects could be detected. With addition of small amounts of HA (62.5 microg), nucleation of new HA was observed. The effects of urinary macromolecules, i.e., osteopontin (OPN), recombinant glutathione-S-transferase-OPN (G-OPN), Tamm-Horsfall protein, chondroitin sulfate, human serum albumin, mixed urinary macromolecules from a stone-former (SFU1), mixed urinary macromolecules from a normal individual (NU1), and polyaspartic acid (PA), were examined in this system. Crystal growth inhibition, as measured by the slope of linear titration curves in this system, was observed with PA, G-OPN, OPN, SFU1, and NU1. All of the macromolecules tested inhibited aggregation, including Tamm-Horsfall protein, which did not inhibit growth. As reflected by the ratio of the final number of particles to the initial number in the 62.5-microg seed addition, the macromolecules that were most effective in inhibiting growth, i.e., OPN, G-OPN, PA, SFU1, and NU1, actually increased secondary nucleation. Recombinant G-OPN demonstrated less inhibitory activity than did OPN isolated from cell culture. Chondroitin sulfate and human serum albumin exhibited no significant effects on the various components of HA crystallization under these conditions. SFU1 and NU1 slowed growth and increased secondary nucleation to similar degrees, and neither exhibited any measurable effect on aggregation. Therefore, crystal surface sites that participate in nucleation, growth, and aggregation processes are affected independently by macromolecules, presumably because of differences in their structural features. These results illustrate the utility of combining these techniques to provide a much greater understanding of crystallization behavior than that possible with either analysis alone.
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Affiliation(s)
- Ann M Beshensky
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeffrey A Wesson
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elaine M Worcester
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elena J Sorokina
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carl J Snyder
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jack G Kleinman
- Nephrology Division, Department of Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin
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Borghi L, Guerra A, Meschi T, Briganti A, Schianchi T, Allegri F, Novarini A. Relationship between supersaturation and calcium oxalate crystallization in normals and idiopathic calcium oxalate stone formers. Kidney Int 1999; 55:1041-50. [PMID: 10027942 DOI: 10.1046/j.1523-1755.1999.0550031041.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In an earlier study on recurrent CaOx stone formers with no detectable abnormalities, we found that the urine of these subjects had a lower tolerance to oxalate load than controls and that the removal of urinary macromolecules with a molecular weight greater than 10,000 D improved their tolerance to oxalate. METHODS The effects on CaOx crystallization of reduced urinary supersaturation of calcium oxalate (CaOx), induced by night water load, were studied in 12 normal males and in 15 male OxCa stone formers who were free from urinary metabolic abnormalities. The effect of the macromolecules, purified and retrieved from the natural and diluted urine, were analyzed in a metastable solution of CaOx. RESULTS The water load caused an increase in urine volume (from 307 +/- 111 to 572 +/- 322 ml/8 hr, P = 0.014 in normal subjects, and from 266 +/- 92 to 518 +/- 208 ml/8 hr, P = 0.001 in the stone formers) and a concomitant reduction of the relative CaOx supersaturation (from 8.7 +/- 2.5 to 5.1 +/- 2.5 ml/8 hr, P = 0.001 in normal subjects, and from 10.4 +/- 3.5 to 5.0 +/- 2.7 ml/8 hr, P = 0.001 in the stone formers). The decrease in CaOx supersaturation was accompanied by an increase of the permissible increment in oxalate, both in normal subjects (from 43.8 +/- 10.1 to 67.2 +/- 30. 3 mg/liter, P = 0.018) and in the stone formers (from 25.7 +/- 9.4 to 43.7 +/- 17.1 mg/liter, P = 0.0001), without any significant variations of the upper limit of metastability for CaOx (from 21.6 +/- 5.3 to 20.5 +/- 4.2 mg/liter in normal subjects, and from 18.7 +/- 4.5 to 17.1 +/- 3.7 mg/liter in the stone formers). The inhibitory effect of urinary macromolecules with molecular weight greater than 10,000 Daltons did not undergo any change when the latter were recovered from concentrated or diluted urine, either in normal subjects or in the stone formers. CONCLUSIONS Reduced CaOx supersaturation by means of water load has a protective effect with regards to CaOx crystallization in subjects who do not present any of the common urinary stone risk factors.
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Affiliation(s)
- L Borghi
- Institute of Semeiotica Medica, University of Parma, Parma, Italy.
