Role of the organic matter in calcium oxalate lithiasis

Urine contains variable amounts of organic matter derived from cell degradation. The cellular detritus is composed by membranous and cytosolic glycoproteins, etc. The aim of this paper was to study the role of organic matter in calcium oxalate crystal development and to evaluate the action of some crystallization inhibitors on this process. Crystallization studies were carried out on urine in stagnant urine as well as under flow conditions, in presence and absence of cellular debris. Low amounts of cellular debris (when batch conditions were used), exhibited some inhibitory activity on heterogeneous nucleation of calcium oxalate monohydrate crystals, probably due to glycoproteins. Increasing amounts of cellular debris, however, promoted the nucleation of calcium oxalate monohydrate crystals. When cellular debris was retained in a cavity with a urine flow, this organic matter effectively induced the development of primary aggregates of calcium oxalate monohydrate crystals (crystallization range 2.8 mg/h per mg of organic matter). Presence of crystallization inhibitors prevented or minimized crystal development. These findings show that cell debris provides the necessary elements for the development of oxalate crystals and that this process can be effectively inhibited by presence of crystallization inhibitors.