Renal geology (quantitative renal stone analysis) by ‘Fourier transform infrared spectroscopy’

ORIGINAL ARTICLE

Renal geology (quantitative renal stone analysis) by ‘Fouriertransform infrared spectroscopy’

Iqbal Singh

Received: 24 June 2007 / Accepted: 17 December 2007 / Published online: 26 January 2008

� Springer Science+Business Media B.V. 2008

Abstract

Aim To prospectively determine the precise stone

composition (quantitative analysis) by using infrared

spectroscopy in patients with urinary stone disease

presenting to our clinic. To determine an ideal

method for stone analysis suitable for use in a

clinical setting.

Methods After routine and a detailed metabolic

workup of all patients of urolithiasis, stone

samples of 50 patients of urolithiasis satisfying

the entry criteria were subjected to the Fourier

transform infrared spectroscopic analysis after

adequate sample homogenization at a single test-

ing center.

Results Calcium oxalate monohydrate and dihy-

drate stone mixture was most commonly encountered

in 35 (71%) followed by calcium phosphate, carbon-

ate apatite, magnesium ammonium hexahydrate and

xanthine stones.

Conclusions Fourier transform infrared spectros-

copy allows an accurate, reliable quantitative

method of stone analysis. It also helps in maintaining

a computerized large reference library. Knowledge of

precise stone composition may allow the institution

of appropriate prophylactic therapy despite the

absence of any detectable metabolic abnormalities.

This may prevent and or delay stone recurrence.

Keywords Metabolic � Renal stones �Spectroscopy � Stone analysis � Urolithiasis

Introduction

Urolithiasis is a recurrent condition that is accompa-

nied by significant morbidity. The average lifetime

prevalence of kidney stones may be as high as 20% in

the general population [1]. While appropriate uro-

logical intervention addresses the symptomatic stone

episodes, the institution of further prophylactic mea-

sures to prevent recurrences is also of utmost

importance. This necessitates a thorough metabolic

workup and an accurate quantitative stone analysis.

Without an appropriate workup, stone analysis and

proper follow up the recurrence rates may be as high

as 10–23%/year and may reach to 50% within

5 years, leading to 1.9–2.9 lost days of work with

each stone present/removed [1]. Many clinicians

often neglect the analysis of urinary stones. It is with

this perspective in mind that we planned to evaluate

the role of Fourier transformed infrared spectroscopy

(FT-IRS) in urolithiasis, and this forms the basis of

our current study.

I. Singh (&)

Division of Urology, Department of Surgery, University

College of Medical Sciences (University of Delhi) & GTB

Hospital, F-14 South Extension Part-2, New Delhi

110049, India

e-mail: [email protected]

123

Int Urol Nephrol (2008) 40:595–602

DOI 10.1007/s11255-007-9327-2

Methods

Patients with (1) history of graveluria, ureteric colics/

crystalluria, past history of stone disease/recurrence/

known metabolic abnormality, and (2) established stone

disease of the urinary tract on the basis of an X-ray KUB,

ultrasound (USG), or intravenous pyelography (IVP)

were included in this study. After a detailed history,

clinical examination, blood biochemistry and renal

function tests were carried out. Metabolic workup

included: urine (24 h volume, specific gravity, pH,

crystals, pus cells, bacteria, cytology and c/s), urine

chemistry (24 h calcium, phosphorus, uric acid and

oxalate-3 samples on an unrestricted diet), blood

chemistry (serum calcium, phosphorus and uric acid-3

samples), and S. PTH (in case of hypercalcemia and

hypercalciuria). Diagnostic investigations such as X-ray

KUB, IVP/USG were performed in all the cases to

define the stone location/burden.

