Urological Research

, Volume 39, Issue 6, pp 421–427 | Cite as

Aggregation of freshly precipitated calcium oxalate crystals in urine of calcium stone patients and controls

Original Paper

Abstract

Aggregation (AGN) of freshly precipitated calcium oxalate crystals was photometrically studied in urine of 30 calcium stone patients and 30 controls, in solutions containing urinary macromolecules (UMS) and in an inhibitor free control solution (CS). Crystals were produced by oxalate titration and crystallization was monitored measuring optical density (OD). Tests were repeated adding hydroxyapatite (HAP) to urine and UMS and adding citrate and pyrophosphate (PPi) to UMS of the controls. AGN was recognized as a rapid OD decrease being at least three times faster than sedimentation of single crystals (p < 0.001) and used to calculate an extent of AGN (EA%). The time between the end of titration and the beginning of AGN was determined as suspension stability (SS). The main effect of urinary inhibitors was retardation of AGN without changing EA, SS being higher in urine than UMS (p < 0.001) and in UMS than CS (p < 0.001). In urine of 63% of controls but only in 33% of patients, no AGN was recorded (p < 0.05). The high inhibitory activity of urine could not be reproduced in UMS even in combination with 3.5 mM citrate or 0.05 mM PPi. 0.05 mg/mL HAP reduced SS in all urine samples to low values and increased the rate of rapid OD decrease, being a measure for the size of aggregates. Retarding AGN of crystals during their passage through the kidney seems to be an important mechanism to prevent stone formation during crystalluria. The promotion of AGN by HAP reveals a new role of Randall’s plaques in nephrolithiasis.

Keywords

Calcium oxalate Aggregation Urinary macromolecules Hydroxyapatite Nephrolithiasis 

