Papillary and Nonpapillary Calcium Oxalate Monohydrate Renal Calculi: Comparative Study of Etiologic Factors

Abstract

Calcium oxalate monohydrate (COM) renal calculi can be classified into two groups: papillary and nonpapillary. In this paper, a comparative study between etiologic factors of COM papillary and nonpapillary calculi is performed. The study included 40 patients with COM renal calculi. The urine of these individuals was analyzed. Case history, lifestyle, and dietetic habits were obtained.No significant differences between urinary biochemical data of both groups were observed; 50% of COM papillary stone formers and 40% of COM nonpapillary stone formers had urolithiasis family history. A low consumption of phytate-rich products was observed for both groups. A relationship between profession with occupational exposure to cytotoxic products and COM papillary renal lithiasis was detected.The results suggest that COM papillary calculi would be associated to papillary epithelium alterations together with a crystallization inhibitors deficit, whereas COM nonpapillary calculi would be associated to the presence of heterogeneous nucleants and a crystallization inhibitors deficit.

Dietary roles of phytate and phytase in human nutrition: A review

“…Epidemiological studies have shown that renal stones are more prevalent in developed countries, where populations consume diets based on refined flour compared, than in developing nations, consuming predominantly cereals and legumes, known for their high phytate contents. In human studies, phytate has been demonstrated to be effective against four types of renal stones (Felix, Costa-Bauza, & Prieto, 2006), namely calcium oxalate monohydrate papillary calculi (characterised by induction of subepithelial calcifications) (Pieras, Costa-Bauza, Ramis, & Grases, 2006), calcium oxalate monohydrate unattached calculi (formed in renal cavities) (Daudon, Bader, & Jungers, 1993), calcium oxalate dihydrate/hydroxyapatite mixed calculi (associated with hypercalciuria and hypocitraturia) (Grases, Costa-Bauza, Ramis, Montesinos, & Conte, 2002) and Brushite calculi (associated with tubular acidosis) (Felix et al, 2006). The mechanism is that phytate can interfere with formation of calculi (crystals) of calcium oxalate and phosphate (Grases et al, 2000a(Grases et al, , 2001.…”

Characterization of Calcium Oxalate Hydrates and the Transformation Process

“…The synthesis of COM described in the literature [28,31] were adapted optimizing the following parameters: addition rate, pH, ageing time, temperature and volume of water in the crystallizer in order to obtain the monohydrated species, avoiding the co-precipitation of COD, and to achieve big and well defined crystallites. The final selected conditions were as follows: 250 mL of Na 2 Ox 40 mM and 250 mL of CaCl 2 40 mM were adjusted to pH 6 (pH of human urine, the most common medium of calcium oxalate precipitation [32,33] ). Both solutions were simultaneously added dropwise (2.5 mL/min) into a crystallizer containing Milli-Q water (1000 mL, degassed for 30 min by sonication), with the pH adjusted to 6 and at 75°C, under constant stirring.…”

Factors Associated With the Lower Prevalence of Nephrolithiasis in Children Compared With Adults

“…When these calculi are observed by a stereoscopic microscope or by scanning electron microscope, an attachment site to the papillae in clearly detectable, and their inner structure basically consists on a core near to the attachment site (concave zone), from which radially striated concentrically laminated layers originate 13 c) Calcium oxalate dihydrate (COD) renal calculi, typically consisting on randomly distributed yellowish bipyramidal COD crystals, which form primary aggregates 11,12 The two different phases of calcium oxalate that can be found in renal calculi (COM and COD) present different crystal morphology and infrared spectra.…”

“…Cit is an inhibitor of kidney stone formation that also forms index values indicate that there are no statistical difference in calcium oxalate urinary supersaturation between the papillary COM group, the unattached COM group and the healthy adult group. This can be explained since the papillary COM calculi start to develop as a result of an injury in the renal papillae tissue, and this is independent on urinary supersaturation.Unattached COM calculi are associated to normal supersaturation values and to the presence of retained heterogeneous nucleants (uric acid, hydroxyapatite, organic matter, etc)13 . However, COD group has a higher urinary supersaturation (p<0.001) when compared with the healthy adult group.…”