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.     

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.     

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.     

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.     

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.     

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。     

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。     

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。     

磷酸铵镁结石患者尿微晶组分分析及其与结石形成的关系

采用X射线衍射(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)研究了磷酸铵镁结石患者尿液中微晶的组分、形貌、粒径和Zeta电位,并对其结石进行了组分分析.结果表明,结石类型、尿微晶组分和尿液pH三者之间存在密切的联系:磷酸铵镁结石病人的尿液pH值较高,通常在6....     

Identification of Urinary Stone Components by X‐Ray Photoelectron Spectroscopy

Abstract

X‐ray photoelectron spectroscopy (XPS) has been used for the first time to study the composition of calcium oxalate (CaOxa) stones and uric acid stones. This technique allows for the identification and location of various inorganic and organic species at the same time. In CaOxa stones, there were less than 10% of phosphates. Sectional analyses of these stones indicated that the content of phosphorus in the stone center is higher than that in stone crust. In uric acid stones, CaOxa was rarely found. XPS is able to detect differences in chemical functionality. In uric acid stones, the binding energy (E _b) for nitrogen atoms were about 399.5 ± 0.2 eV, which are largely characteristic of organic nitrogens N (?3). In comparison, the E _b values of N (+5) in inorganic compounds are about 401 eV.     

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.     

Analytical Assessments of Gallstones and Urinary Stones: A Comprehensive Review of the Development from Laser to LIBS

Abstract

Laser-induced breakdown spectroscopy (LIBS) is a sensitive optical technique capable of fast multi-elemental analysis of various kinds of materials (solid, liquids, and gases) and its applications are growing rapidly and continue to extend to include a broad variety of biological materials. Its application is suited particularly for urinary stones and gallstones bulk analysis and microanalysis because investigation of the spatial distribution of matrix and trace elements can help to explain their emergence and growth. Therefore, we review the application of LIBS for the analysis of different kinds of gallstones and urinary stones. In brief, we also describe the history, fundamentals, advantages, and disadvantages of LIBS and its potential for spectrochemical analysis of gallstones and kidney stones. We also emphasize the applications of different kinds of lasers in urology, particularly the laser ablation of gallstones and urinary stones and its recent progress. We also summarize and compare the analytical figures of merits of analytical techniques that are commonly used to characterize and/or analyze stones.     

Ultrasonic parameters of concentric laminated uric acid stones

Recently a new idea for the disintegration of urinary calculi based upon the large difference of the acoustic impedance inside urinary calculi was suggested. This large difference of acoustical impedance between the two main components of kidney stones, is confirmed in this paper for smooth laminated uric acid stones by two different experimental techniques measuring sound velocities: a surface contact and a submersion technique. Our measured values correlate well with the large differences of the earlier reported measured sound velocities. In general, the disintegration of a urinary stone can be described as follows: a urinary calculus is an inhomogeneous geometrical structure, and its structure plays an important role in the disintegration process.     

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.     

Experience with the [13C2]oxalate absorption test

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.     

尿酸结石患者尿液中的微晶组分及其与结石形成的关系

采用X射线衍射(XRD)、傅里叶变换红外(FTIR)光谱、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10例尿酸结石患者尿微晶的组分、Zeta电位、形貌及其与尿酸结石形成的关系.结果表明,尿酸结石患者的尿pH值较低,大都在4.8～5.7之间;尿微晶的主要成分为尿酸.其粒度分布很不均匀,从几纳米到几十微米不等,并有聚集现象.相比健康对照者尿纳米微品的Zeta电位(-10.1mV),尿酸结石患者的Zeta电位负值更小(-6.02 mV).对这些患者进行药物治疗(服用柠檬酸钾)后,尿pH可上升到6.5左右,此时尿液中的大部分尿酸转变为溶解度显著增加的尿酸盐,因此,尿酸结石形成的危险性显著降低.本文结果表明,尿石组分、尿微晶组分及尿pH三者之间存在密切的联系.     

三聚氰胺结石与疑似三聚氰胺结石的红外光谱分析

本文通过对三聚氰胺、尿酸、三聚氰胺结石和疑似三聚氰胺结石的红外光谱分析, 根据它们的特征峰位、峰形的特点和三聚氰胺、尿酸、草酸钙的标准红外光谱比较, 推出三聚氰胺结石由尿酸、尿酸胺、草酸钙和三聚氰胺形成的混合性结石。疑似三聚氰胺结石是草酸钙结石。因此, 红外光谱法可作为一种辅助手段, 为医学诊断提供理论依据。     

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。