Article Text

  1. M. Kheda,
  2. P. Fall,
  3. A. Neelakantan*,
  4. F. Marickar**
  1. Medical College of Georgia, Augusta, GA
  2. *Buffalo, NY
  3. **Medical College of Thiruvananthapuram, Kerala, India.


Introduction In the United States, renal stone disease prevalence has been increasing over the last three decades. Our study evaluates the composition of drinking water consumed by stone disease patients and its influence on the morphology of in vitro grown calcium oxalate (CaOx) crystals studied under a scanning electron microscope.

Methods Five patients with a diagnosis of CaOx stone disease were randomly selected. Drinking water samples were requested from the patients and labeled as tap or well water depending on the source. Water samples were analyzed for 10 trace elements (calcium, magnesium, sodium, potassium, carbonate, bicarbonate, chloride, fluoride, phosphorus, and silica) and six other parameters, including pH, total dissolved solids (TDS), and water hardness, using atomic absorption spectrometry. CaOx crystals were grown in vitro in silica gel media by simple diffusion method. Water sample was incorporated into the media. CaOx crystals were also grown in double distilled water, which formed the control group. At 30 days, crystals were analyzed by scanning electron microscopy. Crystals were evaluated on dimensions, surface morphology, and the relative degree of interpenetrating twinning.

Results Of the five patients, three consumed water from the tap and two from the well. Due to the comparability of the results, the patients were divided into a tap water (TW) group and a well-water (WW) group. The Table shows the differences in water analysis, crystal sizes, and relative degree of interpenetrating twinning in all groups.

Conclusions The data presented here demonstrate that there were differences in the in vitro crystal formation among patients depending on the composition and source of drinking water. WW showed higher crystal growth, whereas TW had a smaller and fragile crystal structure. Water with high calcium levels and total hardness promoted crystal formation, whereas fluoride appeared to act as an inhibitor of crystal growth.

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