Allen, S.E.; (2011) Physico-chemical factors influencing calcium oxalate crystallisation in the urinary tract. Doctoral thesis , UCL (University College London).

Abstract

The current treatment for urolithiasis is mostly limited to removing stones rather than preventing their formation. This research investigated a range of bisphosphonates for their inhibitory properties on the crystallisation of calcium oxalate - the commonest constituent of urinary calculi. Calcium oxalate crystals were generated in a well-recognised artificial urine solution (Robertson WG et al. J. Urol 1986; 135:1322-1326) using the Mixed Suspension Mixed Product Removal system. This provided a reliable, reproducible environment closely comparable to urine within the pelvi-calyceal system of a stone-former. Five bisphosphonates were tested at different concentrations for their inhibitory properties on calcium oxalate crystallisation using a state of the art laser diffraction particle-sizer, the Mastersizer. The sizes of calcium oxalate crystals generated in the control experiments, after equilibrium, fell in a biphasic distribution peaking at 20 microns (single crystals) and 100 microns (crystal aggregates). After the addition of bisphosphonates, the group of aggregates diminished significantly and in some cases was completely obliterated. Of those bisphosphonates tested, disodium pamidronate was the most effective inhibitor and disodium clodronate, the least. Bisphosphonates are currently widely used in the treatment of bone disease and are excreted renally at concentrations shown here to be effective against calcium oxalate crystallisation. They therefore hold exciting potential in the prevention of urinary stone disease.

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