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5
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Bouropoulos K, Bouropoulos N, Melekos M, Koutsoukos PG, Chitanu GC, Anghelescu-Dogaru AG, Carpov AA. The inhibition of calcium oxalate monohydrate crystal growth by maleic acid copolymers. J Urol 1998; 159:1755-61. [PMID: 9554407 DOI: 10.1097/00005392-199805000-00107] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The crystallization of calcium oxalate monohydrate (COM) was investigated at conditions of constant supersaturation both in the absence and in the presence of synthetic maleic acid copolymers at 37C, 0.15 M NaCl. The dependence of the rates of COM crystallization in the absence of inhibitors was found to be second order at low and first order at higher supersaturations suggesting a surface diffusion controlled mechanism. The presence of all copolymers tested at concentration levels up to 5 ppm retarded the rates of COM crystal growth up to 90%. The decrease of the COM crystal growth rates by the polymers depended on the nature of the comonomer polymerized with maleic acid and the order of inhibition was found to be vinyl acetate > N-vinylpyrrolidone > styrene. Taking into consideration kinetics data published in the literature concerning the inhibition of COM crystal growth, it is suggested that molecular weight also plays a role, with more inhibition at higher molecular weights. The morphology of the COM crystals grown was unaffected yet the crystals growing at lower rates in the presence of the copolymers were larger and their size more uniform. It is concluded that maleic acid copolymers are strong inhibitors of the crystallization of COM, the inhibitory activity being more pronounced in the case of the linear copolymers.
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Affiliation(s)
- K Bouropoulos
- Department of Urology, School of Medicine, University of Patras, Greece
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Bek-Jensen H, Tiselius HG. Evaluation of urine composition and calcium salt crystallization properties in standardized volume-adjusted 12-h night urine from normal subjects and calcium oxalate stone formers. UROLOGICAL RESEARCH 1997; 25:365-72. [PMID: 9373919 DOI: 10.1007/bf01294667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The volume of 12-h night urine from ten normal men (NM), ten normal women (NW) and 31 male calcium stone formers (SFM) was adjusted to 750 ml and analysed with respect to supersaturation with calcium oxalate (CaOx) and calcium phosphate (CaP), inhibition of CaOx crystal growth and aggregation, as well as the CaOx and CaP crystallization propensity. Concentrations of oxalate and glycosaminoglycans and AP(CaOx) index, an estimate of the CaOx ion-activity product, were higher and the concentration of citrate lower in NM than in NW. In SFM the directly assessed risk of CaOx crystallization was higher and the inhibition of CaOx crystal growth lower than in NM. There were no differences between the groups regarding inhibition of CaOx crystal growth by 74% dialysed urine or inhibition of CaOx crystal aggregation. SFM with mixed CaOxCaP stones had a higher concentration of phosphate and a higher AP(CaP) index at pH 7.0 than SFM with CaOx stones.
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Affiliation(s)
- H Bek-Jensen
- Department of Urology, Faculty of Health Sciences, University Hospital, Linköping, Sweden
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7
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Bek-Jensen H, Fornander AM, Nilsson MA, Tiselius HG. Is citrate an inhibitor of calcium oxalate crystal growth in high concentrations of urine? UROLOGICAL RESEARCH 1996; 24:67-71. [PMID: 8740974 DOI: 10.1007/bf00431081] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effect of citrate on calcium oxalate (CaOx) crystal growth was studied in a system in which series of samples containing [45Ca]calcium chloride were brought to different levels of supersaturation with various concentrations of oxalate. The crystallization was assessed by measuring the amount of isotope remaining in solution 30 min after the addition of CaOx seed crystals to samples containing citrate in concentrations corresponding to those in final urine. The experiments were carried out both in pure salt solutions and in solutions with dialysed urine. Increased concentrations of citrate resulted in a reduced crystallization of CaOx in both the presence and absence of dialysed urine, but with the lowest rate of crystallization in the samples containing urine. The increased concentration of 45Ca remaining in solution reflected a reduced crystallization, which could possibly be explained both by a reduced supersaturation and by an increased inhibition of CaOx crystal growth. The direct effects of citrate on CaOx crystal growth were assessed by calculating the ion-activity product of CaOx (APCaOx) at corresponding degrees of crystallization. The APCaOx recorded at a 30% reduction of the amount of isotope in solution increased with increasing concentrations of citrate between 1.0 and 1.5 mmol/l samples both with and without dialysed urine. These findings indicate that citrate has a weak direct inhibitory effect on CaOx crystal growth, which adds to the reduced growth rate brought about by urinary macromolecules and a decreased supersaturation.
