F. Grases

Simple classification of renal calculi closely related to their micromorphology and etiology

BACKGROUND Classification of renal calculi with clear correlation with the main urinary etiological conditions has been previously established. However, such information is complex and difficult to adapt to clinical routine practice. METHODS A simple classification of renal calculi based on their structure and composition is proposed and applied to 2500 renal calculi to achieve the percentage of each category. The urines of 700 individuals chosen randomly have been analyzed and the results compared with those obtained with 51 healthy subjects. RESULTS 12.9% calculi corresponded to calcium oxalate monohydrate papillary calculi, 16.4% to calcium oxalate monohydrate unattached calculi, 33.8% to calcium oxalate dihydrate calculi, 11.2% calcium oxalate dihydrate/hydroxyapatite mixed calculi, 7.1% hydroxyapatite calculi, 4.1% struvite calculi, 0.6% brushite calculi, 8.2% uric acid calculi, 2.6% calcium oxalate/uric acid mixed calculi, 1.1% cystine calculi and 1.9% various infrequent calculi. Based on the corresponding urinary analytical studies, each kind of calculus is related with the more frequently associated urinary alterations. CONCLUSIONS An important aspect of this classification is the possibility to establish, by means of the correct study of the calculus, some of the main possible etiologic factors closely related to its formation.

Sialolithiasis: mechanism of calculi formation and etiologic factors

BACKGROUND Sialolithiasis is a common disease of salivary glands. The etiology of these calculi is little known and their exact mechanism of formation is unknown. METHODS The composition and structure of 21 sialoliths were studied and the composition of the saliva of each corresponding patient was determined (pH, calcium, magnesium, phosphorus, citrate and phytate). RESULTS Eighteen sialoliths exhibited similar macro and microstructure, being constituted by hydroxyapatite (HAP) and organic matter, normally arranged in a multilayer structure. The three remaining sialoliths were exclusively constituted by organic matter. The salivary Ca of patients with HAP calculi was significantly higher than that found in the saliva of the healthy group. The salivary phytate concentration of patients with HAP calculi was significantly inferior to that found in patients with calculi exclusively formed by organic matter, as well as to that found in saliva of healthy group. Significant differences between the salivary magnesium concentrations of patients with HAP calculi and the control group were also observed. No significant differences between pH and citrate concentrations of the three groups were found. CONCLUSIONS It was concluded that the deficit of crystallization inhibitors such as myo-inositol hexaphosphate (phytate) was also an important etiologic factor implied in the sialolith development.

Renal lithiasis and nutrition.

Renal lithiasis is a multifactorial disease. An important number of etiologic factors can be adequately modified trough diet, since it must be considered that the urine composition is directly related to diet. In fact, the change of inappropriate habitual diet patterns should be the main measure to prevent kidney stones. In this paper, the relation between different dietary factors (liquid intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins) and each type of renal stone (calcium oxalate monohydrate papillary, calcium oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric acid, calcium oxalate/uric acid and cystine) is discussed.

Urinary Phytate in Calcium Oxalate Stone Formers and Healthy People: Dietary Effects on Phytate Excretion

The phytate urinary levels in a group of active calcium oxalate stone formers were studied and compared with those found in healthy people. Urinary phytate was significantly lower for stone formers. If deficit of the capacity to inhibit crystallization of calcium salts is considered an important factor related to calcium stone formation, the excretion of low phytate amounts could be an important risk factor in the development of this type of renal calculi. The influence of dietary phytate on urinary excretion was also studied. Clearly maintenance of a phytate-free diet significantly decreased the urinary excretion of phytate (about 50% after 36 h). This demonstrated the importance of dietary phytate in maintaining adequate urinary levels to permit effective crystallization inhibition of calcium salts and consequently preventing renal stone development.

Effects of phytate and pyrophosphate on brushite and hydroxyapatite crystallization

Abstract This is a comparative study of the effects of phytate and pyrophosphate and other polyphosphates on the crystallization of hydroxyapatite and brushite, the most frequent calcium phosphates involved in calcium oxalate urolithiasis. Brushite and hydroxyapatite crystal formation was studied in synthetic urine, through kinetic-turbidimetric measurements that allowed evaluation of the inhibitory effects on crystallization of insoluble salts. The effectiveness in preventing brushite crystallization decreases in the sequence phytate > polyphosphate > EDTPO > etidronate > pyrophosphate > triphosphate > medronate; whereas the order of effectiveness in preventing hydroxyapatite crystallization was EDTPO > etidronate=pyrophosphate > triphosphate > medronate > polyphosphate > phytate. Phytate, a natural inhibitor in urine, most effectively blocked brushite precipitation (1.21·10−5 M prevented crystallization during time periods of at least 1 h), and pyrophosphate was the natural inhibitor that most effectively blocked hydroxyapatite precipitation (2.87·10−6 M prevented crystallization during time periods of at least 1 h). This demonstrates that low excretion of these substances would pose a risk of renal lithiasis.