Stones retrieved by PCNL, spontaneous passage,

ureteroscopy or open surgeries were subjected to

FT-IRS using the ‘‘Perkin Elmer Spectrum Bx-2’’ [2,

3]. The following methodology was used: 1 mg of the

homogenized stone sample was rehomogenized with

300 mg of potassium bromide (KBr) of spectroscopic

purity and converted into a pellet by exerting a standard

pressure of 100 lbs/sq inch (7.03 kg cm2). The pellet

was then placed in the scanning chamber in the path of

the infrared spectrophotometer. Part of the radiation was

absorbed while the rest was emitted as a Fourier

transformed infrared radiation spectrum. This spectrum

has absorption peaks corresponding to the vibration

frequency of the bonds of atoms comprising the stone.

The peak size directly correlates with the quantity of the

specific chemical. The FT-IRS spectrum is then com-

puter matched against a library of spectra (of over 1,000

various bio and inorganic materials) so as to generate a

precise report on the various stone components.

Various calcareous stones were defined as follow: (1)

calcium oxalate stones were defined as containing

[70% calcium oxalate, (2) calcium apatite stones as

those with [30 hydroxyapatites, (3) mixed calcium

oxalate-apatite stones as those with B70% calcium

oxalate + C5% to B30% calcium apatite, and (4)

primary calcium apatite stones as those with C30%

calcium apatite and B70% calcium oxalate. Non-

calcareous stones were defined as uric acid stones (pure

uric acid and mixed uric acid–calcium oxalate stones),

infection stones (containing magnesium ammonium

phosphate, carbonate apatite, or hydroxyapatite or

tricalcium phosphate) and cystine stones. Fifty patients

were included in the present study, which was carried

out from January 2002 until May 2003.

Results

Out of 50 patients included in the study, 71% had a

mixture of calcium oxalate monohydrate (CaOxMH)

and calcium oxalate dihydrate (CaOxDH) stones,

followed by calcium phosphate (7%), carbonate

apatite (CAP) (7%), magnesium ammonium phos-

phate hexahydrate (MAPHH) (7%), pure calcium

oxalate monohydrate (7%), and xanthine (1%). The

FTIR spectrum of the commonest stone type encoun-

tered (CaOxMH + CaOxDH) is shown in Fig. 1a,

while Fig. 1b depicts the spectrum of a patient

with CaOxMH + CaOxDH + CAP) and Fig. 1c

depicts the spectrum of a struvite stone (CaO-

xMH + MAPHH + CAP). The mean age of the

patients was 38.68 years (10–62 years). Significant

hypercalciuria was present in 5 patients, which

correlated with hypercalcemia in 2 patients, while

CRF was present in 2 patients. None had hyperuri-

cosuria or phosphaturia. Hyperoxaluria was detected

in 1 patient. Culture positive significant bacteriuria

was demonstrated preoperatively in 17 (34%)

patients. Based on the stone analysis report appro-

priate dietary, fluid and medical prophylactic

measures were instituted in these patients. UTI was

aggressively treated until all patient’s urine culture

was reported as insignificant.

Discussion

Although it is well known that a study of the chemical

composition of urinary calculi is important for under-

standing their etiology/management and for prevention

of recurrences, the appropriate method for this has still

not been defined [4]. Currently, the following methods

are available for stone analysis: (1) chemical analysis,

(2) emission spectroscopy, (3) polarizing spectroscopy,

(4) X-ray diffraction, (5) X-ray coherent scatter/

crystallography, (6) thermogravimetry, (7) scanning

electron microscopy, and (8) infrared spectroscopy

(Fig. 2). Chemical analysis has been traditionally used

most widely due to its ease and low cost. This is,

596 Int Urol Nephrol (2008) 40:595–602

123

however, time consuming, necessitates large stone

samples, and cannot distinguish between the two

commonly occurring calcium stones (monohydrate/

dihydrate). X-ray coherent scatter [5] uses a diagnostic

X-ray tube and an image intensifier to measure a

coherent scatter from intact renal stones, preoperatively

to determine the stone composition in vivo before

therapy; this may allow the selection of appropriate

therapy [5]. X-ray crystallography allows an analysis of

small amounts of spontaneously passed stones, gravel,

randal’s plaques and papillary stones [6].

