Experience with the [13C2]Oxalate Absorption Test

Abstract

Hyperoxaluria is the most important risk factor for a formation of calcium oxalate-urinary stones. Usually, the bulk of oxalate will be formed in the human body, but in many patients the oxalate from food plays the decisive role. Conventionally, in urine the endogenous oxalate can not be distinguished from food derived oxalate. We have developed a standardized oxalate-absorption test, applying a physiological dose (50 mg disodium salt of [¹³C₂]oxalic acid) of labelled oxalate. The assay has been published. Now we report on the first extensive applications of this test in 86 volunteers and 135 patients from different groups with calcium oxalate stones or an increased risk of the formation of such stones. In one-third of the patients with calcium oxalate-urinary stones an oxalate hyperabsorption was diagnosed. For these patients, a dietetic stone prophylaxis and/or therapy is indicated.     

The effect of oral administration of calcium and magnesium on intestinal oxalate absorption in humans

Calcium oxalate (CaOx) urolithiasis is the most common urinary stone disease (70-75 % of all stones consist of CaOx in countries with western diet). Oxalate is the most lithogenic substance in CaOx crystallisation in urine. Oxalate is either synthesized within the body or absorbed from food. As oxalate is not metabolized in the human body, it appears unchanged in urine. Conventional analysis methods cannot distinguish between endogenous and exogenous oxalate. Our [13C2]oxalate absorption test enabled measurement of intestinal oxalate absorption and quantification of the influence of Ca- and Mg-supplementation on it. The effects of the oral administration of these supplements were compared in order to obtain valid data for recommendations for CaOx urolithiasis patients. A 10 mmol supplement of both ions decreased the oxalate absorption significantly, calcium being more than twice as effective.     

尿液中的纳米晶体组分及其对草酸钙结石形成的影响

采用高分辨率透射电子显微镜、选区电子衍射、能谱分析和X射线衍射对草酸钙(CaOx)结石患者尿液中纳米晶体的组分进行了准确分析。这些技术检测到一水草酸钙(COM)、尿酸(UA)和磷酸钙(CaP)的存在,能谱分析检测到大量C,O,Ca和少量N和P等元素,表明尿纳米晶体的主要组分是COM,并含有少量的尿酸和磷酸盐。电子显微镜观察到CaOx结石患者尿纳米晶体的粒径主要分布在几十纳米,其结果与Scherer公式计算相符。采用不同孔径的微孔滤膜(0.45,1.2和3 μm)将尿液过滤后,得到的尿微晶衍射峰的数量随着滤膜孔径的增加而增加,表明尿微晶的种类增加。CaOx尿石的形成过程涉及尿液晶体的成核、生长、团聚和与细胞的粘附等过程。尿液中大量纳米COM晶体的存在是草酸钙结石形成的重要原因。纳米UA,CaP晶体能够作为晶巢促进草酸钙结石的形成。     

不同类型尿石的XRD,FTIR和热释光谱分析

采用热释光谱仪(TLD)、X射线衍射仪(XRD)和红外光谱仪(FTIR)研究了四类不同类型肾结石的化学组分,它们分别是:草酸钙、尿酸、磷酸钙和磷酸铵镁结石.实验结果表明,在所研究的305例尿石中,草酸钙为主要组分的占63%,尿酸22%,磷酸钙8%,磷酸铵镁5%,其他组分2%.四类肾结石的热释光谱存在显著差异,可为临床上诊断肾结石的类型提供启示.     

二元羧酸的化学结构与其抑制草酸钙结晶能力研究

采用X射线衍射(XRD)、傅里叶红外光谱(FTIR)和扫描电镜(SEM)研究了相距3个C—C键长具有不同取代基的二元羧酸对草酸钙(CaOxa)晶体生长的影响。这些二元酸包括丁二酸、顺丁二烯酸、反丁二烯酸、苹果酸、天冬氨酸和酒石酸。它们均能抑制一水草酸钙(COM)晶体的聚集,减小COM比表面积,并诱导二水草酸钙(COD)生成,其能力随二元酸上取代的—OH或—NH₂基数量增加而增强。从二元羧酸化学结构讨论了其影响草酸钙结晶效果的分子机理,对COM生长具有最佳抑制效果的羧酸是含有HOOC—CH(R)—CH₂—COOH(ROH或NH₂)分子的化合物。实验结果可为临床上寻找新的防石药物提供参考。     