References

  1. 1.
    Robertson WG, Peacock M, Nordin BEC (1969) Calcium crystalluria in recurrent renal stone formers. Lancet 2:21–24PubMedCrossRefGoogle Scholar
  2. 2.
    Kok DJ, Papapoulos SE, Bijvoet OL (1990) Crystal agglomeration is a major element in calcium oxalate urinary stone formation. Kidney Int 37(1):51–56PubMedCrossRefGoogle Scholar
  3. 3.
    Baumann JM, Affolter B, Meyer R (2010) Crystal sedimentation and stone formation. Urol Res 38:21–27PubMedCrossRefGoogle Scholar
  4. 4.
    Saw NK, Rao PN, Kavanagh JP (2008) A nidus, crystalluria and aggregation: key ingredients for stone enlargement. Urol Res 36(1):11–15PubMedCrossRefGoogle Scholar
  5. 5.
    Matlaga BR, Coe FL, Evan AP, Lingeman JE (2007) The role of Randall’s plaques in the pathogenesis of calcium stones. J Urol 177(1):31–38PubMedCrossRefGoogle Scholar
  6. 6.
    Khan SR, Thamilselvan S (2000) Nephrolithiasis: a consequence of renal epithelial cell exposure to oxalate and calcium oxalate crystals. Mol Urol 4(4):305–312PubMedGoogle Scholar
  7. 7.
    Coe FL, Evan AP, Worcester EM, Lingeman JE (2010) Three pathways for human kidney stone formation. Urol Res 38(3):147–160Google Scholar
  8. 8.
    Khan SR, Kok DJ (2004) Modulators of urinary stone formation. Frontiers Biosci 9:1450–1482CrossRefGoogle Scholar
  9. 9.
    Hess B, Nakagawa Y, Coe FL (1989) Inhibition of calcium oxalate monohydrate crystal aggregation by urine proteins. Am J Physiol (Renal Fluid Electrolyte Physiol 26) 257:99–106Google Scholar
  10. 10.
    Wesson JA, Ganne V, Beshensky AM, Kleinman JG (2005) Regulation by macromolecules of calcium oxalate crystal aggregation in stone formers. Urol Res 33:206–212PubMedCrossRefGoogle Scholar
  11. 11.
    Asplin JR, Parks JH, Chen MS, Lieske JC, Toback FG, Pillay SN, Nakagawa Y, Coe FL (1999) Reduced crystallization inhibition by urine from men with nephrolithiasis. Kidney Int 56:1505–1516PubMedCrossRefGoogle Scholar
  12. 12.
    Asplin JR, Parks JH, Nakagawa Y, Coe FL (2002) Reduced crystallization inhibition by urine from women with nephrolithiasis. Kidney Int 61:1821–1829PubMedCrossRefGoogle Scholar
  13. 13.
    Rodgers AL, Mensah PD, Schwager SL, Sturrock ED (2006) Inhibition of calcium oxalate crystallization by commercial human serum albumin and human urinary albumin isolated from two different race groups: evidence for possible molecular differences. Urol Res 34:373–380PubMedCrossRefGoogle Scholar
  14. 14.
    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 35:55–62PubMedCrossRefGoogle Scholar
  15. 15.
    Webber D, Rodgers AL, Sturrock ED (2007) Glycosylation of prothrombin fragment 1 governs calcium oxalate crystal nucleation and aggregation, but not crystal growth. Urol Res 35:277–285PubMedCrossRefGoogle Scholar
  16. 16.
    Scurr DS, Robertson WG (1986) Modifiers of calcium oxalate crystallization found in urine III. Studies on the role of Tamm–Horsfall mucoprotein and of ionic strength. J Urol 136:505–507PubMedGoogle Scholar
  17. 17.
    Hess B, Zipperle L, Jaeger P (1993) Citrate and calcium effects on Tamm–Horsfall glycoprotein as a modifier of calcium oxalate crystal aggregation. Am J Physiol 265:784–791Google Scholar
  18. 18.
    Baumann JM, Affolter B, Caprez U, Clivaz C, Glück Z, Weber R (2007) Stabilization of calcium oxalate suspension by urinary macromolecules, probably an efficient protection from stone formation. Urol Int 79:267–272PubMedCrossRefGoogle Scholar
  19. 19.
    Højgaard I, Fornander AM, Nilsson MA, Tiselius HG (1999) Crystallization during volume reduction of solutions with a composition corresponding to that in the collecting duct: the influence of hydroxyapatite seed crystals and urinary macromolecules. Urol Res 27:417–425PubMedCrossRefGoogle Scholar
  20. 20.
    Baumann JM, Affolter B, Caprez U, Henze U, Lauper D, Maier F (2001) Hydroxyapatite induction and secondary aggregation of calcium oxalate, two important processes in calcium stone formation. Urol Res 29:417–422PubMedCrossRefGoogle Scholar
  21. 21.
    Baumann JM, Affolter B, Caprez U, Henze U (2003) Calcium oxalate aggregation in whole urine, new aspects of calcium stone formation and metaphylaxis. Eur Urol 43:421–425PubMedCrossRefGoogle Scholar
  22. 22.
    Müller RH (1996) Zetapotential und Partikelladung in der Laborpraxis. Stuttgart, Wissenschaftliche Verlagsgesellschaft, 37Google Scholar
  23. 23.
    Baumann JM, Affolter B, Caprez U, Clivaz C, von Arx U (2009) Role of calcium in the aggregation of particles coated by urinary macromolecules. Urol Int 82:459–463PubMedCrossRefGoogle Scholar
  24. 24.
    Robertson WG (2004) Kidney models of calcium oxalate stone formation. Nephron Physiol 98:21–30CrossRefGoogle Scholar
  25. 25.
    Butt AJ (1952) Role of protective urinary colloid in prevention of renal lithiasis. J Urol 67:450–459PubMedGoogle Scholar
  26. 26.
    Chutipongtanate S, Thongboonkerd V (2010) Red blood cell membrane fragments but not intact red blood cells promote calcium oxalate monohydrate crystal growth and aggregation. J Urol 184(2):743–749PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Stone Research Center ViollierBielSwitzerland
  2. 2.Department of UrologyHospital Center BielBielSwitzerland

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