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Affiliation(s)
- H Bek-Jensen
- Department of Urology, Faculty of Health Sciences, University Hospital, Linköping, Sweden
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8
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Tiselius HG, Bek-Jensen H, Fornander AM, Nilsson MA. Crystallization Properties in Urine from Calcium Oxalate Stone Formers. J Urol 1995. [DOI: 10.1016/s0022-5347(01)66939-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hans-Goran Tiselius
- Department of Urology and Clinical Research Center, Faculty of Health Sciences, University Hospital, Linkoping, Sweden
| | - Hanne Bek-Jensen
- Department of Urology and Clinical Research Center, Faculty of Health Sciences, University Hospital, Linkoping, Sweden
| | - Anne-Marie Fornander
- Department of Urology and Clinical Research Center, Faculty of Health Sciences, University Hospital, Linkoping, Sweden
| | - Mari-Anne Nilsson
- Department of Urology and Clinical Research Center, Faculty of Health Sciences, University Hospital, Linkoping, Sweden
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9
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Borghi L, Meschi T, Guerra A, Bergamaschi E, Mutti A, Novarini A. Effects of urinary macromolecules on the nucleation of calcium oxalate in idiopathic stone formers and healthy controls. Clin Chim Acta 1995; 239:1-11. [PMID: 7586581 DOI: 10.1016/0009-8981(95)06092-r] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Urinary macromolecules have attracted great interest because of their possible role as both promoters and inhibitors of calcium oxalate (CaOx) crystallization and it remains unclear whether there is any difference, in their nucleating activity, between stone formers and controls. We selected 9 male idiopathic CaOx stone formers whose 24-h urines presented no evidence of common urinary stone risk factors such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, hypomagnesiuria or low glycosaminoglycans excretion and 12 male controls (matched for age and body weight) whose 24-h urines did not differ from those of stone formers. The study of urinary CaOx nucleation was made in freshly voided overnight urines whose biochemical composition was almost identical in the two groups. In filtered (0.22 micron) and ultrafiltered (10 kDa) urine we performed an oxalate tolerance test to determine the permissible increment of oxalate, the oxalate level for nucleation and the permissible increment of CaOx relative supersaturation (CaOx RS). In filtered urine from stone formers the permissible increment of oxalate was lower than controls (30 +/- 10.2 vs. 46.7 +/- 9.7 mg/l, P = 0.001), the oxalate level for nucleation was lower (64.4 +/- 14.2 vs. 79.5 +/- 15.6 mg/l, P = 0.035) and the permissible increment of CaOx RS was also lower (9.71 +/- 2.59 vs. 13.39 +/- 3.62, P = 0.018). In ultrafiltered urine these differences disappeared because the removal of macromolecules in stone formers significantly enhanced the oxalate-tolerance values. The difference between the change of the oxalate permissible increment of filtered and ultrafiltered urine allowed a distinction to be made between stone formers and controls that was not feasible in other ways (7.6 +/- 5.3 vs. 3.3 +/- 5.9 mg/l, P < 0.0001). The study suggests that, in idiopathic CaOx stone formers free from common urinary risk factors of CaOx crystallization, there is an increased tendency for CaOx nucleation in urine, which is mediated by macromolecular components.
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Affiliation(s)
- L Borghi
- Institute of Semeiotica Medica, University of Parma Medical School, Italy
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10
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Gohel MD, Shum DK, Li MK. Crystallization of urinary calcium oxalate at standardized osmolality and pH in the frozen state. Clin Chim Acta 1994; 231:11-22. [PMID: 7704943 DOI: 10.1016/0009-8981(94)90249-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The potential of whole urine of stone-formers and normal controls to precipitate crystals of calcium oxalate dihydrate from ions endogenous in urine was investigated by the method of rapid evaporation to 1250 mOsm/kg and subsequent freezing. Over 90% incidence in crystallization was achieved in the two groups. When the population density and size of these crystals were compared, it was found that 50% of urine samples from stone formers (30-50 years of age) were rich in crystal-nucleating and growth-inhibiting factors and the other 50% were not different from normal controls. These effects were observed when polyanionic macromolecules recovered from pooled urine samples of stone-formers or normal controls were dissolved in urine ultrafiltrate and similarly tested. That the urinary polyanions were the active modifiers in the test system was further corroborated by the reversal of crystallization activity of urine samples and the urinary polyanions after they had been through an acidification-reneutralization procedure. The urinary polyanionic macromolecules were found, after enzymatic and/or chemical treatment, to contain chondroitin sulphates, dermatan sulphates, heparan sulphates and glycoproteins.