With the exception of FT-IRS, none of the above can

provide a reliable quantitative stone analysis. Moreover,

with a computerized reference library match of the

closest IR spectrum, FT-IRS can characterize virtually

any stone sample [7]. Corns [8], in a study comparing

conventional and other qualitative analytical methods

with FT-IRS, concluded that FT-IRS was the simplest,

quickest, easiest to learn method of stone analysis with a

small sample providing a positive quantitative identifi-

cation of most of the common stone constituents [8].

Fig. 1 (a) The infrared spectrum of a pure calcium oxalate

stone: CaOxMH (calcium oxalate monohydrate) = 90%,

CaOxDH (calcium oxalate dihydrate) = 10%. (b) The infrared

spectrum of a predominantly apatite stone: CaOxMH (calcium

oxalate monohydrate) = 40%, CaOxDH (calcium oxalate

dihydrate) = 30%, Carb Apat (carbonate apatite) = 30%. (c)

The infrared spectrum of a predominantly struvite stone:

CaOxMH (calcium oxalate monohydrate) = 25%, MgAm-

PO4HH (magnesium ammonium hexahydrate) = 50%, Carb

Apat (carbonate apatite) = 25%

Fig. 2 Showing the diagrammatic sketch of the principle of

infrared spectroscopic stone analysis

Int Urol Nephrol (2008) 40:595–602 597

123

Table 1 Results of stone analysis by FT-IRS in 50 patients

No. Age Metabolic Stone analysis Quantitative Stone type/location

1 40/M HCA + HCU CaOxMH + CaOxDH 90%, 10% Pelvic stone

2 55/F – CaOxMH + CaOxDH 80%, 20% Multiple calyceal stones

3 38/M – CaOxMH + CaOxDH 80%, 20% B/L stones

4 24/F – CaOxMH, CaOxDH, CA 40%, 30%, 30% Stones in duplex kidney

5 55/M UTI CaOxMH + CaOxDH 80%, 20% CRF, staghorn

6 45/F UTI CaOxMH (pure) 100% Giant staghorn stone



9 32/M – CaOxMH + CaOxDH 90%, 10% Multiple calyceal stones

10 34/F – CaOxMH, MAPHH 25%, 50%, 25% Inferior calyceal stones

11 10/M UTI XANTHINE 100% Ureteric stone

12 35/M HCU CaOxMH + CaOxDH 80%, 20% Calyceal bulky staghorn stone

13 23/M – CaOxMH + CaOxDH 90%, 10% Superior calyceal stone


15 36/M UTI CaOxMH + CaOxDH 70%, 30% Superior calyceal stones

16 12/M HCU CaOxMH + CaOxDH 90%, 10% Inferior calyceal stones

17 35/M – CAPO (pure) 100% Multiple calyceal stones

18 25/M UTI CaOxMH + CaOxDH 80%, 20% Multiple calyceal stones

19 50/M UTI CaOxMH + CaOxDH 80%, 20% Calyceal bulky staghorn stone

20 45/M UTI CaOxMH + CaOxDH 70%, 30% Calyceal bulky staghorn stone

21 35/F UTI + HU CaOxMH (pure) 100% Inferior calyceal stones

22 37/M – CaOxMH + CaOxDH 70%, 30% Calyceal bulky staghorn stone

23 42/M UTI CaOxMH (pure) 100% Multiple calyceal stones

24 38/M – CAP + CaOxDH 60%, 40% Calyceal bulky staghorn stone

25 56/M UTI CaOxMH + CaOxDH 70%, 30% Pelvic bulky staghorn stone

26 58/M – CaOxMH + CaOxDH 80%, 20% Calyceal bulky staghorn stone

27 60/M – CaOxMH + CaOxDH 70%, 30% Pelvic bulky staghorn stone


29 30/F – CaOxMH (pure) 100% Pelvic bulky staghorn stone

30 33/F UTI MAPHH + CAP 70%, 30% Staghorn stone

31 45/M – CaOxMH + CaOxDH 70%, 30% Inferior calyceal stones


