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Publications

Journal Article Epublish

PubMed: 42900266 DOI: 10.1007/s00345-026-06865-5

Calcium oxalate kidney stone morphology reflects underlying metabolic and clinical conditions.

World J Urol 44(1)

Authors: Valentine Forté, Ellie Tang, Dominique Bazin, Sandrine Lemoine, Jean-Philippe Haymann, Francisca Joly, Frédéric Panthier, Steeve Doizi, Olivier Traxer, Michel Daudon, Emmanuel Letavernier

Affiliations

  • Physiology Unit, AP-HP, Hôpital Tenon, 75020, Paris, France.
  • Sorbonne Université, UMR S 1155, 75020, Paris, France.
  • INSERM, UMR S 1155, 75020, Paris, France.
  • Institut de Chimie Physique, UMR CNRS 8000, Bâtiment 350, Université Paris Saclay, 91405, Orsay Cedex, France.
  • Hôpital Edouard Herriot, service de Néphrologie, Dialyse, HTA et exploration fonctionnelle rénale, Hospices civils de Lyon, MAREGE, Centre de Référence maladies rénales rares, Lyon, France.
  • Inserm CARMEN 1060, Université de Lyon, Lyon, France.
  • Centre de Recherche sur l'Inflammation (CRI), INSERM U1149, Université Paris Cité, 75018, Paris, France.
  • Gastroenterology and Nutritional Support Department, Hôpital Beaujon (AP-HP), Clichy, France.
  • Sorbonne Université and Urology Unit, Tenon Hospital, 75020, Paris, France.
  • Physiology Unit, AP-HP, Hôpital Tenon, 75020, Paris, France.
  • Sorbonne Université, UMR S 1155, 75020, Paris, France.
  • INSERM, UMR S 1155, 75020, Paris, France.
  • Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital TENON, 4 rue de la Chine, 75020, Paris, France.

Abstract

INTRODUCTION

Nephrolithiasis is a growing public health problem due to dietary changes and global warming. Physical analysis of the composition of urinary stones is recommended to guide treatment but is not always available. A morpho-constitutional classification of kidney stones dividing the prevalent calcium oxalate stones into type I (COM/whewellite Ia-Ie subtypes, related to hyperoxaluria) and type II (COD/weddellite IIa-IIc subtypes, related to hypercalciuria) was proposed several decades ago. The objective was to validate whether the morphology of calcium oxalate stones can guide diagnosis and actually reveal alterations in urine composition.

METHODS

This study used intact and homogeneous calcium oxalate stones (Ia, IIa, Ic, Ie) accompanied by complete metabolic data. The stones underwent stereomicroscopic morphological evaluation and FTIR spectroscopy for accurate classification. Patients underwent standardized 24-h urine and fresh urine assessments to determine key lithogenic parameters.

RESULTS

The morphologies of calcium oxalate stones correlate with specific conditions. Type II stones are associated with hypercalciuria, while type Ic and Ie stones are associated with dramatic hyperoxaluria, as seen in primary hyperoxaluria and enteric hyperoxaluria, respectively.

CONCLUSION

Morphological analysis of calcium oxalate stones should be considered, as it provides specific information and can reveal rare but serious conditions and guide treatment. In the era of artificial intelligence, automated imaging could provide relevant information even in the absence of infrared or X-ray-based stone analysis methods.

MeSH

Urology, Kidney Calculi, Calcium Oxalate, Hyperoxaluria, Classification, Kidney, Hypercalciuria, Calcium, Therapeutics, Oxalates