Journal of Nephrology

, Volume 30, Issue 1, pp 135–140 | Cite as

Interpreting the results of chemical stone analysis in the era of modern stone analysis techniques

  • Ron GiladEmail author
  • James C. WilliamsJr.
  • Kalba D. Usman
  • Ronen Holland
  • Shay Golan
  • Ruth Tor
  • David Lifshitz
Original Article


Introduction and objective

Stone analysis should be performed in all first-time stone formers. The preferred analytical procedures are Fourier-transform infrared spectroscopy (FT-IR) or X-ray diffraction (XRD). However, due to limited resources, chemical analysis (CA) is still in use throughout the world. The aim of the study was to compare FT-IR and CA in well matched stone specimens and characterize the pros and cons of CA.


In a prospective bi-center study, urinary stones were retrieved from 60 consecutive endoscopic procedures. In order to assure that identical stone samples were sent for analyses, the samples were analyzed initially by micro-computed tomography to assess uniformity of each specimen before submitted for FTIR and CA.


Overall, the results of CA did not match with the FTIR results in 56 % of the cases. In 16 % of the cases CA missed the major stone component and in 40 % the minor stone component. 37 of the 60 specimens contained CaOx as major component by FTIR, and CA reported major CaOx in 47/60, resulting in high sensitivity, but very poor specificity. CA was relatively accurate for UA and cystine. CA missed struvite and calcium phosphate as a major component in all cases. In mixed stones the sensitivity of CA for the minor component was poor, generally less than 50 %.


Urinary stone analysis using CA provides only limited data that should be interpreted carefully. Urinary stone analysis using CA is likely to result in clinically significant errors in its assessment of stone composition. Although the monetary costs of CA are relatively modest, this method does not provide the level of analytical specificity required for proper management of patients with metabolic stones.


Nephrolithiasis Stone composition Chemical analysis FT-IR 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Italian Society of Nephrology 2016

Authors and Affiliations

  • Ron Gilad
    • 1
    Email author
  • James C. WilliamsJr.
    • 2
  • Kalba D. Usman
    • 1
  • Ronen Holland
    • 1
  • Shay Golan
    • 1
  • Ruth Tor
    • 3
  • David Lifshitz
    • 1
  1. 1.Sackler School of Medicine, Rabin Medical CenterTel Aviv University and the Institute of UrologyPetach TikvaIsrael
  2. 2.Department of Anatomy and Cell BiologyIndiana University School of MedicineIndianapolisUSA
  3. 3.Chemical LaboratoryRabin Medical CenterPetach TikvaIsrael

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