Biopathological crystallization : a general view about the mechanisms of renal stone formation

Abstract A general classification of most common renal calculi (calcium oxalate, phosphate and uric acid stones) based on their formation mechanism is presented. The main etiological factors that enable their development are discussed considering present knowledge of calcium oxalate, insoluble urinary phosphates and uric acid crystallization and the fine structure of respective renal stones. Considering the formation mechanisms of the discussed calculi, common aspects permit us to distinguish two general mechanisms of calculi formation: development of calculi attached to papillary epithelium and development of calculi in cavities without any attachment to urothelium.

Variation of InsP4,InsP5 and InsP6 levels in tissues and biological fluids depending on dietary phytate

Due to the increasing interest of InsP(6) on human health, the aim of this paper is to compare the levels of highly phosphorilated inositols (InsP(4), InsP(5) and InsP(6)) in organs and biological fluids of rats and to study the influence of the presence and absence of InsP(6) in diets. Thus, for this purpose, the variation of InsP(4), InsP(5) and InsP(6) levels in organs and biological fluids of rats submitted to two different diets were studied. In the AIN-76A diet no InsP(6) was present, yet the other was a 1% InsP(6) modified diet (AIN-76A + 1% InsP(6)). The highest InsP(4), InsP(5) and InsP(6) levels were found to be 10-fold superior in the brain than those found in the kidney. When the InsP(6) was eliminated from the diet, the InsP(6) levels decreased dramatically (97.2% in kidney, 89.8% in brain, 100% in bone, 90.5% in plasma and 98.1% in urine), the InsP(5) levels showed an important decrease (61.2% in kidney, 45.5% in brain, 28.1% in bone, 30% in plasma and 88.6% in urine) and the InsP(4) levels in organs only changed slightly. From these results, it can be deduced that the majority of InsP(6) present in the organism is of dietary origin and its endogenous synthesis is not important. According to the results, it can be evidenced that the endogenous synthesis of InsP(5) can occur, besides InsP(6) can be transformed by enzymatic dephosphorilation in InsP(5).

Phytate acts as an inhibitor in formation of renal calculi.

The aim of this study was to assess the inhibitory action of phytate in formation of renal calculi. Hypertension (induced by nicotine) combined with hypercalcemia (induced by D vitamin) was used to induce calcification in renal tissue in male Wistar rats that were fed a purified phytate free diet. Phytate non-treated rats developed significant calcium deposits in kidneys and papillae, as well as in kidney tubules and vessels, whereas calcium deposits were absent in control and phytate treated rats. Fragments of hydroxyapatite (HAP) calculi exhibited the capacity to induce the growth of calcium salts on their surfaces. Presence of 1.5 mg/L of phytate in the synthetic urine inhibited the formation of calcium oxalate monohydrate on HAP renal calculi in normocalciuric conditions. The findings show that the action of phytate as a crystallization inhibitor takes place both in the intrapapillary tissue and urine.

Effects of Phytic Acid on Renal Stone Formation in Rats

The effects of phytic acid and phytic acid/zinc mixtures on renal urolith development in an animal model of nephrolitiasis were studied. Male rats were divided into four groups of 15, 10, 10 and 12 rats each. The rats of Group I were treated with ethylene glycol; of Group II with ethylene glycol plus zinc; of Group III with ethylene glycol phytic acid; and of Group IV with ethylene glycol plus a mixture of phytic acid/zinc. Urine analysis (24 h) was carried out to determine the levels of calcium, oxalate, citrate, zinc and phytic acid in each group. At the end of the experiment all kidneys were removed and examined macroscopically and microscopically for possible crystal/stone locations and the total calcium amount in the renal papillary tissue was evaluated. In the rats treated with the aqueous phytic acid and phytic acid/zinc mixture, the number of calcifications on the papillary tips and the total calcium amount of the papillary tissue were significantly reduced compared with the controls treated exclusively with ethylene glycol or ethylene glycol plus zinc. Consequently, phytic acid and mixtures of phytic acid/zinc may be a useful agent in the treatment of patients with calcic urolithiasis.

Inositol hexakisphosphate in urine: the relationship between oral intake and urinary excretion

Objective To study the relationship between the oral intake of inositol hexakisphosphate (InsP6, phytic acid, an inhibitor of urinary crystallization) and its urinary excretion, to establish their possible mutual influence.