A few general words about kidney stones I suppose anyone who produces kidney stones knows they are hard and unwanted objects made in the kidney that cause pain, bleeding, and obstruction of the urinary tract, and lead to urinary infections and surgery. Most patients come to realize that stones recur, because over half of those who have formed only one stone will form another within 5 – 10 years. Many patients have seen the stones they form, black, or orange, or yellow, or gray, smooth or spiky, surprisingly small for all the trouble they cause, or surprisingly large to think it really passed through the urinary tract. All patients who have formed stones, at least all the ones I have ever met, want … Continued
A particular manner Here and there physician friends have asked me about how I practice. But however much I have written about kidney stones, nowhere before have I told about how I practice because I feared my style might seem too odd. But it is not if you consider how narrowly I have chosen to focus. My clinical life is based on several facts. One is that doctors send me their patients and expect that I will prevent recurrent stones. That is all they want from me. This means that I can depend on other physicians to do everything else, focus on the pathogenesis of kidney stones in a particular patient and fashion for that patient a program of prevention which will … Continued
The crystals of the common kidney stones I suppose I could have made my pie chart smaller but I wanted it to shine out like some odd colored moon because the names of the stones are so important and so much of what we do depends upon knowing them. They names of kidney stones are the names of the crystals which make up the hard part of the stones: CAOX, Calcium Oxalate; CAP, Calcium phosphate; UA, Uric Acid; Cystine; Struvite. The pie wedges show their relative abundances to each other in our large population of stone forming patients. Calcium oxalate stones are the most common by a wide margin, and that has been true in every accounting of stone types I … Continued
Two related posts, for patients and for physicians, emphasize the fundamental importance of the kidney stone crystal composition in management of kidney stones and by direct extension the importance to patients and their physicians of sending stones for analysis. Here, in a scientific forum, one needs to raise the obvious and complementary issue of quality: can patients and their physicians rely on the results of stone analyses? There is a gold standard Basiri et al recently reviewed all available papers concerning analysis of kidney stone crystals. Like many others, some of whom they reference, X-ray diffraction does indeed reveal the crystal structures and if applied to several regions of a stone is perhaps the ideal method on which to base research … Continued
When I wrote the original article in 2014 limitations of proteomics seemed the main obstacle. This new work by Dr Frank Witzmann shows us the other side of the problem. A master of the modern proteomic techniques, with them Frank shows that the number of unique proteins in just two human calcium oxalate kidney stones is over 1,000. If inadequacy of technique stymied us two years ago, inadequacy of intellect – at least of mine – stymies at least me, now. What to make of so many proteins! What are they doing there? Which ones matter in stone genesis? We have the methods, we have stones to work on, but what shall we ask? As always, the magic is in the vision.
There is no doubt about what I say to patients: “Bring me all the analyses that have been performed on your kidney stones. Bring in any stones you have tucked in a dresser drawer and we will get them analysed.” But what do I say to me, and what do I do as time goes on and more stones form or are passed? Do I analyse all of them? Do you? The problem of keeping track Whenever I get a new patient, the stone analyses are at the top of my mind. How can I do anything rational about prevention if I don’t know what the stone crystals are? If there are no analyses at the first visit, like you … Continued