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Struvite Stone Formation by Ureolytic Biofilm Infections

  • Logan N. Schultz
  • James Connolly
  • Ellen Lauchnor
  • Trace A. Hobbs
  • Robin Gerlach

Abstract

This chapter describes how urinary tract infections can lead to stone formation. The most frequent type of infection stone is struvite (MgNH4PO4 · 6H2O), although it is common that struvite stones and infections are associated with other stone types, often forming large staghorn calculi. A complete understanding of struvite stone formation requires knowledge of the pathogen biology, including metabolic activity and motility, as well as a basic understanding of how minerals form.

The pathogens responsible for struvite stones are those that break down urea into ammonium (NH4+) and inorganic carbon. This reaction, known as ureolysis, increases the pH of urine and the concentration of NH4+, thus increasing the saturation index of struvite. If supersaturation is reached, i.e. the ion activity product (IAP) is greater than the ion activity product at equilibrium (Ksp), struvite stone formation is possible.

An important consideration with urinary tract infections is that pathogens often form attached communities, known as biofilms, which help them to survive physical and chemical stresses. Not only are biofilm-related infections more difficult to treat, but they can facilitate stone formation by creating gradients in chemical concentrations near surfaces. Modern laboratory bioreactors and computer models, described in this chapter, are improving our understanding of how and why infection stones such as struvite form. Current treatment options for infection stones can be painful or ineffective. As more is learned about the complex microbe-fluid-mineral interactions, less-invasive treatments and more-effective prevention strategies will be developed.

Keywords

Urinary Tract Infection (UTI) Struvite Urolithiasis Saturation Index Biofilm Ureolysis Reactive Transport Modeling Geochemical Equilibrium Modeling 

Notes

Acknowledgements

This work was supported by the National Science Foundation through NSF award DMS-0934696. James Connolly was also supported by a NSF-IGERT fellowship in Geobiological Systems at Montana State University (DGE-0654336). Trace Hobbs was supported by a Howard Hughes Medical Institute Scholarship through Montana State University.