混合型尿路结石的XPS和XRD联合分析

为了深入了解广东省珠江三角洲尿路结石的组份,为临床的相关研究和预防提供参考,采用X-射线光电子能谱(XPS)和X-射线衍射法(XRD)对6例典型的混合型尿路结石成份和物相进行了分析。结果表明,所检尿石成份合一水草酸钙、二水草酸钙、羟基磷灰石,其中2例含有少量磷酸铵镁。随着尿石中磷酸盐的增加,一水草酸钙(COM)的含量减少,二水草酸钙(COD)含量增加,表明磷酸盐的沉积抑制了高能量的COD向低能量的COM转化。采用XPS和XRD联合分析,可以较为准确地检测尿路结石的组份和物相。     

EDXRF,FTIR, and XRD characterization of low calcium oxalate urinary stones collected from arid area

Low calcium oxalate urinary stones from the kidney, bladder, and ureter have been collected from the arid area (Taif, Saudi Arabia). After careful washing and drying of the collected stones, the samples were converted into a contamination-free homogenous fine powder with a particles' size smaller than 50 μm. The processed urinary stone powders were studied using attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), laboratory setup and synchrotron radiation X-ray diffraction (XRD), and energy-dispersive X-ray fluorescence (EDXRF). The activated function groups, quantitative phase analysis, and the semi-quantitative elemental analysis of the present urinary stones were identified. Seventeen elements were measured in most of the urinary stone samples. The significant elements are Ca, P, S, Cl, Zn, K, Fe, and Cu, whereas other elements were found alternatively in a few number of urinary stone samples. It was recognized that Ca exists with low concentration, which indicates the presence of different calcium phases even with low percentages. In 33% of the urinary stones, the phosphorus (P) was not measured, but there were high concentrations of sulfur (S) and low concentrations of Ca up to 2.15 ± 0.05%. The ATR-FTIR results indicate that the most compounds of the present urinary stones were urea and cystine combined with low ratios of calcium oxalate and calcium phosphate compounds. The quantitative phase analysis of the XRD of selected samples proves the presence of the cystine, urea, and calcium oxalate phases with different weight percent.     

不同分子量龙须菜多糖对草酸钙结晶的调控作用

植物多糖的化学结构与尿液中的结石抑制剂葡胺聚糖相似,有可能用于预防和治疗肾结石。天然多糖由于分子量和分子体积过大,导致其应用受到限制。研究了四种分子量分别为49.6,16.2,8.2和3.8 kDa的降解龙须菜多糖GLP1,GLP2,GLP3和GLP4对草酸钙(CaOx)晶体生长的调控作用。1H NMR,13C NMR和气相色谱-质谱(GC-MS)谱分析表明四种GLPs由β-D-半乳糖和6-O-硫酸基-3,6-α-L-吡喃半乳糖组成。X射线衍射(XRD)检测表明,在各GLPs存在下,诱导了二水草酸钙(COD)晶体形成,COD的衍射峰出现在晶面间距d=0.617,0.441,0.277和0.224 nm处;而没有多糖存在时只生成一水草酸钙(COM)晶体,COM的衍射峰出现在d=0.593,0.364,0.296和0.235 nm。由于COD比COM更容易排出体外,COD的形成有利于降低结石形成的风险。傅里叶变换红外光谱(FTIR)检测表明,随着GLP分子量减小或GLP浓度增加,草酸根中羧基的不对称伸缩振动ν_as(COO-)和对称对称伸缩振动ν_s(COO-)都发生了不同程度的蓝移,其中ν_as(COO-)从1 618 cm-1增加到1 642 cm-1,ν_s(COO-)从1 318 cm-1增加到1 328 cm-1,即GLP4诱导的全部是COD晶体。扫描电子显微镜(SEM)检测表明,随着GLP分子量减小,不但晶体中COD的比例增加,而且晶体的分散程度增大,晶体更加圆钝。随着GLP分子量减小或GLP浓度增加,其诱导生成的CaOx晶体表面电荷越负,Zeta电位绝对值越大,这有利于抑制晶体的聚集。电感耦合等离子体发射光谱仪(ICP)检测表明,四种GLPs均可以增加溶液中可溶性Ca2+的浓度,同时减少CaOx沉淀的生成量。在浓度为1.0 g·L-1多糖存在时,上清液中可溶性Ca2+的摩尔浓度分别为：GLP4 (37.88 μmol·L-1)>GLP3 (19.70 μmol·L-1)>GLP2 (16.05 μmol·L-1)>GLP1 (10.55 μmol·L-1)。结果表明,四种GLPs均可以抑制COM生长,诱导COD生成,降低晶体的聚集程度,增加晶体表面的Zeta电位绝对值和溶液中可溶性Ca2+浓度,减少CaOx晶体的生成量,且GLPs的调控活性与其分子量呈负相关。这些结果提示GLPs特别是分子量最小的GLP4有可能是防治CaOx结石的潜在药物。     

