Symposium on Urolithiasis

Kidney International (1978) 13, 372–382; doi:10.1038/ki.1978.55

Struvite stones

Donald P Griffith1

1The Urology Service of the Verterans Administration Hospital, the Roy and Lillie Cullen Department of Urologic Research, the J. Sayles Leach Laboratory, and the Urolithiasis Laboratory, Division of Urology, Baylor College of Medicine, Houston, Texas

Correspondence: Dr Donald P Griffith, Associate Professor of Surgery/Urology, Baylor College of Medicine, 1200 Moursund Avenue, Houston, Texas 77030, U.S.A.

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Abstract

Struvite, a crystalline substance first identified in the 18th century, is composed of magnesium ammonium phosphate (MgNH4PO4 dot 6H2O). Ulex, a Swedish geologist, is generally credited with introduction of the term struvite in 1845; he coined the geological expression "struvite" in honor of H. C. G. von Stuve, a Russian diplomat and naturalist (1772–1851) [1]. Von Stuve had published one of the earliest scholarly geological works in 1807 entitled "Mineralogical Memoirs".

Struvite urinary stones have also been referred to as "infection stones" and "triple phosphate" stones. The term triple phosphate stems from early chemical analyses of the stones which demonstrated the presence of calcium, magnesium, ammonium, and phosphate (i.e., three cations and one anion). Carbonate ions were also commonly identified; they were assumed to be associated with calcium as calcium carbonate (CaCO3). Modern crystallographic analyses have shown that human "struvite" stones are a mixture of struvite (MgNH4PO4dot6H2O) and carbonate-apatite (Ca10[PO4]6-CO3). Calcite (CaCO3) is extremely rare (we have found one calcite stone in 20,000 stone analyses) and may be an artifact. In some stones, struvite may be more abundant, whereas in other stones apatite may predominate. There is good evidence (to be reviewed) to link the formation of struvite and carbonate-apatite stones to urinary infection. For the purpose of this review, infection-induced stones are synonymous with struvite and carbonate-apatite.

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