33 50/M HCU CaOxMH + CaOxDH 80%, 20% Multiple calyceal stones

34 53/M – CaOxMH + CaOxDH 70%, 30% Inferior calyceal stones



37 35/m UTI CAPO (pure) 100% Pelvic staghorn stone

38 27/M – CAP + CaOxDH 60%, 40% Inferior calyceal stones

39 17/M HC CaOxMH + CaOxDH 70%, 30% Multiple calyceal stones

40 29/M HC CaOxMH + CaOxDH 80%, 20% Multiple calyceal stones

41 30/F HCA + HCU CAPO (pure) 100% Inferior calyceal stones

42 44/M – CAP + CaOxDH 60%, 40% Multiple calyceal stones

43 49/M UTI CaOxMH + CaOxDH 70%, 30% Pelvic bulky staghorn stone

44 45/M – CaOxMH + CaOxDH 70%, 30% Pelvic bulky staghorn stone

45 48/M HCU CaOxMH + CaOxDH 80%, 20% Pelvic bulky staghorn stone

598 Int Urol Nephrol (2008) 40:595–602

123

FT-IRS is a sensitive, reliable, accurate, safe and

quick method of accurate stone analysis suitable for use

in a clinical laboratory [9, 10]. The high degree of

accuracy is possible due to the computerized area-

measurements of specific absorption peaks of the

spectrum of each sample (mean error rate being

±2–2.5%) [10]. FT-IRS has its limitations though these

are mainly technical [11] in nature: (1) the procedure is

dependent on a proper homogenization of the sample

with KBr that may affect the IRS spectrum quality, (2)

resolution of the apparatus and reproducibility of the

spectrum bands may affect its reliability, and (3) certain

mixtures may be problematic and difficult to interpret

namely uric acid/uric acid dihydrate, whewellite/wed-

ellite in cases of low proportions (\20%) of calcium

oxalate in uric acid calculi [11], and carbonate in struvite

stones, because the NH4 absorption of magnesium

ammonium phosphate overlaps CO3 absorption of

carbonate at 1,420–1,435 cm-1 [11].

In our study, the commonest stone encountered was a

mixture of calcium-oxalate monohydrate (predominant)

and calcium-oxalate-dihydrate (71.4%), followed by

carbonate-apatite (7.14%), calcium-ammonium-hexa-

hydrate (7.14%) and xanthine (7.14%).

According to Pak et al. [12], an exact knowledge

of the renal stone composition may be able to predict

the underlying medical disorder especially with

regard to certain non calcium stones such as oxalate

and uric acid stones [12]. The quantitative stone

analysis by FT-IRS also allows accurate separate

zonewise analysis of the stone nucleus, external and

internal layers not possible by other methods, and is

not prone to errors of judgment unlike the conven-

tional qualitative wet methods of stone analysis [13]

(Tables 1, 2).

Table 3 shows a summary of the comparative

assessment of the various methods of stone analysis

methods being that have been published in the

English literature up to now [13, 20–26]. It may be

inferred that any of these methods is only as good as

the sample used, and different areas of the calculus

must be analyzed separately if useful results are to be

obtained, particularly with regard to the spectroscopy

and X-ray diffraction method of stone analysis [24].