Micro‐Raman spectroscopy identification of urinary stone composition from ureteroscopic lithotripsy urine powder

Urolithiasis is a prevalent, disturbing, and highly recurrent disease. Knowing the composition of a urinary stone is important for prevention purposes. Traditional urinary stone analysis methods need large stone fragments for analysis. However, the advancement of ureteroscopic lithotripsy (URSL) has resulted in micro‐stone fragments and unapparently expelled urinary stone powder. In this study, we developed a micro‐Raman spectroscopy (MRS) based diagnosis method for detecting micro‐stones or stone powders in urine after URSL. In our experiment, urine samples of 10 ml each were collected from 12 patients over the fragmented stone site in the ureter after the URSL procedure. The post‐URSL urine sediments extracted from urine were analyzed by MRS. The small urinary stones caught by grasping forceps were analyzed by both MRS and Fourier‐transform infrared (FTIR) spectroscopy. We have identified common urinary stone compositions: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), dicalcium phosphate dihydrate (DCPD), calcium phosphate hydroxide (hydroxyl apatite or HAP), and uric acid, by using a 632.8 nm He‐Ne laser for excitation, a 100× microscope objective lens for irradiation and collection, and a short photobleaching time for fluorescent background reduction. Thus, we developed an MRS‐based method for analyzing the composition of urinary stone powders directly from the urine samples after the URSL procedure. This approach provides a quick and convenient method for urinary stone analysis. Copyright © 2009 John Wiley & Sons, Ltd.     

海带多糖对草酸钙结晶过程中晶相的影响

采用X射线衍射(XRD)、红外光谱(FTIR)、扫描电子显微镜(SEM)和原子吸收光谱(AAS)等方法研究了从海带中提取的硫酸多糖(SPS)对尿结石主要成分草酸钙结晶的影响。SPS可以稳定热力学亚稳定的二水草酸钙(COD)晶体。随着SPS浓度从0增加到0.60 mg·mL-1,COD晶体的质量百分比从0增加到100％;亚稳溶液中草酸钙的相对过饱和度从1.0增加到19.6。SPS可以稳定COD晶体在溶液中的存在并增加可溶性Ca2+离子的浓度,这有利于防止草酸钙结石形成。结果表明,SPS是一种潜在的防止草酸钙尿结石形成的药物。     

Infrared Analysis of Urinary Stones,Using a Single Reflection Accessory and a KBr Pellet Transmission*

This work is a comparative study of two FTIR techniques applied to urinary stones analysis: single reflection diamond attenuated total reflection (ATR) and KBr pellet transmission (KPT). We show that the two methods allow the identification of all stone components. The ATR technique is more useful and rapid to identify the species without sample pretreatment. Nevertheless, KPT is more appropriate for components determination in urinary stones.

These techniques were applied to the study of a series of 313 calculi. The stone constituents were first identified by ATR, and in a second step, the proportion of each species present in the stone was determined by KPT in whole‐stone mixture.

The results obtained showed the presence of 11 different components classified as follows with the frequency of detection in the stones studied: calcium oxalate monohydrate (whewellite), 78.9%; carbapatite, 33.9%; calcium oxalate dihydrate (weddellite), 24%; uric acid anhydrous, 19.2%; ammonium hydrogen urate, 7%; struvite, 4.8%; cystine, 1%; ammonium sodium urate and other phosphates (amorphous carbonated calcium phosphate, brushite, whitlockite), each in less than 1%.     