References

  1. 1.
    Adams F. The genuine works of hippocrates. New York: William and Wood; 1929.Google Scholar
  2. 2.
    Murphy L. The history of urology. Springfield: Charles C. Thomas Publisher LTD; 1972.Google Scholar
  3. 3.
    Bazin D, Andre G, Weil R, Matzen G, Emmanuel V, Carpentier X, Daudon M. Absence of bacterial imprints on struvite-containing kidney stones: a structural investigation at the mesoscopic and atomic scale. Urology. 2012;79:786–90.CrossRefPubMedGoogle Scholar
  4. 4.
    Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon. 2003;49:71–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Bichler KH, Eipper E, Naber K, Braun V, Zimmermann R, Lahme S. Urinary infection stones. Int J Antimicrob Agents. 2002;19:488–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Jones BD, Mobley HLT. Genetic and biochemical diversity of ureases of proteus, providencia, and morganella species isolated from urinary-tract infection. Infect Immun. 1987;55:2198–203.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Griffith DP. Infection-induced renal calculi. Kidney Int. 1982;21:422–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284:1318–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Armbruster CE, Mobley HLT. Merging mythology and morphology: the multifaceted lifestyle of proteus mirabilis. Nat Rev Microbiol. 2012;10:743–54.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    McLean RJC, Nickel JC, Cheng KJ, Costerton JW. The ecology and pathogenicity of urease-producing bacteria in the urinary-tract. CRC Crit Rev Microbiol. 1988;16:37–79.CrossRefGoogle Scholar
  11. 11.
    Griffith DP. Struvite stones. Kidney Int. 1978;13:372–82.CrossRefPubMedGoogle Scholar
  12. 12.
    Holmes R, Knight J, Assimos D. Origin of urinary oxalate. Indianapolis: AIP; 2007. p. 176.Google Scholar
  13. 13.
    Aage HK, Andersen BL, Blom A, Jensen I. The solubility of struvite. J Radioanal Nucl Chem. 1997;223:213–5.CrossRefGoogle Scholar
  14. 14.
    De Yoreo JJ, Vekilov PG. Principles of crystal nucleation and growth. In: Biomineralization, vol. 54. Washington, DC: Mineralogical Society of America; 2003.Google Scholar
  15. 15.
    Hinman F. Directional growth of renal calculi. J Urol. 1979;121:700–5.PubMedGoogle Scholar
  16. 16.
    Wickham JEA. Matrix and infective renal calculus. Br J Urol. 1975;47:727–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Desgrandchamps F, Moulinier F, Daudon M, Teillac P, LeDuc A. An in vitro comparison of urease-induced encrustation of JJ stents in human urine. Br J Urol. 1997;79:24–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Jones DS, Djokic J, Gorman SP. Characterization and optimization of experimental variables within a reproducible bladder encrustation model and in vitro evaluation of the efficacy of urease inhibitors for the prevention of medical device-related encrustation. J Biomed Mater Res B Appl Biomater. 2006;76B:1–7.CrossRefGoogle Scholar
  19. 19.
    Morris NS, Stickler DJ, Winters C. Which indwelling urethral catheters resist encrustation by proteus mirabilis biofilms? Br J Urol. 1997;80:58–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Tunney MM, Keane PF, Jones DS, Gorman SP. Comparative assessment of ureteral stent biomaterial encrustation. Biomaterials. 1996;17:1541–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Chew BH, Duvdevani M, Denstedt JD. New developments in ureteral stent design, materials and coatings. Expert Rev Med Devices. 2006;3:395–403.CrossRefPubMedGoogle Scholar
  22. 22.
    Gilmore BF, Hamill TM, Jones DS, Gorman SP. Validation of the cdc biofilm reactor as a dynamic model for assessment of encrustation formation on urological device materials. J Biomed Mater Res B Appl Biomater. 2010;93B:128–40.Google Scholar
  23. 23.
    Schulz A, Vestweber AM, Leis W, Stark D, Dressler D. An improved model of a catheterised human bladder for screening bactericidal agents. Aktuelle Urol. 2008;39:53–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Bucs SS, Radu AI, Lavric V, Vrouwenvelder JS, Picioreanu C. Effect of different commercial feed spacers on biofouling of reverse osmosis membrane systems: a numerical study. Desalination. 2014;343:26–37.CrossRefGoogle Scholar
  25. 25.
    Radu AI, Bergwerff L, van Loosdrecht MCM, Picioreanu C. A two-dimensional mechanistic model for scaling in spiral wound membrane systems. Chem Eng J. 2014;241:77–91.CrossRefGoogle Scholar
  26. 26.
    Parkhurst D, Appelo C: User’s guide to PHREEQC (Version 2) — A Computer Program For Speciation, Batch-Reaction, One-Dimensional Transport, And Inverse Geochemical Calculations. U.S. Geological Survey Water-Resources Investigations Report 99–4259. 312 pp. (1999). http://pubs.er.usgs.gov/publication/wri994259
  27. 27.
    Nardi A, Idiart A, Trinchero P, de Vries LM, Molinero J. Interface comsol-phreeqc (icp), an efficient numerical framework for the solution of coupled multiphysics and geochemistry. Comput Geosci. 2014;69:10–21.CrossRefGoogle Scholar
  28. 28.
    Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones-pathogenesis, microbiology, and management strategies. Nat Rev Urol. 2014;11:333–41.CrossRefPubMedGoogle Scholar
  29. 29.
    Parmar MS. Kidney stones. Br Med J. 2004;328:1420–4.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Chemical and Biological EngineeringCenter for Biofilm Engineering, Montana State UniversityBozemanUSA
  2. 2.Department of Chemical and Biological EngineeringCenter for Biofilm Engineering, Montana State UniversityBozemanUSA
  3. 3.Hyalite Engineers, PLLCBozemanUSA
  4. 4.Civil Engineering, Center for Biofilm EngineeringMontana State UniversityBozemanUSA
  5. 5.Department of Chemistry and Biochemistry, Center for Biofilm EngineeringMontana State UniversityBozemanUSA

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