Crystallization and stone formation inside the nephron. 1996

D J Kok
Department of Pediatric Urology, Erasmus University Hospital Rotterdam, The Netherlands.

A model is presented visualizing the events leading to calcium-salt, crystal- and stone-formation inside the nephron. For each nephron segment, handling of urine components relevant to stone formation is considered and urine composition determined. This information was applied to nucleation experiments simulating passage of urine through a nephron. The model and in vitro experiments suggest that within normal transit times for the respective nephron segments, particles of a hydroxyapatite-like material first form near the bend in the Loop of Henle of juxtamedullary nephrons. From there on, calcium oxalate particles start to appear: first dihydrate, then monohydrate. In the collecting duct system, particle size increases primarily due to crystal agglomeration. Several conclusions with clinical and experimental relevance can be drawn. An increase in urinary volume does not decrease the chance of crystal formation in the Loop of Henle, but does decrease passage time through the collecting ducts, and thus, the time allowed for large particle formation. A calcium load does not increase the risk for nucleation up to the distal tubule, but does increase the risk of large particle formation in the collecting ducts. An oxalate load increases the chance for nucleation throughout the nephron. For experiments simulating crystallization processes occurring inside the nephron, diluted urines should be used. They should be diluted 16 to 50 times for testing nucleation, 2 to 30 times for testing crystal growth, and 2 to 20 times for testing crystal agglomeration. Undiluted urines may be used to mimic conditions in the pelvis and the bladder.

UI MeSH Term Description Entries
D007669 Kidney Calculi Stones in the KIDNEY, usually formed in the urine-collecting area of the kidney (KIDNEY PELVIS). Their sizes vary and most contains CALCIUM OXALATE. Kidney Stones,Renal Calculi,Nephrolith,Renal Calculus,Calculi, Kidney,Calculi, Renal,Calculus, Kidney,Calculus, Renal,Kidney Calculus,Kidney Stone,Stone, Kidney,Stones, Kidney
D008954 Models, Biological Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment. Biological Model,Biological Models,Model, Biological,Models, Biologic,Biologic Model,Biologic Models,Model, Biologic
D009399 Nephrons The functional units of the kidney, consisting of the glomerulus and the attached tubule. Nephron
D010316 Particle Size Relating to the size of solids. Particle Sizes,Size, Particle,Sizes, Particle
D002129 Calcium Oxalate The calcium salt of oxalic acid, occurring in the urine as crystals and in certain calculi. Calcium Oxalate (1:1),Calcium Oxalate Dihydrate,Calcium Oxalate Dihydrate (1:1),Calcium Oxalate Monohydrate,Calcium Oxalate Monohydrate (1:1),Calcium Oxalate Trihydrate,Dihydrate, Calcium Oxalate,Monohydrate, Calcium Oxalate,Oxalate, Calcium,Trihydrate, Calcium Oxalate
D003460 Crystallization The formation of crystalline substances from solutions or melts. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed) Crystalline Polymorphs,Polymorphism, Crystallization,Crystal Growth,Polymorphic Crystals,Crystal, Polymorphic,Crystalline Polymorph,Crystallization Polymorphism,Crystallization Polymorphisms,Crystals, Polymorphic,Growth, Crystal,Polymorph, Crystalline,Polymorphic Crystal,Polymorphisms, Crystallization,Polymorphs, Crystalline
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006863 Hydrogen-Ion Concentration The normality of a solution with respect to HYDROGEN ions; H+. It is related to acidity measurements in most cases by pH pH,Concentration, Hydrogen-Ion,Concentrations, Hydrogen-Ion,Hydrogen Ion Concentration,Hydrogen-Ion Concentrations

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