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Heterogeneity in calcium nephrolithiasis: A materials perspective

Published online by Cambridge University Press:  08 May 2017

Benjamin A. Sherer ,
Ling Chen ,
Feifei Yang ,
Krishna Ramaswamy ,
David W. Killilea ,
Ryan S. Hsi ,
Marshall L. Stoller  and
Sunita P. Ho
Benjamin A. Sherer
Affiliation:
Department of Urology, University of California San Francisco, San Francisco, CA 94143
Ling Chen
Affiliation:
Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143
Feifei Yang
Affiliation:
Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143
Krishna Ramaswamy
Affiliation:
Department of Urology, University of California San Francisco, San Francisco, CA 94143
David W. Killilea
Affiliation:
Children’s Hospital Oakland Research Institute, Oakland, CA 94609
Ryan S. Hsi
Affiliation:
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
Marshall L. Stoller
Affiliation:
Department of Urology, University of California San Francisco, San Francisco, CA 94143
Sunita P. Ho*
Affiliation:
Division of Biomaterials and Bioengineering, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA 94143
*
a) Address all correspondence to this author. e-mail: sunita.ho@ucsf.edu
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Abstract

Calcium-based renal calculi demonstrated significant heterogeneity in the structure, density, mineral composition, and material hardness not elucidated by routine clinical testing. Mineral density distributions within calcium oxalate stones revealed differential areas of low (590±80 mg/cc), medium (840±140 mg/cc), and high (1100±200 mg/cc) densities. Apatite stones also contained regions of low (700±200 mg/cc), medium (1100±200 mg/cc), and high (1400±140 mg/cc) densities within layers extending from single or multiple nucleation sites. Despite having lower average mineral density, calcium oxalate (CaOx) stones demonstrated higher material hardness compared to apatite stones, suggesting other chemical components might be involved in determining stone hardness properties. Carbon concentrated sites were identified between morphologic layers in CaOx stones and in stratified layers of apatite stones. Elemental analyses revealed numerous additional trace elements in both stone types. Despite the widespread assumption that stone mineral density is an indicator of susceptibility to lithotripsy, calcium stone mineral density estimates do not directly correlate with actual ex vivo stone hardness. Underlying stone heterogeneity in both structure and mineral density could explain why historical approaches have failed in accurately predicting response of stones to lithotripsy.

Keywords

microstructurehardnesschemical composition
Type
Articles
Information
Journal of Materials Research , Volume 32 , Issue 13 , 14 July 2017 , pp. 2497 - 2509
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Copyright
Copyright © Materials Research Society 2017 

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Footnotes

Contributing Editor: Adrian B. Mann

References

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