Urolithiasis in Patients with End Stage Renal Failure

Abstract

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.

Incidence and Management of Dialysis Patients with Renal Calculi

“…Ozasa et al [6] analyzed the molecular components of these protein stones and found that they are composed of (in decreasing order): ß 2 -microglobulin, lysozyme, serum amyloid P protein, albumin, and Tamm-Horsfall protein. Daudon et al [7] reported 4 different types of stones that they isolated from 30 of their stone-producing hemodialysis patients. Daudon et al [7] classified the stones as follows: (1) protein stones; (2) calcium oxalate stones; (3) mixed stones (protein and calcium oxalate), and (4) aluminium magnesium urate stones.…”

“…Daudon et al [7] reported 4 different types of stones that they isolated from 30 of their stone-producing hemodialysis patients. Daudon et al [7] classified the stones as follows: (1) protein stones; (2) calcium oxalate stones; (3) mixed stones (protein and calcium oxalate), and (4) aluminium magnesium urate stones.…”

“…Daudon et al [7] proposed that these stones were probably due to a high urinary uric acid level which allowed some precipitation of urate crystals which in turn served as a nidus for the further precipitation of Al and Mg.…”

“…Seventy-five percent of all these stones are calcium stones, with the remaining 25% consisting of struvite stones, uric acid stones, and cysteine stones [1]. Surprisingly, studies show that 5-13% of all hemodialysis patients, some of whom produce very little, if any, urine, and most of whom have no prior history of stone disease, developed symptomatic kidney stones [2][3][4][5][6][7].…”

Infrared and Raman spectroscopy of urinary calculi: A review

“…55 leads to 2,8-dihydroxyadenine stone formation Daudon 56 also reported the presence of alumiand/or crystalluria. 60 The stones usually present num magnesium complex urate found in six cases in childhood and may be easily confused with uric after treatment with aluminum hydroxide in the acid stones when analyzed chemically.…”