Harnessing Calcium‐Oxalate‐ (CaOx‐) Nanocrystal‐Induced Prodeath Autophagy for Attenuating Human Renal Proximal Tubular Epithelial Cell Injury

Calcium oxalate (CaOx) stone is the most common type of kidney stone, with a formation process comprising supersaturation, nucleation, growth, aggregation to crystals, and adhesion on renal tubular epithelial cells. CaOx stones generally lead to renal injury; however, the underlying mechanism remains poorly understood. Accumulating evidence suggests that nanosized materials could induce much greater toxicity than bulk materials with the same components. As aggregation to nanocrystals is necessary to form CaOx stones and nanocrystals have been widely reported to elicit either prodeath or prosurvival autophagy, the aim is to address the precise role of autophagy in CaOx‐ nanocrystal‐induced cytotoxicity. Clinical CaOx stones from patients are collected followed by ball milling. As a result, CaOx nanocrystals significantly reduce renal cell viability in a dose‐ and time‐dependent manner. Further study shows that CaOx nanocrystals possess an autophagy‐inducing capacity and autophagic flux is complete. Autophagy abrogation by specific chemical inhibitor wortmannin or chloroquine obviously attenuates cytotoxicity, strongly suggesting that prodeath autophagy contributes to CaOx nanocrystals‐elicited cytotoxicity. Finally, it is revealed that autophagy is an essential signaling pathway participating in apoptosis regulation. Collectively, the findings demonstrate the role of autophagy in CaOx‐nanocrystal‐elicited cytotoxicity, and harnessing autophagy can be helpful to design promising strategies for attenuating kidney injury in nephrolithiasis.     

Infrared spectroscopy for the study of urinary calculi

The occurance of the urinary stones varies according to the geographical regions. The presence of stones in the urinary system causes pain and discomfort. These generate colics and hence are sometimes life threatening. In the present study, infrared measurements have been made on several stone samples. It has been found that calcium oxalate, calcium phosphate, magnesiunm ammonium phosphate, calcium carbonate, uric acid, -cystine and xanthin are present, as expected. Also, silicon dioxide is found to be present in some of the stones but in small quantity, in addition to the above constituents. This constituent is responsible to exhibit piezoelectricity in the urinary calculi.     

草酸钙结石患者尿液中纳米级和微米级晶体研究

尿液中存在的微晶与尿石症的形成密切相关。采用X射线粉末衍射(XRD)、傅里叶变换红外光谱(FTIR)、纳米粒度仪、扫描电子显微镜(SEM)和透射电子显微镜(TEM)研究了20位草酸钙结石患者尿液中纳米级和微米级晶体的组分、形貌和Zeta电位,并与结石组分进行了比较。结果表明,草酸钙结石中常常含有少量共生的尿酸、磷酸钙和磷酸铵镁;而草酸钙结石患者的尿微晶组分主要为尿酸、磷酸盐和草酸钙等,晶体棱角尖锐,尺寸不一,从几十纳米到几十微米不等,并且有明显的团聚现象。20位草酸钙结石患者的尿纳米晶体的Zeta电位平均值为-5.92 mV,明显高于20位健康对照者尿纳米晶体的Zeta电位(平均值-12.9 mV);相比之下,结石患者尿液pH值(平均值为6.03)则与健康对照者(平均值5.92)没有明显差异。利用现代仪器分析方法分析尿液微晶与尿石组分的关系,可为临床上对症下药,制定预防与治疗措施提供重要的依据。     

Spectroscopic study of inhibition of calcium oxalate calculi growth by Larrea tridentata

