Metabolic assessment in pure struvite stones formers: is it necessary? / Avaliação metabólica em formadores de cálculo de estruvita pura: é necessário?

Abstract Background and objective: Magnesium ammonium phosphate stones (MAP), also known as struvite stones, are associated with urinary infection and impairment of renal unit. The aim of this study is to evaluate the urinary metabolic risk factors for recurrence of renal calculi in patients submitted to nephrectomy due to MAP stones. Methods: We retrospectively reviewed the charts of patients > 18 years old submitted to total nephrectomy due to pure MAP stones and pure calcium oxalate (CaOx) stones from July 2006 to July 2016. Urinary metabolic parameters were assessed through 24-hour urine exams ≥ 3 months after nephrectomy. Urinary metabolic parameters and new event related to lithiasis were compared. Results: Twenty-eight and 39 patients were included in MAP and CaOx group, respectively. Abnormalities in 24-hour urine samples were similar between groups. Hypercalciuria occurred in 7.1 and 10.3% of patients in MAP and CaOx group, respectively (p = 0.66), whereas hypocitraturia was present in 65.2 and 59.0% of patients with MAP and CaOx group, respectively (p = 0.41). No significant difference in new events was found between MAP and CaOx groups (17.9 vs. 23.1%, respectively; p = 0.60). Conclusion: A 24-hour urine evaluation should be offered to patients submitted to nephrectomy due to pure MAP stones in order to detect metabolic risk, improve treatment, and prevent stone recurrence.

Resumo Contexto e objetivo: Cálculos de fosfato de amônio e magnésio (FAM), também conhecidos como cálculos de estruvita, estão associados à infecção urinária e ao comprometimento da unidade renal. O objetivo deste estudo é avaliar os fatores de risco metabólico-urinários para recorrência de cálculos renais em pacientes submetidos à nefrectomia devido a cálculo de FAM. Métodos: Revisamos retrospectivamente os prontuários de pacientes > 18 anos submetidos à nefrectomia total devido a cálculos de FAM puro e cálculos de oxalato de cálcio puro (OxCa) de julho de 2006 a julho de 2016. Os parâmetros metabólicos urinários foram avaliados através de exames de urina de 24 horas ≥ 3 meses após a nefrectomia. Os parâmetros metabólicos urinários e um novo evento relacionado à litíase foram comparados. Resultados: Vinte e oito e 39 pacientes foram incluídos nos grupos FAM e OxCa, respectivamente. As anormalidades em amostras de urina de 24 horas foram similares entre os grupos. A hipercalciúria ocorreu em 7,1 e 10,3% dos pacientes nos grupos FAM e OxCa, respectivamente (p = 0,66), enquanto a hipocitratúria esteve presente em 65,2 e 59,0% dos pacientes nos grupos FAM e OxCa, respectivamente (p = 0,41). Nenhuma diferença significativa em novos eventos foi encontrada entre os grupos FAM e OxCa (17,9 vs. 23,1%, respectivamente; p = 0,60). Conclusão: Uma avaliação de urina de 24 horas deve ser oferecida aos pacientes submetidos à nefrectomia devido a cálculos de FAM puro, a fim de detectar risco metabólico, melhorar o tratamento e prevenir a recorrência de cálculos.

Nucleação na formação de estruvita: estado da arte / Nucleation in the formation of struvite: state of art

RESUMO Estimativas recentes indicam que a duração de toda a reserva de rochas fosfatadas do planeta não ultrapassa 400 anos e que a produção de fertilizantes nitrogenados é insustentável energeticamente. Atualmente, o tratamento de esgoto está sendo visto como uma unidade de recuperação de recursos (água, energia e nutrientes) em vez de uma de final de tubo. Portanto, as tecnologias de recuperação devem ser priorizadas em relação às de remoção. Estruvita (fosfato de amônio e magnésio) é um cristal que pode ser produzido a partir do esgoto doméstico e tem maior eficiência agrícola do que os fertilizantes convencionais. Apesar de a cristalização ser um tema bastante estudado em todo o mundo e extremamente desenvolvido tecnologicamente, sua utilização na engenharia sanitária ainda não é comum, especialmente no Brasil. Um dos assuntos menos pesquisados na formação da estruvita é a nucleação. Portanto, o presente artigo traz uma revisão bibliográfica crítica e atual e mostra as lacunas no conhecimento sobre esse assunto.

ABSTRACT Recent estimation for the duration of global phosphate reserves does not exceed 400 years and the production of nitrogen fertilizers is energetically unsustainable. Nowadays, wastewater treatment plants have been seen as resource recovery facilities (water, energy and nutrients) instead of "end-of-pipe" utilities. Thus, nutrient-recovery technologies should be prioritized over the removal ones. Struvite (phosphate of ammonium and magnesium) is a crystal, produced from sewage, with a higher agricultural efficiency when compared to conventional fertilizers. Despite the crystallization is a topic extensively studied worldwide and highly technologically developed, its use in sanitary engineering is still not common, especially in Brazil. As the aspects related to struvite nucleation have been insufficiently studied, this paper presents a critical and updated literature review, and shows the gaps in the current knowledge about this topic.

