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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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Effects of urine dilution on quantity, size and aggregation of calcium oxalate crystals induced in vitro by an oxalate load

Angela Guerra1 / Franca Allegri2 / Tiziana Meschi3 / Giuditta Adorni4 / Beatrice Prati5 / Antonio Nouvenne6 / Almerico Novarini7 / Umberto Maggiore8 / Enrico Fiaccadori9 / Loris Borghi10











Corresponding author: Loris Borghi MD, Dipartimento di Scienze Cliniche, Università di Parma, Via Gramsci 14, 43100 Parma, Italy Phone: +39-0521-702007, Fax: +39-0521-940993,

Citation Information: Clinical Chemical Laboratory Medicine. Volume 43, Issue 6, Pages 585–589, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2005.102, July 2005

Publication History

January 24, 2005
March 30, 2005
Published Online:


Increasing urinary volume is an important tool in the prevention of calcium renal stones. However, the mechanism of how it actually works is only partially understood. This study aimed at assessing how urine dilution affects urinary calcium oxalate crystallization. A total of 16 male idiopathic calcium oxalate (CaOx) stone-formers and 12 normal male subjects were studied and 4 h urine samples were taken twice, under low (undiluted urine) and high hydration conditions (diluted urine). An equal oxalate load (1.3 mmol/L) was added to both types of urine and the crystallization parameters were assessed. In both stone-formers and normal subjects, the crystallization processes were significantly (p<0.05 or less) more marked in the undiluted urine than in the diluted urine in terms of: a) total quantity of calcium oxalate dihydrate (COD) and calcium oxalate monohydrate (COM) crystals; b) total quantity of crystalline aggregates; and c) aggregation index (i.e., ratio between the area occupied by crystalline aggregates and the area occupied by all the crystals present). The comparison between stone-formers and normal subjects showed that the greatest difference was for the size of COD crystals, which were larger in the urine of the stone-formers. A further important finding was an inverse relationship between changes in urinary volume and in the aggregation index (r=–0.53, p=0.004). In conclusion, urine dilution considerably reduces crystallization phenomena induced in vitro by an oxalate load in both calcium stone-formers and normal subjects.

Keywords: calcium nephrolithiasis; calcium oxalate crystallization; oxalate load; urinary volume; water load.

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