While the wet chemical analytical qualitative method

of urinary stone analysis remains the traditional gold

standard, these have been increasingly globally

replaced with the more accurate and quantitative

Table 1 continued

No. Age Metabolic Stone analysis Quantitative Stone type/location

46 37/M – CAPO (pure) 100% Upper ureteric stone


48 50/M UTI CaOxMH, CaOxDH 80%, 20% Multiple calyceal stones


50 30/F UTI MAPHH (pure) 100% Stone in calyceal diverticulum

HCA/HCU Hypercalcemia/hypercalciuria, CaOxMH/DH calcium oxalate mono hydrate/dihydrate, CAPO calcium phosphate, CAPcarbonate apatite, MAPHH, magnesium ammonium hexahydrate

Table 2 Results of FT-IRS stone analysis reported by other workers

No Author Size Results Location

1 Pak et al. [12] 1,392 CaOx [ Mixed CaOx-CaAp [ Pure Ca-Ap Canada

2 Oussama et al. [14] 45 CaOxMH [ CaOxDH [ Struvite [ Uric acid Morocco

3 Balla et al. [15] 80 CaOx [ Struvite [ Uric acid Sudan

4 Harrache et al. [16] 60 CaOxMH [ AmUrate [ Struvite [ Uric acid Algeria

5 Thomas et al. [17] 17 Bi hydrated Ca Hydrophosphate—commonest Paris

6 Normand et al. [18] 300 CaOxMH [ CaOxDH [ Struvite [ UA [ CarbAp France

7 Rizvi et al. [19] 150 CaOxalate—commonest stone Pakistan

8 Modlin and Davies [4] 52 CaPhosphate—commonest stone S. Africa

9 Ligabue et al. [10] 64 Apatite-nucleus, UA & CaOx-External Italy

Int Urol Nephrol (2008) 40:595–602 599

123

Ta

ble

3A

nal

ysi

so

fd

iffe

ren

tm

eth

od

s[1

3,

20–

26

]o

fu

rin

ary

sto

ne

anal

ysi

s(b

ased

on

the

chem

ical

anal

ysi

sas

the

go

ldst

and

ard

)

Tes

tP

rin

cip

lean

dm

eth

od

Pro

s&

con

sO

ther

feat

ure

s

Ch

emic

alan

aly

sis

(CA

)C

on

ven

tio

nal

qu

alit

ativ

ew

etch

emic

al

met

ho

db

ased

on

clu

ster

anal

ysi

s

Po

st-o

pan

aly

sis.

Itis

anem

pir

ical

met

ho

dw

ith

a1

0–

60

%m

atch

ing

erro

r

Tra

dit

ion

ally

itca

no

nly

det

ect

the

rad

ical

san

dn

ot

the

pre

cise

typ

eo

fsa

lt.

Can

no

td

isti

ng

uis

ho

xal

ate/

ph

osp

hat

e

FT

IRsp

ectr

osc

op

y

(FT

–IR

S)

Qu

anti

tati

ve

anal

ysi

s.U

ses

KB

r

tech

niq

ue,

bas

edo

nIn

frar

edsp

ectr

al

anal

ysi

s

Hig

hac

cura

cy(9

8–

99

%),

Po

st-o

p

anal

ysi

s.S

ing

lem

ost

use

ful,

easy

to

lear

nra

pid

met

ho

d,

use

sth

ele

ast

vo

lum

eo

fsa

mp

le,

bu

td

iffe

ren

tar

eas

nee

dto

be

anal

yze

dse

par

atel

y

Pre

cise

%d

etec

tio

no

fv

ario

us

sto

ne

com

po

siti

on

(Wd

,W

h,

St,

Cp

,U

a,C

a).

Itis

equ

ally

sen

siti

ve

for

ox

alat

e/

ph

osp

hat

e,ca

nd

isti

ng

uis

hW

h/W

e,

spu

rio

us/

org

anic

sam

ple

sal

so

NM

Rsp

ectr

osc

op

y

(NM

RS

)

Qu

anti

tati

ve

anal

ysi

s.B

ased

on

13

C&

31

Pm

agic

-an

gle

spin

nin

g(M

AS

)

soli

d-s

tate

(SS

)N

MR

In-v

ivo

inta

ctst

on

eco

mp

osi

tio

nal

anal

ysi

s.D

egre

eo

fac

cura

cy:

can

acco

un

tfo

ru

pto

60

–8

5%

(by

wei

gh

t)

of

the

calc

uli

con

stit

uen

ts

Can

det

ect/

iden

tify

the

maj

or

cry

stal

lin

e/

amo

rph

ou

sim

mo

bil

e/m

ob

ile,

pro

ton

ated

/no

n-p

roto

nat

edo

rgan

ic&

ino

rgan

icco

mp

on

ents

CT

spec

tro

sco

py

(CT

S)

Qu

alit

ativ

ean

aly

sis.

