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| Correlation analysis between urinary crystals and upper urinary calculi |
Xi Zhanga,Yang Zhengb,Yichun Wanga,Xiyi Weia,Shuai Wanga,Jie Zhengc,Jixiang Yaoc,Chen Xud,Zhijun Caod,Chao Qina,*( ),Lujiang Yie,*(),Ninghong Songa,*()
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aDepartment of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
bNanjing Hospital of Traditional Chinese Medicine, Nanjing Hospital of Chinese Medicine, Nanjing, China
cDepartment of Urology, Wuhu Hospital Affiliated to East China Normal University, Wuhu, China
dDepartment of Urology, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China
eDepartment of Laboratory, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China |
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Abstract Objective: This study aimed to analyze the correlation between urinary crystals and urinary calculi. Methods: Clinical data, including urinary crystal types, were collected from 237 patients with urinary calculi. The detection rate of urine crystals and their correlation with stone composition were analyzed. The receiver operating characteristic curve analysis was used to determine the best cut-off value for predicting stone formation risk based on calcium oxalate crystals in urine. Results: Calcium oxalate was the most common component in 237 patients. Among them, 201 (84.81%) patients had stones containing calcium oxalate. In these patients, calcium oxalate crystals were detected in 45.77% (92/201) of cases. In different groups of calcium oxalate stones, calcium oxalate crystals accounted for more than 90% of the total number of crystals detected in each group. The detection rate of calcium oxalate crystals was higher in first-time stone formers than in recurrent patients. The receiver operating characteristic curve analysis suggested a cut-off value of 110 crystals/μL for predicting stone formation, validated with 65 patients and 100 normal people. Conclusion: Calcium oxalate crystals in urine can predict the composition of calcium oxalate stones and indicate a higher risk of stone formation when the number exceeds 110 crystals/μL. This non-invasive method may guide clinical treatment and prevention strategies.
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Received: 19 April 2023
Available online: 20 October 2024
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Corresponding Authors:
*E-mail address: qinchao@njmu.edu.cn (C. Qin), lj.yi@njmu.edu.cn (L. Yi), songninghong_urol@163.com (N. Song).
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| Stone composition | Total | Urinary crystal | None urinary crystal | Crystallization detection rate, % | Match, % | Mismatch,% | COC detection rate, % | | COC | PC | UC | CC | | Calcium oxalate calculus | 97 | 42 | 3 | 1 | 0 | 51 | 47.42 | 91.30 | 8.70 | 43.30 | | Calcium oxalate mixed carbonate apatite | 83 | 43 | 1 | 0 | 0 | 39 | 53.01 | 97.73 | 2.27 | 51.81 | | Calcium oxalate mixed uric acid calculus | 20 | 7 | 0 | 2 | 0 | 11 | 45.00 | 100 | 0 | 35.00 | | Struvite mixed carbonate apatite | 16 | 1 | 5 | 1 | 0 | 9 | 43.75 | 71.43 | 28.57 | 6.25 | | Uric acid calculus | 15 | 1 | 1 | 4 | 0 | 9 | 40.00 | 66.67 | 33.33 | 6.67 | | Struvite calculus | 2 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | | Carbonate apatite mixed hydroxyapatite | 1 | 1 | 0 | 0 | 0 | 0 | 100 | 0 | 100 | 100 | | Calcium oxalate mixed l-cystine calculus | 1 | 0 | 0 | 0 | 1 | 0 | 100 | 100 | 0 | 0 | | Carbonate apatite mixed l-cystine calculus | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | | l-cystine calculus | 1 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | | Total | 237 | 95 | 10 | 8 | 1 | 123 | 48.10 | 91.23 | 8.77 | 40.08 |
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The crystal detection, match, mismatch, and COC detection rate in various urinary calculi.
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The morphology of urine crystals under the microscope (10×40). (A) The morphology of dihydrated calcium oxalate crystal; (B) The morphology of monohydrated calcium oxalate crystal; (C) Type I morphology of phosphate crystals; (D) Type II morphology of phosphate crystals; (E) Type I morphology of uric acid crystal; (F) Type II morphology of uric acid crystal.
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| Characteristics | Calcium oxalate mixed carbonate apatite (n=43) | Calcium oxalate mixed uric acid calculus (n=7) | Calcium oxalate calculus (n=42) | p-Value | | Gender, n (%) | | | | 0.659 | | Male | 30 (32.6) | 6 (6.5) | 29 (31.5) | | | Female | 13 (14.1) | 1 (1.1) | 13 (14.1) | | | Age, year, n (%) | | | | 0.040 | | ≤52 | 27 (29.3) | 2 (2.2) | 16 (17.4) | | | >52 | 16 (17.4) | 5 (5.4) | 26 (28.3) | | | Stone location, n (%) | | | | 0.023 | | Kidney and ureter | 12 (13.0) | 0 (0) | 18 (19.6) | | | Ureter | 13 (14.1) | 2 (2.2) | 3 (3.3) | | | Kidney | 18 (19.6) | 5 (5.4) | 21 (22.8) | | | History, n (%) | | | | 0.040 | | First | 30 (32.6) | 2 (2.2) | 32 (34.8) | | | Recrudescence | 13 (14.1) | 5 (5.4) | 10 (10.9) | |
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Differences in the detection of calcium oxalate crystals in various clinical phenotypes (n=92).
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Differences in the urine specific gravity and maximum stone diameter between calcium oxalate crystal and non-crystal groups. (A and B) Calcium oxalate stones; (C and D) Calcium oxalate mixed carbonate apatite stones; (E and F) Calcium oxalate mixed uric acid stones. ? p<0.05; ?? p<0.01; ??? p<0.001; NS, no significance.
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Screening for the best cut-off for predicting the risk of stone formation through the receiver operating characteristic curve analysis. AUC, area under the curve.
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Validation of the best cut-off for predicting the risk of stone formation. (A) The distribution, retest results, and proportion of calcium oxalate crystal and non-crystal groups in the calcium oxalate stone validation group; (B) The distribution, retest results, and proportion of calcium oxalate crystals and non-crystal groups in the normal validation group.
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