Urolithiasis, the category of diseases associated with the formation of kidney stones, has many causes. However, only a few have been documented as aggravating calculi depositions and aggregations. This amply justifies continued work in developing effective and efficient inhibition and treatment techniques. The recent resurgence in reviews on plant antiurolithiatic activity has given credence to the application of modern spectroscopic analysis, and has led us to this study. Results obtained from Raman and infrared (IR) absorption analysis of inhibited calculi growth resulting from laboratory synthesis of calcium oxalate crystals accompanied by the natural infusion of Larrea tridentata are reported. A visible decrease in calcium oxalate crystal growth with increasing amounts of L. tridentata herbal infusion was observed in photomicrographs, as well as a color change from white‐transparent for pure crystals to light orange‐brown for crystals with inhibitor. Both Raman and IR absorption spectra reveal a monohydrate structure for the crystals grown alone, which transform to a dihydrate morphology with the addition of the L. tridentata inhibitor. Furthermore, the resulting data support the possibilities of the influences, in this complex process, of the nordihydroguaiaretic acid (NDGA) and its derivative compounds from L. tridentata and the bonding of the magnesium of the inhibitor with the oxalate ion on the surface of the calculi crystals. This assumption corroborates well with the micrographs obtained under higher magnification, which show that the separated small crystallites consist of a darker brownish core, which we attribute to the dominance of growth inhibition by NDGA, surrounded by light transparent thin shells, which possibly correspond to passivation of the crystals by magnesium oxalate. Copyright © 2010 John Wiley & Sons, Ltd.     

Efficiency of applying ammonium oxalate for protection of monumental limestone by poultice, immersion and brushing methods

Samples of cretaceous limestone have been treated with three application methods (poultice, immersion and brushing) using different concentrations of ammonium oxalate solution (AmOx) and varying treatment time in order to test the efficiency of surface and in-depth formation of a protective layer of calcium oxalate (CaOx). Synchrotron-based microanalytical techniques (SR-μXRD with 12.5 μm×7.5 μm (H×V) probe size, SR-μFTIR with 10 μm×10 μm and 8 μm×20 μm probe sizes) and laboratory μFTIR, XRD and SEM have been employed for analysis of the treated samples. Synchrotron-based techniques showed variations in the CaOx distribution along the surface on a micrometer scale. All treatments resulted in the development of a CaOx layer with a maximum thickness of approximately 40 μm. Application by the brushing method with 10 1-min applications with 5-min breaks during one hour showed a development of the calcium oxalate layer equivalent to the poultice treatment taking 10 h. This treatment could be preferred for large marble or limestone surfaces where poultice usage is economically not feasible.     

Effect of oxalate test dose size on absolute and percent oxalate absorption

The purpose of this pilot study was to establish the dependence or independence of oxalate absorption on the quantity of the test dose of sodium oxalate over a range of test doses corresponding to physiological dietary oxalate intake values. Gastrointestinal oxalate absorption was measured with the [13C2]oxalate absorption test. Six healthy volunteers were always tested under standardized dietary conditions with 63 mg dietary oxalate and 800 mg dietary calcium per day. The volunteers were tested thrice each with sodium oxalate test doses of 25, 50, 200, and 600 mg. Additionally, 1000 mg sodium oxalate was applied once to three of these volunteers. The oxalate absorption of the six volunteers tested under the standardized conditions with 50 mg sodium [13C2]oxalate was 7.2 +/- 2.62 % (mean +/- SD), similar to the 120 volunteers tested previously: 8.0 +/- 4.4 % (mean +/- SD). The tests with sodium [13C2]oxalate doses in the range 25-1000 mg revealed similar percent oxalate absorption values. In conclusion, in healthy volunteers, the amount of oxalate absorbed in the gastrointestinal tract increased proportionally with the higher test doses of oxalate. However, percent oxalate absorption remained unchanged with test doses in the dose range of physiological dietary oxalate intakes.     

服药前后草酸钙结石患者尿微晶的性质变化

采用X射线衍射(XRD)、傅里叶变换红外光谱(FTIR)、纳米粒度仪和透射电子显微镜(TEM)研究了6例草酸钙结石患者在服药前后尿微晶性质的变化.结果表明,服药后尿pH值由服药前的5.87±0.51增加至6.23±0.74;服药前的主要成分为尿酸、一水草酸钙(COM)和磷酸氢盐,服药后尿微晶种类和数量均比服药前减少;服药前,尿微晶的平均粒径为(579±326) nm,服药后减小至(404±338) nm;服药前尿微晶的Zeta电位为(-4.28±2.55) mV,服药后为(-7.29±4.16) mV,Zeta电位变负有利于防止尿微晶沉积;服药前尿微品棱角尖锐,有明显的团聚现象,而服药后尿微晶形貌圆钝,团聚较少.采用现代仪器分析研究服药前后草酸钙结石患者尿液微晶的性质变化,对临床上预防和治疗尿结石具有重要的临床意义.     