Use

sm

ult

isli

ceu

n-

enh

ance

dh

elic

alC

Tan

dth

esi

ng

le

abso

lute

HU

val

ue/

den

sity

In-v

ivo

inta

ctst

on

eco

mp

osi

tio

nal

anal

ysi

s.D

egre

eo

fac

cura

cy:

hig

h8

1%

of

the

calc

uli

can

be

corr

ectl

yp

ick

ed

up

.S

mal

l(U

a)ca

lcu

lim

ayb

em

isse

d,

even

wit

hm

axim

alK

v-C

T

Co

nsp

icu

ity

of

smal

lca

lcu

liin

crea

ses

wit

hh

igh

erk

van

dm

Ase

ttin

gs,

hig

her

Kv

bei

ng

mo

rev

ital

.A

t1

40

Kv

&

30

0m

Ath

eS

DT

SF

—0

.84

mm

(Wd

)–

1.4

mm

(Ua)

.C

and

etec

tp

ure

&m

ixed

uri

nar

yst

on

es

X-r

ayd

iffr

acti

on

(XR

D)

Bas

edo

nan

aly

sis

of

the

mic

ro-a

rea

X-r

ay

dif

frac

tio

np

atte

rno

fu

rin

ary

sto

nes

In-v

itro

sto

ne

anal

ysi

sb

yX

RD

+X

PS

is

on

eo

fth

eb

est

met

ho

ds

wit

hre

gar

dto

corr

ectn

ess.

No

tro

uti

nel

yav

aila

ble

By

com

bin

ing

XR

Dan

dX

PS

the

com

po

siti

on

s&

ph

ases

of

man

ym

ixed

uri

nar

yst

on

esca

nb

eo

bta

ined

wit

h

hig

hac

cura

cy

X-r

ayp

ho

toel

ectr

on

spec

tro

sco

py

(XP

S)

Bas

edo

n,

Ram

anw

ave

form

spec

tral

pat

tern

anal

ysi

s

X-r

ayco

her

ent

scat

ter

(XC

S)

Eac

hp

ure

sam

ple

pro

du

ces

ad

isti

nct

coh

eren

tsc

atte

rsi

gn

atu

rep

atte

rno

f

circ

ula

rsy

mm

etry

(ser

ies

of

bro

adri

ng

s

of

var

iou

sin

ten

siti

es)

In-v

ivo

tech

niq

ue

for

the

inta

ctre

nal

sto

ne

anal

ysi

su

ses

X-r

ay

dif

frac

tom

eter

Co

her

ent

scat

ter

sig

nat

ure

so

fst

on

e

com

po

nen

tsar

eac

qu

ired

fro

mp

ure

chem

ical

sam

ple

s&

sto

nes

iden

tifi

ed

by

IRS

Co

mp

ara

tive

sum

ma

ry

Sto

ne

det

ecti

on

thre

sho

ldsi

zefa

cto

r(S

DT

F)

(cal

culu

ssi

ze:

50

%

pro

bab

ilit

yo

fb

ein

gd

etec

ted

)

