Abstract
The chemical analysis of an urolith is often interpreted as “stone’s composition”. However, it must be taken into consideration, that in most cases, only a fragment of the stone has been sent to the laboratory. In some recurrent patients, stone compositions either vary considerably between episodes or the analytical result obtained from the stone fragment does not fit with the data of e.g. current 24 h-urinalysis or urinary pH-records. The question arises, whether this outcome may be the result of an improper stone sampling scheme. On a simple layered 2D-stone model composed of two mineral phases it is shown, how the choice of a stone fragment process may influence the result of “stone composition”. Depending on the initial position of fragment within the whole stone, the respective calculated analyses can relevantly differ from the whole stone composition as well as strongly between two fragments. Even under the simplified conditions of a 2D-2-component-model “grown” under defined conditions, the differences between the analyses of the different specimens taken from a stone are in part remarkable. The more it can be argued that these differences increase if a real 3D-urolith is investigated. Further sampling biases may evolve and increase the problem of proper sampling:, e.g., if an urolith’s more resistant parts remain intact while ESWL or laser-based stone fragmentation (“dusting”), the weak parts became fully disintegrated and removed from the body as fine-grained sludge—the stone’s fine fraction is lost although its composition may carry important information on the stone’s pathogenesis. Consequently, a “stone analysis” only obtained from the harder remains reveals an incomplete result, a fact that in principle limits its clinical interpretation. Choice of stone fragment is crucial. The extent of the uncertainty of an analysis resulting from potential selection biases should not be underestimated. Thus, sampling should be considered as an important part of the processes of quality assurance and management. Errors made at this early stage of diagnosis finding will affect the analytical result and thus influence the clarification of the underlying pathomechanism. This can lead to an improper metaphylactic strategy potentially causing recurrent stone formation which otherwise would have been prevented. A decision scheme for analysis of urinary stones removed using endoscopic methods is suggested.
Similar content being viewed by others
References
Smith CL (1998) Renal stone analysis: is there any clinical value? Curr Opin Nephrol Hypertens 7(6):703–709
Forshaw R (2015) Unlocking the past: the role of dental analysis in archaeology. Dent Hist 60(2):51–62
Skoglund P, Thompson JC, Prendergast ME et al (2017) Reconstructing prehistoric African population structure. Cell 171(1):59–71
Daudon M, Jungers P (2012) Stone composition and morphology: a window on etiology. In: Talati J, Tiselius HG, Albala D, Ye Z (eds) Urolithiasis. Springer, London
Miller NL, Williams JC Jr, Evan AP et al (2010) In idiopathic calcium oxalate stone-formers, unattached stones show evidence of having originated as attached stones on Randall’s plaque. BJU Int 105(2):242–245
Cloutier J, Villa L, Traxer O, Daudon M (2014) Kidney stone analysis: “Give me your stone, I will tell you who you are!”. World J Urol 33(2):157–169
Daudon M, Bouzidi H, Bazin D (2010) Composition and morphology of phosphate stones and their relation with etiology. Urol Res 38(6):459–467
Dessombz A, Letavernier E, Haymann JP et al (2015) Calcium phosphate stone morphology can reliably predict distal renal tubular acidosis. J Urol 193(5):1564–1569
Daudon M, Jungers P, Bazin D et al (2018) Recurrence rates of urinary calculi according to stone composition and morphology. Urolithiasis 46(5):459–470
Pearle MS, Goldfarb DS, Assimos DG (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324
EAU Guidelines. Edn. Presented at the EAU Annual Congress London 2018. ISBN 978-94-92671-01-1. EAU Guidelines Office, Arnhem, The Netherlands. https://uroweb.org/guidelines/compilations-of-all-guideline.
