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Todorov LG. et al., 2022: GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles.

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Todorov LG, Sivaguru M, Krambeck AE, Lee MS, Lieske JC, Fouke BW.
Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Cytometry and Microscopy to Omics Facility, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Department of Evolution, Ecology and Behavior, University of Illinois at Urbana-Champaign, Urbana, IL, USA.

Abstract

Shock wave lithotripsy (SWL) is an effective and commonly applied clinical treatment for human kidney stones. Yet the success of SWL is counterbalanced by the risk of retained fragments causing recurrent stone formation, which may require retreatment. This study has applied GeoBioMed experimental and analytical approaches to determine the size frequency distribution, fracture patterns, and reactive surface area of SWL-derived particles within the context of their original crystal growth structure (crystalline architecture) as revealed by confocal autofluorescence (CAF) and super-resolution autofluorescence (SRAF) microscopy. Multiple calcium oxalate (CaOx) stones were removed from a Mayo Clinic patient using standard percutaneous nephrolithotomy (PCNL) and shock pulse lithotripsy (SPL). This produced approximately 4-12 mm-diameter PCNL-derived fragments that were experimentally treated ex vivo with SWL to form hundreds of smaller particles. Fractures propagated through the crystalline architecture of PCNL-derived fragments in a variety of geometric orientations to form rectangular, pointed, concentrically spalled, and irregular SWL-derived particles. Size frequency distributions ranged from fine silt (4-8 μm) to very fine pebbles (2-4 mm), according to the Wentworth grain size scale, with a mean size of fine sand (125-250 μm). Importantly, these SWL-derived particles are smaller than the 3-4 mm-diameter detection limit of clinical computed tomography (CT) techniques and can be retained on internal kidney membrane surfaces. This creates clinically undetectable crystallization seed points with extremely high reactive surface areas, which dramatically enhance the multiple events of crystallization and dissolution (diagenetic phase transitions) that may lead to the high rates of CaOx kidney stone recurrence after SWL treatment.
Sci Rep. 2022 Nov 1;12(1):18371. doi: 10.1038/s41598-022-233315.PMID: 36319741. FREE ARTICLE

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Comments 1

Peter Alken
Peter Alken on Thursday, 16 March 2023 09:30

Old wine in new bottles? (Luke 5:36-39)
This publication with the beautiful pictures of stone fragments and crystals reminds me of the time about 40 years ago when visually very appealing SEM findings of kidney stones were used to explain stone formation on the basis of mineralogy and the physical laws of crystal formation. Unfortunately, this work has never led to clinically actionable advances. GeoBioMed (1) is a new beginning on this path. The senior author has an apatite for kidney stones  (2). If the combination of tissue trauma - by PNL or ESWL - and stone dust is a fatal combination leading to stone recurrence, then URS could be the winner, with only one negative factor: tiny stone fragments by stone dust with the laser, but minimal or no tissue lesions.

1 Sivaguru M, Lieske JC, Krambeck AE, Fouke BW. GeoBioMed sheds new light on human kidney stone crystallization and dissolution. Nat Rev Urol. 2020 Jan;17(1):1-2. doi: 10.1038/s41585-019-0256-5. PMID: 31676884.
2 Fouke, B.W. An apatite for kidney stones. Nat. Geosci. 15, 692–693 (2022). https://doi.org/10.1038/s41561-022-01013-1

Peter Alken

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Old wine in new bottles? (Luke 5:36-39) This publication with the beautiful pictures of stone fragments and crystals reminds me of the time about 40 years ago when visually very appealing SEM findings of kidney stones were used to explain stone formation on the basis of mineralogy and the physical laws of crystal formation. Unfortunately, this work has never led to clinically actionable advances. GeoBioMed (1) is a new beginning on this path. The senior author has an apatite for kidney stones  (2). If the combination of tissue trauma - by PNL or ESWL - and stone dust is a fatal combination leading to stone recurrence, then URS could be the winner, with only one negative factor: tiny stone fragments by stone dust with the laser, but minimal or no tissue lesions. 1 Sivaguru M, Lieske JC, Krambeck AE, Fouke BW. GeoBioMed sheds new light on human kidney stone crystallization and dissolution. Nat Rev Urol. 2020 Jan;17(1):1-2. doi: 10.1038/s41585-019-0256-5. PMID: 31676884. 2 Fouke, B.W. An apatite for kidney stones. Nat. Geosci. 15, 692–693 (2022). https://doi.org/10.1038/s41561-022-01013-1 Peter Alken
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