High carbonate level of apatite in kidney stones implies infection, but is it predictive

Kate M. Englert, James A. McAteer, James E. Lingeman, James Williams

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The presence of infectious microorganisms in urinary stones is commonly inferred from stone composition, especially by the presence of struvite in a stone. The presence of highly carbonated apatite has also been proposed as a marker of the presence of bacteria within a stone. We retrospectively studied 368 patients who had undergone percutaneous nephrolithotomy (PCNL), and who also had culture results for both stone and urine. Urine culture showed no association with stone mineral content, but stone culture was more often positive in struvite-containing stones (73 % positive) and majority apatite stones (65 %) than in other stone types (54 %, lower than the others, P\0.02). In 51 patients in whom the carbonate content of apatite could be measured, carbonate in the apatite was weakly predictive of positive stone culture with an optimal cutoff value of 13.5 % carbonate (sensitivity 0.61, specificity 0.80). In positive cultures of stones (all mineral types combined), organisms that characteristically produce urease were present in 71 % of the cases, with no difference in this proportion among different types of stone. In summary, the type of mineral in the stone was predictive of positive stone culture, but this correlation is imperfect, as over half of non-struvite, non-apatite stones were found to harbor culturable organisms. We conclude that mineral type is an inadequate predictor of whether a stone contains infectious organisms, and that stone culture is more likely to provide information useful to the management of patients undergoing PCNL.

Original languageEnglish
Pages (from-to)389-394
Number of pages6
JournalUrological Research
Volume41
Issue number5
DOIs
StatePublished - Oct 2013

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Kidney Calculi
Minerals
Percutaneous Nephrostomy
Apatites
Infection
Urine
Urinary Calculi
Urease
Carbonates
Bacteria
Sensitivity and Specificity
carboapatite
Struvite

Keywords

  • Calcium phosphate
  • Infection
  • Nephrolithiasis
  • Struvite

ASJC Scopus subject areas

  • Urology

Cite this

High carbonate level of apatite in kidney stones implies infection, but is it predictive. / Englert, Kate M.; McAteer, James A.; Lingeman, James E.; Williams, James.

In: Urological Research, Vol. 41, No. 5, 10.2013, p. 389-394.

Research output: Contribution to journalArticle

Englert, Kate M. ; McAteer, James A. ; Lingeman, James E. ; Williams, James. / High carbonate level of apatite in kidney stones implies infection, but is it predictive. In: Urological Research. 2013 ; Vol. 41, No. 5. pp. 389-394.
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