Sakhaee K (2008) Nephrolithiasis as a systemic disorder. Curr Opin Nephrol Hypertens 17:304–309
Pak CY, Poindexter JR, Adams-Huet B et al (2003) Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115:26–32
Manzoor MAP, Agrawal AK, Singh B et al (2019) Morphological characteristics and microstructure of kidney stones using synchrotron radiation μCT reveal the mechanism of crystal growth and aggregation in mixed stones. PLoS ONE 14(3):e0214003
Manzoor MAP, Mujeeburahiman M, Rekha PD (2019) Electron probe micro-analysis reveals the complexity of mineral deposition mechanisms in urinary stones. Urolithiasis 47(2):137–148
Racek M, Racek J, Hupáková I (2019) Scanning electron microscopy in analysis of urinary stones. Scand J Clin Lab Invest 79:208–217
Grases F, Sohnel O, Costa-Bauza A et al (2007) Structural features of three ureteral calculi. Int Urol Nephrol 39:765–769
Castiglione V, Sacré PY, Cavalier E et al (2018) Raman chemical imaging, a new tool in kidney stone structure analysis: case-study and comparison to Fourier transform Infrared spectroscopy. PLoS ONE 13(8):e0201460
Ellis DI, Goodacre R (2006) Metabolic fingerprinting in disease diagnosis: biomedical application of infrared and Raman spectroscopy. Analyst 131:875–885
Ma RH, Luo XB, Li Q et al (2017) The systematic classification of urinary stones combine-using FTIR and SEM-EDAX. Int J Surg 41:150–161
Jaswal BBS, Singh VK (2015) Analytical assessments of gallstones and urinary stones: a comprehensive review of the development from laser to LIBS. Appl Spectrosc Rev 50(6):473–498
Singh VK, Jaswal BBS, Sharmaa J et al (2017) Spectroscopic investigations on kidney stones using Fourier transform infrared and X-ray fluorescence spectrometry. X-Ray Spectrom 46:283–291
Kuta J, Machát J, Benová D et al (2013) Association of minor and trace elements with mineralogical constituents of urinary stones: a hard nut to crack in existing studies of urolithiasis. Environ Geochem Health 35(4):511–522
Singh VK, Rai PK (2014) Kidney stone analysis techniques and the role of major and trace elements on their pathogenesis: a review. Biophys Rev 6(3–4):291–310
Sivaguru M, Saw JJ, Williams JC Jr et al (2018) Geobiology reveals how human kidney stones dissolve in vivo. Sci Rep 8(1):13731
Mandel NS, Mandel IC, Kolbach-Mandel AM (2017) Accurate stone analysis: the impact on disease diagnosis and treatment. Urolithiasis 45(1):3–9
Basiri A, Taheri M, Taheri F (2012) What is the state of the stone analysis techniques in urolithiasis? Urol J 9:445–454
Hesse A, Sanders G (1988) Atlas of infrared spectra for the analysis of urinary calculi. Georg Thieme, Stuttgart-New York
Laube N, Pullmann M, Hergarten S et al (2003) Influence of urinary stones on the composition of a 24-hour urine sample. Clin Chem 49:281–285
Omara M, Tarplina S, El Mahdya AED et al (2015) Does 24-hour urine supersaturation predict stone composition? World J Nephrol Urol 4(1):169–172
Williams J, Arsenault MA, Buczkowski BJ, et al (2006) Surficial sediment character of the Louisiana offshore continental shelf region: A GIS Compilation—USGS Open-File Report 2006-1195; Wentworth grain size chart from United States Geological Survey, supplementary online resource https://pubs.usgs.gov/of/2006/1195/htmldocs/images/chart.pdf
Pietropaolo A, Patrick Jones P, Whitehurst L, Somani BK (2019) Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months. Urolithiasis 47(4):391–394
Krambeck AE, Khan NF, Jackson ME et al (2010) Inaccurate reporting of mineral composition by commercial stone analysis laboratories: implications for infection and metabolic stones. J Urol 184(4):1543–1549
Gerlach RW, Nocerino JM (2001) Guidance for obtaining representative laboratory analytical subsamples from particulate laboratory samples. Environmental Protection Agency, United States. EPA/600/R-03/027, November 2003.
Ramsey MH, Ellison SLR (eds.) (2007) Eurachem/EUROLAB/CITAC/Nordtest/AMC Guide: Measurement uncertainty arising from sampling: a guide to methods and approaches. Eurachem. ISBN 978-0-948926-26-6.
Clanton US, Fletcher CR (1976) Sample size and sampling error as the source of dispersion in chemical analyses. Proc Lunar Sci Conf 1976:1413–1428
Kok DJ, Boellaard W, Ridwan Y et al (2017) Timelines of the “free-particle” and “fixed-particle” models of stone-formation: theoretical and experimental investigations. Urolithiasis 45(1):33–41
Chang CC, Chiua Y (2016) Applying quantitative micro-Raman spectroscopy to analyze stone compositions extracted from ureteroscopic lithotripsy urine. Urol Sci 28(1):19–22
Funding
None.
Author information
Authors and Affiliations
Contributions
NL conceived the original idea; all the authors contributed equally to the manuscript and reviewed the final paper.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Laube, N., Klein, F. & Fisang, C. The surgeon’s role on chemical investigations of the composition of urinary stones. Urolithiasis 48, 435–441 (2020). https://doi.org/10.1007/s00240-020-01195-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-020-01195-6