Architecture of mixed calcium oxalate dihydrate and monohydrate stones

Calcium oxalate dihydrate (COD) and monohydrate (COM) are the most frequent constituents of urinary stones, and there still exist some questions about the interrelation between the two hydrates. Architecture of mixed COD and COM stones was observed by electron microscopy to solve the questions. The fractured surface of a stone is composed of the fractured face of the crystals. In this situation a morphological criterion of typical dipyramid shape is useless to identify COD. But we could identify COD using the partial dissolution method, which etched square pits on COD crystals. COD and COM formed distinctly separate layers. COD was always found in the stone surface and COM in the center. The stone surface was covered by a thick layer of organic matrix, and the intercrystalline space was filled with matrix. The crystals were grown thrusting the matrix aside to minimize the space. Although COD is more soluble than COM, the urine contains specific substances that favor the formation of COD. Supposing the stone matrix excludes these substances selectively, the gel-state matrix provides a preferable condition for COM formation. This hypothesis is suitable to explain the high incidence of COM stones. An abrupt change of the crystalline constituent can be explained by COD crystal deposition on COM stones. Frequent COD crystalluria can explain why COD is always found in the stone surface. Once the stone surface is covered with COD crystals, they continue to grow in the gel-state matrix or deposit further to form the bulk of the stone.