A study of primary nucleation of calcium oxalate monohydrate: II. Effect of urinary species

Kidney stones consist of various organic and inorganic compounds. Calcium oxalate monohydrate (COM) is the main inorganic constituent of kidney stones. However, the mechanisms for the formation of calcium oxalate kidney stones are not well understood. In this regard, there are several hypotheses including nucleation, crystal growth and/or aggregation of formed COM crystals. The effect of some urinary species such as oxalate, calcium, citrate, and protein on nucleation and crystallization characteristics of COM is determined by measuring the weight of formed crystals and their size distributions under different chemical conditions, which simulate the urinary environment. Statistical experimental designs are used to determine the interaction effects among various factors. The data clearly show that oxalate and calcium promote nucleation and crystallization of COM. This is attributed to formation of a thermodynamically stable calcium oxalate monohydrate resulting from supersaturation. Citrate, however, inhibits nucleation and further crystal growth. These results are explained on the basis of the high affinity of citrate to combine with calcium to form soluble calcium citrate complexes. Thus, citrate competes with oxalate ion for binding to calcium cations. These conditions decrease the amount of free calcium ions available to form calcium oxalate crystals. In case of protein (mucin), however, the results suggest that no significant effect could be measured of mucin on nucleation and crystal growth.