Saeed R. Khan, Patricia A. Glenton, Renal Backov, Daniel R. Talham

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Presence of lipids in urine, crystals and stones: Implications for the formation of kidney stones Saeed R. Khan, Patricia A. Glenton, Renal Backov, Daniel R. Talham Kidney International Volume 62, Issue 6, Pages 2062-2072 (December 2002) DOI: 10.1046/j.1523-1755.2002.00676.x Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 1 Histograms showing the distribution of the observed COM crystal orientations under Langmuir monolayers of six different phospholipid interfaces from a calcium oxalate subphase of relative supersaturation of 5. Data are shown for high (A) and low (B) surface pressure. The number of densities reported, are on average over at least 40 mm2. Note that DPPC, DPPS, DPPG, have different polar headgroups, while the series DPPG, DMPG, POPG, and DOPG has the same headgroup but different lipophilic tails. Symbols are: (▪) total crystals: () faces 10-1; () faces 010; (□) agglomerates. Kidney International 2002 62, 2062-2072DOI: (10.1046/j.1523-1755.2002.00676.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 2 Views of the calcium oxalate monohydrate (COM) crystal structure perpendicular (A andC) and parallel (B andD) to the (10-1) face. Views C and D are space-filling representations, showing the different sizes of the ions. Calcium ions and oxalate ions are indicated. The structure consists of sheets parallel to the (10-1) face that alternate between calcium-rich and oxalate-rich. Anionic additives are expected to stabilize the calcium-rich layers, giving the surface shown in C. The large ionic radius of Ca2+ causes it to project well beyond the oxalate ion (view D) and dominate the surface. Key to atom coloring: calcium is green; oxygen, red; carbon, black; hydrogen, blue. Kidney International 2002 62, 2062-2072DOI: (10.1046/j.1523-1755.2002.00676.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 3 Scanning electron micrograph of the CaOx crystals growing on a Langmuir monolayer. Bar = 1 μm. (A) A single CaOx monohydrate growing with 10-1 face toward the monolayer. (B) An aggregate of CaOx monohydrate crystals growing on the monolayer. Kidney International 2002 62, 2062-2072DOI: (10.1046/j.1523-1755.2002.00676.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 4 Schematic presentation of changes in cell membrane phospholipids and nucleation of calcium oxalate crystals based on Wiessner et al49 and Khan 50. Two-dimensional (A–D) and three-dimensional (a–d) views. (A, a) Normal membrane with only the neutral phospholipids (yellow circles) on the outer surface. (B, b) Movement of acidic phospholipids (red circles) from inside to the outside. (C, c) Lateral movement of acidic phospholipids into specific domains and concentration of calcium ions. (D, d) Interaction between calcium and oxalate ions and nucleation of CaOx crystal. Kidney International 2002 62, 2062-2072DOI: (10.1046/j.1523-1755.2002.00676.x) Copyright © 2002 International Society of Nephrology Terms and Conditions