GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles

Lauren G. Todorov; Mayandi Sivaguru; Amy E. Krambeck; Matthew S Lee; John C. Lieske; Bruce W. Fouke

doi:10.1038/s41598-022-23331-5

GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles

Lauren G. Todorov, Mayandi Sivaguru, Amy E. Krambeck, Matthew S Lee, John C. Lieske, Bruce W. Fouke^*

^*Corresponding author for this work

Urology

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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.

Original language	English (US)
Article number	18371
Journal	Scientific reports
Volume	12
Issue number	1
DOIs	https://doi.org/10.1038/s41598-022-23331-5
State	Published - Dec 2022

Funding

The authors acknowledge the invaluable contributions of the staff of the Buehler Petrographic in Lake Bluff, IL. The authors also thank Wui Siew Tan, Dornier Inc., Singapore and Brock Faulkner Dornier Inc., USA for their donation of Dornier Lithotripter III and funding as a Technical Testing Agreement for performing this study. We also thank Angela Waits, Clinical Research Coordinator at the Mayo Clinic in Rochester, Minnesota, for assisting in sample collection and obtaining patient consent. This research was supported by the Mayo Clinic & Illinois Strategic Alliance for Technology-Based Healthcare, Mayo Clinic Center for Individualized Medicine, Mayo Clinic O’Brien Urology Research Center (No. NIDDKU54. DK100227), and the Carle Illinois College of Medicine.

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10.1038/s41598-022-23331-5

Cite this

@article{929e1819d604418fa8d649c2f0949f34,

title = "GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles",

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.",

author = "Todorov, {Lauren G.} and Mayandi Sivaguru and Krambeck, {Amy E.} and Lee, {Matthew S} and Lieske, {John C.} and Fouke, {Bruce W.}",

note = "Funding Information: The authors acknowledge the invaluable contributions of the staff of the Buehler Petrographic in Lake Bluff, IL. The authors also thank Wui Siew Tan, Dornier Inc., Singapore and Brock Faulkner Dornier Inc., USA for their donation of Dornier Lithotripter III and funding as a Technical Testing Agreement for performing this study. We also thank Angela Waits, Clinical Research Coordinator at the Mayo Clinic in Rochester, Minnesota, for assisting in sample collection and obtaining patient consent. Funding Information: This research was supported by the Mayo Clinic & Illinois Strategic Alliance for Technology-Based Healthcare, Mayo Clinic Center for Individualized Medicine, Mayo Clinic O{\textquoteright}Brien Urology Research Center (No. NIDDKU54. DK100227), and the Carle Illinois College of Medicine. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

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doi = "10.1038/s41598-022-23331-5",

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T1 - GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles

AU - Todorov, Lauren G.

AU - Sivaguru, Mayandi

AU - Krambeck, Amy E.

AU - Lee, Matthew S

AU - Lieske, John C.

AU - Fouke, Bruce W.

N1 - Funding Information: The authors acknowledge the invaluable contributions of the staff of the Buehler Petrographic in Lake Bluff, IL. The authors also thank Wui Siew Tan, Dornier Inc., Singapore and Brock Faulkner Dornier Inc., USA for their donation of Dornier Lithotripter III and funding as a Technical Testing Agreement for performing this study. We also thank Angela Waits, Clinical Research Coordinator at the Mayo Clinic in Rochester, Minnesota, for assisting in sample collection and obtaining patient consent. Funding Information: This research was supported by the Mayo Clinic & Illinois Strategic Alliance for Technology-Based Healthcare, Mayo Clinic Center for Individualized Medicine, Mayo Clinic O’Brien Urology Research Center (No. NIDDKU54. DK100227), and the Carle Illinois College of Medicine. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - 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.

AB - 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.

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GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles

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