Skip to Main content Skip to Navigation
Journal articles

Calcium Phosphate Stone Morphology Can Reliably Predict Distal Renal Tubular Acidosis

Abstract : Purpose Calcium stones represent 85% to 90% of all urinary calculi, including various crystalline compositions and etiological conditions. Calcium phosphate accounts for 10% to 15% of cases. These stones are mainly related to 3 groups of risk factors, including calcium or phosphate metabolism disturbance, renal acidification defects and urinary tract infection. Identifying the stone etiology often requires extensive metabolic evaluation. We assessed whether stone analysis including morphological typing in addition to stone composition could be a valuable help for diagnosis. Materials and Methods Of 60,564 stones analyzed by morphological examination and infrared spectroscopy at our laboratory 6,439 (10.6%) were mainly composed of carbapatite. Of these stone 1,093 patients were included in study who had an available etiological diagnosis and stones containing at least 70% of calcium phosphate without struvite. Results Of the 1,093 calcium phosphate stones 12.8% showed a peculiar morphology termed IVa2, characterized by a smooth aspect and a glazed brown-yellow appearance with tiny cracks. IVa2 morphology was observed in 96.1% of stones associated with inherited distal renal tubular acidosis. In contrast, the other stones of similar composition but different morphology were related to distal renal tubular acidosis in only 3.9% of cases. In addition, IVa2 stones were found in 65% of calcium phosphate stone formers associated with Sjögren syndrome and in 35% of calcium phosphate stones in patients with medullary sponge kidney. These 2 conditions are related to a mild to moderate distal acidification defect. Conclusions Identifying IVa2 stone morphology is clinically relevant because it should prompt clinicians to search for complete or incomplete distal acidosis and initiate specific therapy to decrease recurrence.
Document type :
Journal articles
Complete list of metadatas

Cited literature [30 references]  Display  Hide  Download

https://hal.sorbonne-universite.fr/hal-01148416
Contributor : Administrateur Hal-Upmc <>
Submitted on : Monday, May 4, 2015 - 3:22:12 PM
Last modification on : Friday, October 30, 2020 - 2:40:02 PM
Long-term archiving on: : Monday, September 14, 2015 - 6:26:15 PM

File

Dessombz_Acidosis_Urology_2015...
Files produced by the author(s)

Identifiers

Citation

Arnaud Dessombz, Letavernier Emmanuel, Jean-Philippe Haymann, Dominique Bazin, Michel Daudon. Calcium Phosphate Stone Morphology Can Reliably Predict Distal Renal Tubular Acidosis. Journal of Urology, Elsevier, 2015, 193 (5), pp.1564-1569. ⟨10.1016/j.juro.2014.12.017⟩. ⟨hal-01148416⟩

Share

Metrics

Record views

569

Files downloads

1204