John R. Asplin, Joan H. Parks, Yashushi Nakagawa, Fredric L. Coe, M.D.

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Reduced crystallization inhibition by urine from women with nephrolithiasis John R. Asplin, Joan H. Parks, Yashushi Nakagawa, Fredric L. Coe, M.D. Kidney International Volume 61, Issue 5, Pages 1821-1829 (May 2002) DOI: 10.1046/j.1523-1755.2002.00307.x Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 1 Notched box plots of standard urine stone risk factors. All values are 24-hour urine in mg except for phosphorous and uric acid (g/day), volume (liters), and sodium, potassium, sulfate and ammonium ion (mEq). Abbreviations are: FN, female normals; FSF, female stone formers. Stone formers and normals did not differ in regard to any measurement by t test except calcium excretion. Notches of bars represent 95% confidence limits, which overlap between FN and FSF in all cases. Kidney International 2002 61, 1821-1829DOI: (10.1046/j.1523-1755.2002.00307.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 2 Upper limits of metastability (ULM) and supersaturation (SS) values. Values of ULM versus SS for (A) CaP and (B) CaOx are for normals (○) and patients (•) are all above the diagonal lines of identity with two exceptions. ULM correlates with SS for CaP and CaOx for normals, and CaP for patients. Ellipses are calculated at 1SD to contain 68.8% of points. Kidney International 2002 61, 1821-1829DOI: (10.1046/j.1523-1755.2002.00307.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 3 ULM - SS distances. Normals (○) cluster in an 80% ellipse of containment that includes only 4 patient points (•). Six patient points are 2 SD below the normal mean for CaOx ULM to SS distance (vertical dashed line) and 5 are 2 SD below the normal mean for CaP ULM to SS distance (horizontal dashed line). Border plots demonstrate the low values of the distance for patients, especially in relation to CaP (right border). Kidney International 2002 61, 1821-1829DOI: (10.1046/j.1523-1755.2002.00307.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 4 Effects of urine citrate on ULM values. (A) ULM CaP (y axis) rises with urine citrate concentration (x axis); values of the regression coefficients are significant for both patients (•) and normals (○). (B) ULM CaOx (y axis) rises with urine citrate concentration for patients but not normals (regression coefficients are in the Results section). Ellipses are calculated at 1SD to contain 68.8% of points. Kidney International 2002 61, 1821-1829DOI: (10.1046/j.1523-1755.2002.00307.x) Copyright © 2002 International Society of Nephrology Terms and Conditions

Figure 5 Frequency distributions of four tests of inhibition. Values for patients (•) and normals (○) deviate greatly for the ULM to SS distance for CaP (A). For the ULM to SS distance for CaOx (B) about half of patient points differ dramatically from normals, the others being indistinguishable. (C) Growth inhibition by patients and normals was indistinguishable, as was aggregation inhibitions (D). Lines show 1.5 and 2 SD displacements from the normal means. Notched box plots are separate for CaP (A) and connote a highly significant population difference, but overlap for CaOx (B) connoting a difference within subgroups. Kidney International 2002 61, 1821-1829DOI: (10.1046/j.1523-1755.2002.00307.x) Copyright © 2002 International Society of Nephrology Terms and Conditions