Fine structure of calcium oxalate monohydrate renal calculi

Fine structure, location and size of the core of 12 calcium oxalate monohydrate (COM) papillar calculi from different 'idiopathic' stone-formers were studied by an optical and scanning electron microscope equipped with the EDAX analytical device. Each individual core exhibited a unique overall structure composed of loosely arranged twined and intergrown crystals of plate-like and/or columnar shape and particles of 'rosette' structure with considerable void space among crystals in some cases or compact structure in others. Crystals were covered by a thin layer or organic material mostly invisible to the microscope. Sometimes debris of organic origin in a core was observed. A substantial amount of organic matrix appeared at the core boundary, often in the form of amorphous plates. The outer striated layer of COM stone consisting of tightly packed columnar crystals originated on this matrix. The stone core was located near the stone surface that was attached to the kidney wall and contained foreign particles that act as heterogeneous nucleants of calcium oxalate crystals.