Lighting the anaerobic digestion process in rural areas: struvite from cattle manure digestate / Lighting the anaerobic digestion process in rural areas: struvite from cattle manure digestate

RESUMEN El objetivo de esta investigación fue obtener estruvita a partir del digerido de un digestor rural, alimentado con estiércol bovino. Con el fin de determinar las variables de operación para recuperar estruvita (iones PO4 3- y NH4+), se desarrolló un diseño de experimentos, en el cual se evaluó el efecto combinado de la relación molar de Mg2+:PO4 3- (1.5:1, 2.5:1 y 3.5:1), tiempo de reacción (10, 50 y 90 min) y velocidad de agitación (100, 450 y 800 rpm). Las condiciones determinadas como favorables fueron relación molar 1.5, tiempo de reacción 50 min y una velocidad de agitación de 450 rpm. Estos resultados muestran que la recuperación de fosfato más alta es alcanzada el contenido de Mg ya presente en el digerido de estiércol bovino (153 mg/L). Los porcentajes de recuperación obtenidos fueron 55 ± 4.94 % y 58 ± 7.72 % para NH4+ y PO4 3- respectivamente. La formación y composición de cristales de estruvita se confirmó mediante microscopía petrografía, microscopía electrónica de barrido (SEM) y radiación infrarroja. El rendimiento de estruvita obteniendo fue 295.75 mg/L de digerido utilizado.

ABSTRACT The aim of this research was recovery nutrients (PO4 3- and NH4+ ions) in form of struvite, used cattle manure digestate from low cost anaerobic digester. In order to determinate operating variables (Mg2+: PO4 3- molar ratio, reaction time and stirring speed) an experimental design was developed. Struvite crystal was identified by mean of petrographic microscopy and infrared radiation. The highest recovery rates of 55±4.94 % and 58±7.72 % for NH4+ and PO4 3-, respectively was achieved at 1.5 molar ratio, 50 minutes reaction time and 450 rpm stirring speed. Struvite yield was 295.75 mg/L. These results show that the highest phosphate recovery is achieved with the magnesium concentration (153 mg/L) contained in the cattle manure digestate.

RESUMO O intuito desta investigação foi obter estruvita partindo do digerido de um digestor rural, alimentado com esterco bovino. A fim de determinar as variáveis de operação para recuperar a estruvita (íons PO4 3" e NH4 +), foi desenvolvido um delineamento experimental, no qual foi avaliado o efeito combinado da razão molar de Mg2+: PO4 3" (1.5:1, 2.5:1 e 3.5: 1), tempo de reação (10, 50 e 90 min) e a velocidade de agitação (100, 450 e 800 rpm). A combinação de condições determinadas como favoráveis foram: relação molar de 1.5, tempo de reação de 50 minutos e velocidade de agitação de 450 rpm. Estes resultados indicam que a maior recuperação de fosfato é obtida com a concentração de magnésio (153 mg / L) contida no esterco bovino digerido. As porcentagens de recuperação obtidas foram de 55 ± 4.94% e 58 ± 7.72% para NH4+ e PO4 3" respectivamente. A formação e composição de cristais de estruvita foram confirmadas por meio de microscopia de petrografia, microscopia eletrônica de varredura (SEM) e radiação infravermelha. O rendimento da estruvita obtida foi de 295.75 mg /L de digerido utilizado.

Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa

ABSTRACT Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules. Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammonium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments. Results: We observed decrease in number, dimension, and growth rate of struvite crystals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems. Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.

The challenge of cystine and struvite stone formers: clinical, metabolic and surgical assessment

ABSTRACT Purpose: To compare the clinical, metabolic, and calculi characteristics of cystine and struvite stone patients after percutaneous nephrolithotripsy (PCNL). Material and Methods: Between January/2006-July/2013, 11 cystine stone patients were treated in our clinic. Of those, 3 were excluded due to incomplete follow-up. Eight cystine stone patients (2 with bilateral disease; 10 renal units-RU) were considered for further analysis. A cohort of 8 struvite stone formers (10RU) was matched having the same age, gender, body mass index (BMI) and Guys stone score. Analyzed parameters comprised demographic data, serum/urinary metabolic evaluation and surgical outcomes. Results: Both groups had 6 female patients. Groups were similar in regards to age, gender, BMI, stone burden, and serum creatinine (p=NS). All patients had PCNL as the first surgical treatment modality. Stone free rate (SFR) after the first PCNL tended to be lower (0%) in the cystine compared to the struvite group (40%)(p=0.08). Final SFR after secondary procedures increased to 70% in cystine and 80% in struvite patients (p=1.0); mean number of procedures to achieve stone free status was higher in the first group (3.57 vs. 2.0;p=0.028). Hypocitraturia was found in all patients, but struvite cases presented with lower mean urinary citrate levels (p=0.016). Other common abnormalities were elevated urinary pH (cystine 75% and struvite 62.5%;p=1.0) and low urinary volume (62.5%,37.5%;p=0.63). Conclusion: Multiple interventions and suboptimal stone free rates are trait of the significant stone burden of struvite and cystine patients. Underlying metabolic abnormalities characterized by increased urinary pH, hypocitraturia and low urinary volume are often encountered in both populations.