NM

RS

[F

T–

IRS

[C

TS

[X

RD

+X

PS

[X

CS

[C

A

Rel

ativ

eco

stfa

cto

r(b

ased

on

infr

astr

uct

ure

cost

)N

MR

S[

CT

[F

T–

IRS

[X

RD

+X

PS

[X

CS

[C

A

Deg

ree

of

accu

racy

XR

D+

XP

S[

FT

–IR

S[

NM

RS

[X

CS

[C

TS

[C

A

HU

Ho

un

sefi

eld

un

it(s

pec

ific

den

sity

for

var

iou

sst

on

es),

KB

rp

ota

ssiu

mb

rom

ide,

Wh

wh

ewel

lite

(cal

ciu

mo

xal

ate

mo

no

hy

dra

te),

Wd

wed

del

lite

(cal

ciu

mo

xal

ate

dih

yd

rate

),U

Au

ric

acid

St

stru

vit

e(c

alci

um

mag

nes

ium

amm

on

ium

hex

ahy

dra

te),

Cp

calc

ium

ph

osp

hat

e,C

aca

rbam

ate

600 Int Urol Nephrol (2008) 40:595–602

123

methods, such as infrared/CT or NMR spectroscopy

and X-ray diffraction scatter techniques, in many

advanced diagnostic stone centers. Though infrared

spectroscopy originated as early as 1976 [13] it has

gained in popularity as a reliable method of in-vitro

quantitative stone analysis only in the last decade.

Literature surveys also reveal that methods like

thermogravimetric [25] and chemical/crystallo-

graphic [26] stone analysis over the last three

decades have gradually lost their steam and have

become more or less obsolete for the purpose of

reliable quantitative urinary stone analysis. While the

diagnostic reliability of these newer tests has been

confirmed by several studies [13, 20–24], the utility

of FT-IRS as a routine screening test is also

established. Certain spectroscopy methods (such as

CT) [20, 21, 23, 24] are already being used in many

centers as screening tests and are also being used

reliably to predict stone fragility prior to shock wave

lithotripsy in many stone centers across the globe.

Conclusion

Calcium oxalate was the commonest stone encoun-

tered in the present study. This is in conformity with

the findings in the rest of the world. FT-IRS provides

an accurate and precise quantitative stone analysis.

By means of the computerized infrared spectropho-

tometer and the large reference library an exact

quantitative stone signature is possible, thereby

overcoming the operator and subjective bias in

interpreting the infrared spectrum. FT-IRS is an

efficient and precise way to determine urinary stone

composition; the use of this diagnostic modality

should be freely extended to all such centers manag-

ing urolithiasis. Knowledge of the precise stone

composition allowed institution of appropriate pro-

phylactic dietary and medical therapy even in the

absence of any proven metabolic abnormalities, and

this may help in the prevention of urinary stone

recurrence.

References

1. Kepinsky J et al (2000) Metabolic investigation of recur-

rent nephrolithiasis: compliance with recommendations.

Urology 56:915–920

2. Wall I et al (1986) Biochemical risk factors in patients with

renal staghorn stone disease. Urology 28:377–380

3. Hesse A, Sanders G (1988) Atlas of infrared spectra for the

analysis of urinary concrements. Thieme, Stuttgart

4. Modlin M, Davies PJ (1981) The composition of renal

stones analysed by infrared spectroscopy. S Afr Med J

59:337–341

5. Batchelar DL, Chun SS, Wollin TA, Tan JK, Beiko DT,

Cunningham IA, Denstedt JD (2002) Predicting urinary

stone composition using X-ray coherent scatter: a novel

technique with potential clinical applications. J Urol

168:260–265

6. Cifuentes Delatte L, Minon-Cifuentes J, Medina JA (1987)

New studies on papillary calculi. J Urol 137:1024–1029

7. Lehmann CA, McClure GL, Smolens I (1988) Identifica-

tion of renal calculi by computerized infrared

spectroscopy. Clin Chim Acta 173:107–116

8. Corns CM (1983) Infrared analysis of renal calculi: a

comparison with conventional techniques. Ann Clin Bio-

chem 20(Pt 1):20–25

9. Mandel G, Mandel N (1996) Analysis of stones. In: Coe

FL, Favus MJ, Pak CYC, Parks JH, Preminger GM (eds)

