Stone Morphology: Implication for Pathogenesis

Daudon, Michel; Jungers, Paul; Bazin, Dominique
September 2008
AIP Conference Proceedings;9/18/2008, Vol. 1049 Issue 1, p199
Academic Journal
Urinary stones of similar crystalline composition as identified by X-ray diffraction or Fourier transform infrared spectroscopy (FT-IR) may exhibit distinct structures, which are reflected in distinctive stone morphology. Among factors involved in stone morphology—some reflecting lithogenic activity, others depending on the crystal shape, or on the propensity of crystalline phases to form large aggregates, finally the environment where the stone is growing—all of these factors influence the inner structure of the stone and its superficial characteristics. We present here examples of the clinical interest of refined morphologic examination of stones, in addition to X-ray diffraction or FT-IR identification of its components. Such combination of methods allows the identification of specific etiologies among calcium oxalate stones, especially a morphological type pathognomonic of primary hyperoxaluria and other types related to distinct conditions of stone formation. Among phosphatic stones—in addition to stone composition, which must be considered not only on the basis of the main component, but also taking into account the minor crystalline phases, which often are clinically relevant—morphological types also contribute to diagnosis of the underlying etiology, especially for stones related to distal tubular acidosis. Finally, common purine stones also exhibit different morphologies related to stone composition and etiology: two main structures for uric acid and two for ammonium urate help to distinguish risk factors and lithogenic conditions involved in the formation of these calculi. Morphologic examination is a simple, rapid and cheap method that points to specific diseases or lithogenic factors. Better awareness of its clinical relevance should lead to wider utilization.


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