Infrared spectrophotometry and Raman spectroscopy, thanks to the laser molecular microsond (MOLE), are two analytical techniques particularly well suited to a precise analysis of the composition and structure of urinary calculi. They both showed noteworthy efficiency in their ability to recognize the various crystalline or amorphous mineral and organic species. The MOLE permits analysis of crystals 1 mu in size, demonstrating its usefulness in the study of calculi nuclei as well as in the study of urinary crystals. These analyses are a very important source of information about conditions of crystalline nucleation and growth as well as about ions and molecules which can take place in the formation and the evolution of the diverse crystalline phases. On the clinical level, these data can contribute to a better comprehension of the formation of every stone.
Renal stones from 30 chronic hemodialysis patients were subjected to morphological study by means of microscopic examination and to constitutional analysis with infrared spectrophotometry. In 29 patients calculi could be classified into 3 main types: 1) protein stones made of pure proteins or with a protein core and less than 30% calcium oxalate (9 cases, or 30%)--they were observed predominantly in patients with primary glomerular disease, 2) oxalo-protein stones with a core of calcium oxalate and a total stone content of more than 30% calcium oxalate (15 cases, or 50%)--they appeared to be related to metabolic factors, such as high urinary oxalate and low urinary citrate concentration, and to iatrogenic factors, namely vitamin D3 and calcium salt supplementation, and 3) aluminum-magnesium urate stones, probably induced by aluminum overload (6 cases, or 20%). Thus, our study indicates that a significant proportion (70%) of stones formed by hemodialysis patients may be due to metabolic and iatrogenic factors. Our data suggest that accurate analysis of such stones provides useful information on pathogenetic factors and consequently may give clues to their prophylaxis.
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