Kidney stones. Lippincott-Raven, Philadelphia, pp 323–

335

10. Ligabue A, Biagi R, Fini M, Bertusi G (1977) Infrared

spectroscopy in the quantitative determination of urinary

calculi constituents. Quad Sclavo Diagn 13(2):186–196

11. Takasaki E (1996) Carbonate in struvite stone detected in

Raman spectra compared with infrared spectra and X-ray

diffraction. Int J Urol 3:27–30

12. Pak CY, Poindexter JR, Adams-Huet B, Pearle MS (2003)

Predictive value of kidney stone composition in the

detection of metabolic abnormalities. Am J Med

115(1):26–32

13. Oliver LK, Sweet RV (1976) A system of interpretation of

infrared spectra of calculi for routine use in the clinical

laboratory. Clin Chim Acta 72(1):17–32

14. Oussama A, Kzaiber F, Mernari B, Semmoud A, Daudon

M (2000) Analysis of calculi by infrared spectroscopy in

children from the Moroccan mid-Atlas region. Ann Urol

(Paris) 34(6):384–390

15. Balla AA, Salah AM, Khattab AH, Kambal A, Bongartz D,

Hoppe B, Hesse A (1998) Mineral composition of renal

stones from the Sudan. Urol Int 61(3):154–156

16. Harrache D, Mesri A, Addou A, Semmoud A, Lacour B,

Daudon M (1997) Urolithiasis in children in West Algeria.

Ann Urol (Paris) 31(2):84–88

17. Thomas J, Thomas E, Fompeydie D, Arvis G, Zerbib M,

Benassayag E, Flam T, Debre B (1995) Urinary calculi,

consisting of dehydrated calcium phosphate. Clinical,

biological, radiologic aspects, clinical course and man-

agement. J Urol (Paris) 101(3):139–152

18. Normand M, Bergua D, Bouvet JP, Cayotte JL, Gottis M

(1989) Correlation of the cause and composition of renal

calculi. Value of morphologic and infrared analysis. Ann

Biol Clin (Paris) 47(1):29–34

19. Rizvi SA, Naqvi SA, Hussain Z, Shahjehan S (1985) Renal

stones in children in Pakistan. Br J Urol 57(6):618–621

20. Bak M, Thomsen JK, Jakobsen HJ, Petersen SE, Petersen

TE, Nielsen NC (2000) Solid-state 13 C and 31 P NMR

analysis of urinary stones. J Urol 164:856–863

Int Urol Nephrol (2008) 40:595–602 601

123

21. Tublin ME, Murphy ME, Delong DM, Tessler FN, Kliewer

MA (2002) Conspicuity of renal calculi at unenhanced CT:

effects of calculus composition and size and CT technique.

Radiology 225(1):91–96

22. Abdel-Halim RE, Abdel-Halim MR (2006) A review of

urinary stone analysis techniques. Saudi Med J 27(10):

1462–1467

23. Bellin MF, Renard-Penna R, Conort P, Bissery A, Meric

JB, Daudon M et al (2004) Helical CT evaluation of the

chemical composition of urinary tract calculi with a dis-

criminant analysis of CT-attenuation values and density.

Eur Radiol 14(11):2134–2140

24. Schubert G (2006) Stone analysis review. Urol Res

34(2):146–150

25. Rose GA, Woodfine C (1976) The thermogravimetric

analysis of renal stones (in clinical practice). Br J Urol

48(6):403–412

26. Sutor DJ, Wooley SE, MacKenzie KR, Wilson R, Scott R,

Morgan HG (1971) Urinary tract calculi—a comparison of

chemical and crystallographic analyses. Br J Urol

43(2):149–153

602 Int Urol Nephrol (2008) 40:595–602

123

Documents

Renal geology (quantitative renal stone analysis) by ‘Fourier transform infrared spectroscopy’