Precipitação química de estruvita: Recuperação de nutrientes em reator cônico de leito fluidizado utilizando magnésia industrial de baixo custo / Chemical precipitation of struvite: Nutrients recovery in conic fluidized bed reactor using a low-cost industrial magnesia compound

O processo físico-químico da precipitação de estruvita é uma técnica que apresenta elevado potencial na remoção de nutrientes, a partir de diferentes tipologias de efluentes. O presente estudo teve por objetivo a avaliação de um composto industrial com elevado teor de magnésia e baixo custo como fonte reagente alternativa de magnésio e alcalinidade necessários ao processo de precipitação, tornando-o economicamente viável com a redução de gastos despendidos com químicos. Suspensões de Mg(OH)2 foram obtidas e tiveram desempenho avaliado em função da remoção de nutrientes, a partir de um efluente sintético rico em N-NH4+ e P-PO43-, e qualidade dos cristais gerados, com a identificação do mineral de interesse - estruvita. O experimento foi realizado em escala laboratorial utilizando reator cônico de leito fluidizado operado em semi-contínuo. O adequado controle operacional do pH (8,0-8,5) pela adição automatizada da suspensão de Mg(OH)2 possibilitou uma considerável remoção de P-PO43-, que atingiu valor médio igual a 93,5%. Os sólidos recuperados no processo apresentaram pureza de, aproximadamente, 84% de estruvita.

The physico-chemical process of struvite precipitation is a technique that demonstrates a high potential in nutrients recovery from different kinds of wastewaters. This study aimed to evaluate the use of a low cost industrial compound with high magnesia content as alternative reagent source of magnesium ions and alkalinity required for precipitation. It was a strategy to turn the process economically viable and reduce the chemical costs. Mg(OH)2slurries were obtained and evaluated regarding the nutrients recovery from a synthetic wastewater rich in NH4+-N and PO43--P and the quality of the generated crystals with the identification of the mineral of interest - the struvite. The experiment was performed in laboratory scale using a conic fluidized bed reactor in a semi-continuous operation. The proper pH control (8.0-8.5) by the automated addition of Mg(OH)2slurry allowed considerable PO43--P removal equal to 93.5%. The recovered solids from the process showed purity of approximately 84% of struvite.

Growth inhibition of struvite crystals by the aqueous root extract of Rotula aquatica.

Formation of urinary stone is a serious and debilitating problem throughout the world. In the present study, the inhibitory effect of aqueous extract of root of Rotula aquatica was investigated against struvite crystals (one of the components of urinary stone) grown in vitro using single diffusion gel growth technique. For setting the gel, sodium metasilicate solution (specific gravity 1.05) and 0.5 M aqueous solution of ammonium dihydrogen phosphate were mixed, so that the pH of the mixture could be set at 7.0. Equal amounts of supernatant solution of magnesium acetate (1.0 M) prepared with 0.0%, 0.5% and 1% concentrations of the extract were gently poured on the set gels. It was observed that the number, dimension, total mass, total volume, growth rate and depth of growth of struvite crystals decreased with the increasing extract concentrations in the supernatant solutions. The enhancement of dissolution rate and fragmentation of struvite crystals suggested potential application of the extract for inhibition of struvite type urinary stone.

Experimental Urinary Stone Formation by Sex Hormones in Rats and Analysis of Composition of the Stones / 대한비뇨기과학회지

PURPOSE: The incidence of renal stones is three times higher in men than women due to sex hormones, and most are calcium oxalate stones. Therefore, the effects of testosterone and estrogen in the formation of urinary stones were investigated. MATERIALS AND METHODS: One hundred female Sprague-Dawley rats were divided into seven groups. The first was the control group; the second was injected with testosterone cypionate into the muscle, every week; the third was fed tamoxifen only, everyday; the fourth was oophorectomized; the fifth was fed tamoxifen after an oophorectomy; the sixth was treated with testosterone after an oophorectomy; and the seventh was injected with testosterone, weekly, and fed tamoxifen everyday after an oophorectomy. The bladder stone formation and degree of renal crystal deposition of the control group was compared with those of the other groups. The composition of the bladder stones was analyzed by SEM (scanning electron microscopy)-EDX (energy dispersive X-ray microanalysis). RESULTS: Bladder stones were found in 9 rats from group 6 only, which also showed the most predominant renal crystal deposition rate (65.5%). There was a statistical significance in the renal crystal deposition rate only between groups 6 and 1. According to SEM-EDX analysis of the bladder stones, they were composed of struvite and apatite. CONCLUSIONS: It is suggested that testosterone and estrogen influenced the formation of struvite and apatite stones.