Timelines of the "free-particle" and "fixed-particle" models of stone-formation: theoretical and experimental investigations

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dc.contributor.authorKok, DJen_AU
dc.contributor.authorBoellaard, Wen_AU
dc.contributor.authorRidwan, RYen_AU
dc.contributor.authorLevchenko, VAen_AU
dc.date.accessioned2017-06-19T00:42:03Zen_AU
dc.date.available2017-06-19T00:42:03Zen_AU
dc.date.issued2017-02-01en_AU
dc.date.statistics2017-06-19en_AU
dc.description.abstractTwo major theories on renal stone formation will be reviewed, the “free-particle” and “fixed-particle” mechanisms. These theories combine data on intrinsic factors (inborn metabolic errors), extrinsic factors (diet), renal cell responses and the physico-chemistry and biochemistry of urine into mechanisms of stone formation. This paper describes the specific role of time in both mechanisms. The timeline of crystal- and stone formation was deducted from literature data and was measured for two stones using radioisotope decay analysis. The stones of similar size and composition showed, respectively, a timeline of a few years and a development that took decades. In combination with data on stone architecture and patient characteristics these timelines are explained using the free-particle and fixed-particle mechanisms. Consideration of the timeline of stone formation has clinical implications. We conclude that the fixed-particle mechanism can be a slow process where decades pass between the first formation of a precipitate in the renal interstitium and the clinical presentation of the stone. Added to the fact that the mechanism of this initial precipitation is still ill defined, the conditions that started fixed-particle stone formation in an individual patient can be obscure. Blood and urine analysis in such patients does not necessarily reveal the individual’s risk for recurrence as lifestyle may have changed over time. This is in fact what defines the so-called idiopathic stoneformers. For these patients, prevention of outgrowth of previously formed precipitates, papillary plaques, may be more relevant than prevention of new plaque formation. In contrast, a patient who has formed a stone in a relatively short time through the free-particle mechanism is more likely to show abnormal values in blood and urine that explain the starting event of stone formation. In these patients, measurement of such values provides useful information to guide preventive measures. © 2016, The Author(s).en_AU
dc.identifier.citationKok, D. J., Boellaard, W., Ridwan, R. Y. & Levchenko, V. A. (2017). Timelines of the “free-particle” and “fixed-particle” models of stone-formation: theoretical and experimental investigations. Urolithiasis, 45(1), 33-41. doi:10.1007/s00240-016-0946-xen_AU
dc.identifier.govdoc8266en_AU
dc.identifier.issn2194-7236en_AU
dc.identifier.issue1en_AU
dc.identifier.journaltitleUrolithiasisen_AU
dc.identifier.pagination33-41en_AU
dc.identifier.urihttps://doi.org/10.1007/s00240-016-0946-xen_AU
dc.identifier.urihttp://apo.ansto.gov.au/dspace/handle/10238/8737en_AU
dc.identifier.volume45en_AU
dc.language.isoenen_AU
dc.publisherSpringeren_AU
dc.subjectIsotopesen_AU
dc.subjectCalcium phosphatesen_AU
dc.subjectBlooden_AU
dc.subjectUrineen_AU
dc.subjectPatientsen_AU
dc.subjectPlaque formationen_AU
dc.titleTimelines of the "free-particle" and "fixed-particle" models of stone-formation: theoretical and experimental investigationsen_AU
dc.typeJournal Articleen_AU
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