Spectroscopic investigations on kidney stones using Fourier transform infrared and X‐ray fluorescence spectrometry

Kidney stone is the most painful and prevalent urological disorder of the urinary system throughout the world. Thus, analysis of kidney stones is an integral part in the evaluation of patents having stone disease. Spectroscopic investigations of stones provide an idea about the pathogenesis of stones for its better cure and treatment. Hence, the present work targets multispectroscopic investigations on kidney stones using Fourier transform infrared (FTIR) and wave dispersive X‐ray fluorescence (WD‐XRF) spectroscopy which are the most useful analytical methods for the purpose of bio‐medical diagnostics. In the present study, FTIR spectral method is used to investigate the chemical composition and classification of kidney stones. The multicomponents of kidney stones such as calcium oxalate, hydroxyl apatite, phosphates, carbonates, and struvite were investigated and studied. Qualitative and quantitative determination of major and trace elements present in the kidney stones was performed employing WD‐XRF spectroscopy. The wide range of elements determined in the kidney stones were calcium (Ca), magnesium (Mg), phosphorous (P), sodium (Na), potassium (K), chlorine (Cl), sulfur (S), silicon (Si), iodine (I), titanium (Ti), iron (Fe), ruthenium (Ru), zinc (Zn), aluminum (Al), strontium (Sr), nickel (Ni), copper (Cu), and bromine (Br). For the first time, ruthenium was detected in kidney stone samples employing WD‐XRF in very low concentration. Our results revealed that the presence and relative concentrations of trace elements in different kinds of stones are different and depend on the stone types. From the experiments carried out on kidney stones for trace elemental detection, it was found that WD‐XRF is a robust analytical tool that can be useful for the diagnosis of urological disorders. We have also compared our findings with the results reported using XRF technique. The results obtained in the present paper show interesting prospects for FTIR and WD‐XRF spectrometry in nephrolithiasis. Copyright © 2017 John Wiley & Sons, Ltd.     

不同形貌二水草酸钙对阴离子表面活性剂AOT的吸附差异

人体尿液中存在大量具有生物表面活性的物质,而这些物质与尿液中不同形貌的草酸钙微晶间的吸附关系并未得到人们广泛关注。挑选了常用的阴离子表面活性剂磺基琥珀酸钠二辛酯(AOT)作为吸附物质,研究了不同形貌的二水草酸钙(COD)晶体对AOT的吸附差异,探究草酸钙结石的形成机理。采用X射线粉末衍射仪(XRD)和傅里叶变换红外光谱仪(FTIR)表征,并通过谱图差异分析了吸附AOT前后棒状、圆钝形、花状、十字形和双锥形COD晶体的组分变化;采用Zeta电位分析仪测定吸附AOT后晶体表面的Zeta电位随AOT浓度的变化;采用比色法通过紫外可见分光光度计测定不同浓度AOT存在下晶体的吸附量变化并绘制吸附曲线。随着AOT浓度的增加,COD的吸附量逐渐上升,最后达到吸附饱和状态,各吸附曲线均呈S型。不同形貌COD对AOT的最大吸附量大小顺序为：棒状COD (41.0 mg·g-1)>圆钝形COD (37.5 mg·g-1)>花状COD (35.0 mg·g-1)>十字形COD (27.2 mg·g-1)>双锥形COD (20.9 mg·g-1)。COD晶体的比表面积越大,表面提供的活性位点也越多,越有利于表面活性剂AOT在晶体表面的吸附;富含Ca2+的(100)晶面更利于阴离子的AOT的优先吸附;此外COD晶体的内能越大,越会抑制AOT在COD表面的吸附,导致吸附量降低。吸附了AOT的COD晶体稳定性显著增加,COD向COM转变的速度明显降低。基于AOT在不同形貌的COD晶体表面的吸附特点,提出了COD晶体吸附AOT的分子模型。COD晶体对AOT的吸附与晶体形貌密切相关。容易吸附AOT的COD晶体形貌更容易粘附在带负电荷受损伤的细胞表面,加大草酸钙结石形成的风险。