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Affiliation(s)
- M D Gohel
- Department of Biochemistry, Faculty of Medicine, University of Hong Kong
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11
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Zaharopoulos P, Wen JW, Wong J. Matrix crystals in cytologic urine specimens: observations on their mineral composition by energy dispersive X-ray microanalysis and morphologic scanning electron microscopy. Diagn Cytopathol 1994; 11:38-46. [PMID: 7956658 DOI: 10.1002/dc.2840110110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Crystals consisting by light microscopy of organic matrix (matrix crystals) encountered in cytologic urine specimens of 8 patients were examined for mineral phase components by scanning electron microscopy with energy dispersive X-ray microanalysis (SEM-EDX) and by morphologic scanning electron microscopy (SEM) performed separately in four of the eight cases. Whenever possible (three cases) mineralized crystals present in these specimens were examined separately by SEM-EDX for comparison of mineral phase composition with that of the corresponding matrix forms. Although by SEM-EDX components of matrix, glass and slide preparation media interfere with the precise estimation of the mineral phase components, the results of this method supported by the SEM morphology suggest that crystals consisting of organic matrix include a mineral phase, the lattice structure of which provides them from the early stages of formation with the characteristic morphology of the fully mineralized forms. This also suggests that organic matrix plays a role in the nucleation of minerals during the formation of certain urinary crystals.
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Affiliation(s)
- P Zaharopoulos
- Department of Pathology, University of Texas Medical Branch, Galveston 77550
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12
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Ebisuno S, Kohjimoto Y, Yoshida T, Ohkawa T. Effect of urinary macromolecules on aggregation of calcium oxalate in recurrent calcium stone formers and healthy. UROLOGICAL RESEARCH 1993; 21:265-8. [PMID: 8212414 DOI: 10.1007/bf00307708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The inhibitory activity of urinary macromolecules on the aggregation of calcium oxalate crystals was studied using an aggregometer originally devised to measure thrombocyte aggregation capacity by means of the optical turbidity at 660 nm. The macromolecular fraction of the urine (molecular weight above 5000) of recurrent calcium stone formers showed much less inhibitory activity than that of healthy controls (P < 0.05). It was speculated on the basis of the results of gel filtration that there were some proteins (molecular weight about 10,000-30,000) which had inhibitory activities for the aggregation of calcium oxalate. This gives support to the assumption that macromolecules are important during the phase of aggregation of calcium oxalate crystals.
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Affiliation(s)
- S Ebisuno
- Department of Urology, Minami Wakayama National Hospital, Tanabe shi, Japan
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Utsunomiya M, Koide T, Yoshioka T, Yamaguchi S, Okuyama A. Influence of ionic strength on crystal adsorption and inhibitory activity of macromolecules. BRITISH JOURNAL OF UROLOGY 1993; 71:516-22. [PMID: 8518855 DOI: 10.1111/j.1464-410x.1993.tb16017.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigated the influence of ionic strength on both the binding ability of macromolecules onto calcium oxalate crystals and the inhibitory activity of macromolecules related to calcium oxalate crystal growth and aggregation in vitro. The amount of heparin sodium salt adsorbed onto calcium oxalate crystals was studied in both a seed and a non-seed crystal system at various ionic strengths with the aid of radiolabelled heparin. In both adsorption models, adsorption of heparin was greater in the buffered solutions of lower ionic strength, and significantly so in the range of physiological ionic strength. The inhibitory activity of heparin in the non-seed crystal system, which was determined using a Coulter Multisizer, increased as the adsorbed dose increased. The naturally existing urinary macromolecules showed a similar change in their inhibitory activity on calcium oxalate crystal growth and/or aggregation in accordance with changes in ionic strength. These results indicate that macromolecular inhibitory activity seems to be enhanced in urine of lower ionic strength as a result of an increased adsorption of macromolecules on the surface of calcium oxalate crystals.
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Affiliation(s)
- M Utsunomiya
- Department of Urology, Osaka University Medical School, Japan
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14
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Baumann JM. Physico-chemical aspects of calcium stone formation. UROLOGICAL RESEARCH 1990; 18 Suppl 1:S25-30. [PMID: 1963243 DOI: 10.1007/bf00301524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J M Baumann
- Department of Urology, Biel Hospital, Switzerland
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