Health Stream Literature Summary - Issue 56 - December 2009

Effect of drinking water on formation of renal calculi.
Iosub, I., Malinovschi, V., Grigorie, V., Murariu, A. and Meghea, A. (2009) Key Engineering Materials, 415; 37-40.

The aim of this study was to investigate possible correlations between the quality parameters of drinking water and the formation of uroliths (a calculus in the urine or the urinary tract). Kidney calculi which were surgically extracted from 90 patients diagnosed with kidney stones during the period 2004-2008 were investigated. The patients were selected from Horezu-Ramnicu Valcea region, Romania, a zone well known for a high incidence of kidney stones and also with hard drinking water. Various drinking water sources were samples and analysed for physical and chemical characteristics including pH, conductivity, total hardness, fix residue and calcium, that might be relevant for kidney stone formation and compared with samples from water supply networks of Bucharest or Pitesti.

The preliminary examination revealed two groups of kidney stones: those containing oxalates and phosphates and those containing monohydrated oxalate. Qualitative phase analysis by means of X ray diffraction of the calculi enabled their classification in to four main groups. Oxalates-urates, oxalates-carbonates-phosphates, monohydrate oxalate and urates. A good correlation was found between the hardness value of the water and content of calcium ions. High values of conductivity and basic pH indicate a significant permanent hardness caused by mainly chlorides and sulphates. For most of the samples with low calcium content, both the hardness and conductivities show low values as well. Water sources with calcium content higher than 100 mg/L appear to be potential candidates for the kidney calculi formation. The dominant proportion of calculi were from the oxalates and urates group (41%) and these calculi were found in patients who worked in places with high temperatures. A high occurrence of calculi made of monohydrate calcium oxalate was found mainly in patients who live in areas where the drinking water has a high concentration of calcium and who have a low consumption of meat in their diet.

This type of research on the composition of kidney calculi and how this relates to the external environmental factors, to nutritional habits or to work and lifestyle conditions will have a favourable impact on human health by identifying the conditions that cause kidney calculi formation and therefore how to prevent the formation.

Comment The data presented in this paper do not appear to be sufficient to infer a linkage of kidney stone composition with water calcium content as no comparison is presented with the composition of kidney stones in patients resident in soft water areas.

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