Abstract
Jackstone calculi, having arms that extend out from the body of the stone, were first described over a century ago, but this morphology of stones has been little studied. We examined 98 jackstones from 50 different patient specimens using micro-computed tomography (micro CT) and infrared (IR) spectroscopy. Micro CT showed that jackstone arms consisted of an X-ray lucent core within each arm. This X-ray lucent core frequently showed sporadic, thin layers of apatite arranged transversely to the axis of the arm. The shells of the jackstones were always composed of calcium oxalate (CaOx), and with the monohydrate form the majority or sole mineral. Study of layering in the shell regions by micro CT showed that growth lines extended from the body of the stone out onto jack arms and that the thickness of the shell covering of jack arms often thinned with distance from the stone body, suggesting that the arms grew at a faster radial rate than did the stone body. Histological cross-sections of decalcified jackstone arms showed the core to be more highly autofluorescent than was the CaOx shell, and immunohistochemistry showed the core to be enriched in Tamm-Horsfall protein. We hypothesize that the protein-rich core of a jack arm might preferentially bind more protein from the urine and resist deposition of CaOx, such that the arm grows in a linear manner and at a faster rate than the bulk of the stone. This hypothesis thus predicts an enrichment of certain urine proteins in the core of the jack arm, a theory that is testable by appropriate analysis.
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References
Price PC (1860) Fourteen calculi removed from the bladder of a man aged 72, by the operation of lithotomy; curious form of the larger stones. Transactions of the Pathological Society of London 11:166–168
Ord WM, Shattock SG (1895) On the microscopic structure of urinary calculi of oxalate of lime. Trans Path Soc London 46:91–132
Perlmutter S, Hsu CT, Villa PA, Katz DS (2002) Sonography of a human jackstone calculus. J Ultrasound Med 21:1047–1051
Singh KJ, Tiwari A, Goyal A (2011) Jackstone: A rare entity of vesical calculus. Indian J Urol 27:543–544
Subasinghe D, Goonewardena S, Kathiragamathamby V (2017) Jack stone in the bladder: case report of a rare entity. BMC Urol 17:401
Carneiro C, Cunha MF, Brito J (2020) Jackstone Calculus. Urology 137:e6–e7
Williams JC Jr, McAteer JA, Evan AP, Lingeman JE (2010) Micro-computed tomography for analysis of urinary calculi. Urol Res 38:477–484
Schindelin J, Arganda-Carreras I, Frise E, Kaynig V, Longair M, Pietzsch T, Preibisch S, Rueden C, Saalfeld S, Schmid B, Tinevez JY, White DJ, Hartenstein V, Eliceiri K, Tomancak P, Cardona A (2012) Fiji: an open-source platform for biological-image analysis. Nat Methods 9:676–682
Canela VH, Bledsoe SB, Lingeman JE, Gerber G, Worcester EM, El-Achkar TM, Williams Jr JC (2021) Demineralization and sectioning of human kidney stones: A molecular investigation revealing the spatial heterogeneity of the stone matrix. Physiol Rep 9:e14658
Winfree S, Weiler C, Bledsoe SB, Gardner T, Sommer AJ, Evan AP, Lingeman JE, Krambeck AE, Worcester EM, El-Achkar TM, Williams JC, Jr. (2021) Multimodal imaging reveals a unique autofluorescence signature of Randall's plaque. Urolithiasis, in press
Crowe AR, Yue W (2019) Semi-quantitative determination of protein expression using immunohistochemistry staining and analysis: an integrated protocol. Bio-protocol 9(24):e3465. https://doi.org/10.21769/BioProtoc.3465
Seyed Jafari SM, Hunger RE (2017) IHC Optical Density Score: A New Practical Method for Quantitative Immunohistochemistry Image Analysis. Appl Immunohistochem Mol Morphol 25:e12–e13
Williams JC Jr, Worcester E, Lingeman JE (2017) What can the microstructure of stones tell us? Urolithiasis 45:19–25
Borofsky MS, Paonessa JE, Evan AP, Williams JC Jr, Coe FL, Worcester EM, Lingeman JE (2016) A Proposed Grading System to Standardize the Description of Renal Papillary Appearance at the Time of Endoscopy in Patients with Nephrolithiasis. J Endourol 30:122–127
Rivera M, Cockerill PA, Enders F, Mehta RA, Vaughan L, Vrtiska TJ, Hernandez LPH, Holmes Iii DR, Rule AD, Lieske JC, Krambeck AE (2016) Characterization of Inner Medullary Collecting Duct Plug Formation among Idiopathic Calcium Oxalate Stone Formers. Urology 94:47–52
Daudon M, Williams JC, Jr. (2020) Characteristics of Human Kidney Stones. In: Coe F, Worcester EM, Lingeman JE, Evan AP (eds) Kidney Stones. Jaypee Medical Publishers, pp 77–97
Boyce WH (1968) Organic matrix of human urinary concretions. Am J Med 45:673–683
Leal JJ, Finlayson B (1977) Adsorption of naturally occurring polymers onto calcium oxalate crystal surfaces. Invest Urol 14(4):278–283
Khan SR, Finlayson B, Hackett RL (1983) (1983) Stone matrix as proteins adsorbed on crystal surfaces: a microscopic study. Scanning Electron Microsc I:379–385
Khan SR, Hackett, RL (1984) Microstructure of decalcified human calcium oxalate urinary stones. Scan Electron Microsc 6(1984/II):935–41
Khan SR, Hackett RL (1993) Role of organic matrix in urinary stone formation: an ultrastructural study of crystal matrix interface of calcium oxalate monohydrate stones. J Urol 150(1):239–245. https://doi.org/10.1016/s0022-5347(17)35454-x
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 35:55–62
El-Achkar TM, McCracken R, Liu Y, Heitmeier MR, Bourgeois S, Ryerse J, Wu XR (2013) Tamm-Horsfall protein translocates to the basolateral domain of thick ascending limbs, interstitium, and circulation during recovery from acute kidney injury. Am J Physiol Renal Physiol 304:F1066-1075
Witzmann FA, Evan AP, Coe FL, Worcester EM, Lingeman JE, Williams JC Jr (2016) Label-free proteomic methodology for the analysis of human kidney stone matrix composition. Proteome Sci 14:4
Wesson JA, Kolbach-Mandel AM, Hoffmann BR, Davis C, Mandel NS et al (2019) Selective protein enrichment in calcium oxalate stone matrix: a window to pathogenesis? Urolithiasis 47:521–532. https://doi.org/10.1007/s00240-019-01131-3
Acknowledgements
We would like to thank Jim Smotherman at Beck Analytical for providing discarded stones for study. Special thanks to Andre Turner, Charles Robling, Angela Sabo and Tony Gardner for assistance in specimen collection.
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Funding by NIH P01 DK056788, S10 RR023710, S10 OD016208 and R01 DK124776.
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Local Internal Review Board approved stone collection from patients.
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Canela, V.H., Dzien, C., Bledsoe, S.B. et al. Human jackstone arms show a protein-rich, X-ray lucent core, suggesting that proteins drive their rapid and linear growth. Urolithiasis 50, 21–28 (2022). https://doi.org/10.1007/s00240-021-01275-1
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DOI: https://doi.org/10.1007/s00240-021-01275-1