Deep learning computer vision algorithm for detecting kidney stone composition.

OBJECTIVES: To assess the recall of a deep learning (DL) method to automatically detect kidney stones composition from digital photographs of stones. MATERIALS AND METHODS: A total of 63 human kidney stones of varied compositions were obtained from a stone laboratory including calcium oxalate monohydrate (COM), uric acid (UA), magnesium ammonium phosphate hexahydrate (MAPH/struvite), calcium hydrogen phosphate dihydrate (CHPD/brushite), and cystine stones. At least two images of the stones, both surface and inner core, were captured on a digital camera for all stones. A deep convolutional neural network (CNN), ResNet-101 (ResNet, Microsoft), was applied as a multi-class classification model, to each image. This model was assessed using leave-one-out cross-validation with the primary outcome being network prediction recall. RESULTS: The composition prediction recall for each composition was as follows: UA 94% (n = 17), COM 90% (n = 21), MAPH/struvite 86% (n = 7), cystine 75% (n = 4), CHPD/brushite 71% (n = 14). The overall weighted recall of the CNNs composition analysis was 85% for the entire cohort. Specificity and precision for each stone type were as follows: UA (97.83%, 94.12%), COM (97.62%, 95%), struvite (91.84%, 71.43%), cystine (98.31%, 75%), and brushite (96.43%, 75%). CONCLUSION: Deep CNNs can be used to identify kidney stone composition from digital photographs with good recall. Future work is needed to see if DL can be used for detecting stone composition during digital endoscopy. This technology may enable integrated endoscopic and laser systems that automatically provide laser settings based on stone composition recognition with the goal to improve surgical efficiency.

A novel method for the stabilization of soluble contaminants in electrolytic manganese residue: Using low-cost phosphogypsum leachate and magnesia/calcium oxide.

Electrolytic manganese residue (EMR) contains a large amount of NH4+-N and Mn2+ and can negatively impact the environment. A stabilization treatment of soluble contaminants in the EMR is necessary for its reuse and safe stacking. This study presents experimental results for the stabilization of NH4+-N and Mn2+ in the EMR using phosphogypsum leachate as a low-cost phosphate source and MgO/CaO (PLMC) process. The results demonstrated that the stabilization efficiency of NH4+-N and Mn2+ was 93.65% and 99.99%, respectively, under the following conditions: a phosphogypsum leachate dose of 1.5 mL g-1, an added MgO dose of 0.036 g g-1, an added CaO dose of 0.1 g g-1 and a reaction time of 2 h. The stabilization effect of the PLMC process was higher and more cost effective than that of using Na3PO4·12H2O and MgO/CaO. The concentration of NH4+-N and Mn2+ in the leaching liquor decreased to 80 mg L-1 and 0.5 mg L-1, respectively, after the stabilization under the optimum conditions. The stabilization characteristics indicated that NH4+-N was stabilized to form NH4MgPO4·6H2O (struvite) and that Mn2+ was stabilized to form Mn5(PO4)2(OH)4, Mn3(PO4)2·3H2O and Mn(OH)2. PO43--P, F-, and heavy metal ions of the phosphogypsum leachate were removed from the leaching liquor and stabilized in the treated EMR.

Development of phosphorus recovery reactor for enlargement of struvite crystals using seawater as the magnesium source.

Struvite crystallization is an interesting method for the recovery of phosphorus (P) from wastewater. However, the struvite crystals obtained are small, which makes them difficult to separate from wastewater. A continuous reactor for enlarging struvite crystals was developed. Batch-scale experiments were conducted to investigate the optimum factors for the enlargement of struvite crystals. The results of pH experiments showed that P recovery efficiency increased with an increase of pH values (7.6 to 10), while the size of struvite crystals decreased. The results of the Mg:P ratios found that the maximum P recovery efficiency occurred at the maximum ratio of Mg:P. The sizes of struvite crystals were not significantly different. For the variation of temperature values, the results showed that P recovery efficiency and crystal sizes decreased when temperature values increased. Therefore, the optimized conditions for P recovery efficiency and enlargement of struvite crystals for the continuous reactor were pH 8.5 and an Mg:P ratio of 1.2:1 at 30 °C (room temperature). The treated swine wastewater and seawater were continuously fed in at the bottom of the reactor. After 30 days, the size of struvite crystals had increased from 125 µm to 0.83 mm (seven times).

Comparative study of heavy metal residues in struvite products recovered from swine wastewater using fluidised bed and stirred reactors.

Struvite (MgNH4PO4·6H2O) crystallisation is a promising approach for phosphorus recovery from swine wastewater. Currently, intensive pig feeding has made heavy metals (HMs) extensive in swine wastewater; therefore, significant amounts of HMs have been detected in struvite recovery products. In this study, the HM residues in the struvite products recovered from stirred and fluidised bed reactors were investigated. The results showed that Zn, Mn, and Cu were the most abundant elements in swine wastewater (1,175.3 ± 178.0, 745.4 ± 51.5, and 209.3 ± 54.4 µg L-1, respectively). The HMs, especially Zn (97.0%) and Cu (96.8%), were mainly distributed in the total suspended solids (TSS) of the swine wastewater. Redundancy analysis revealed that the HMs in the struvite products harvested from the fluidised bed reactor were mainly attributable to the aggregation of dissolved matters, because most TSS were elutriated through fluidisation. In contrast, the HMs in the struvite products harvested from the stirred reactor mainly originated from the TSS, which complexed with the HMs, and co-precipitated and settled with the struvite products. Furthermore, chemical fractionation of the HM species confirmed that the presence of HMs in the struvite products was mainly attributable to metal precipitation and organic aggregation.

Application of image processing on struvite recovery from swine wastewater by using the fluidized bed.

Fluidized granulation is one of the common methods used in wastewater treatment and resource recovery with harvesting millimeter-scale large particles. Presently, effective methods are lacking to measure the fluidized granules ranging from micro- to millimeter scales, with the consequence of ineffectively controlling and optimizing the granulation process. In this work, recovering struvite (MgNH4PO4·6H2O) from swine wastewater by using a fluidized bed was taken as an example. Image processing was applied to analyze the properties of different types of struvite granules, including morphology, particle size distribution, number density and mass concentration. Four stages of the struvite crystal evolution were therefore defined: aggregation, aggregate compaction, cluster-agglomerating and coating growth. These stages could occur simultaneously or sequentially. Up-flow rates of 30-80 mm/s in the fluidized bed sustained 600-876 g/L granular solids. Results revealed that the coating-growth granules were formed with compact aggregates or cluster-agglomerating granules as the nuclei. The growth rates for the different types of particles, including population growth, mass increase and particle size enlargement, were determined. In final, a schematic illustration for struvite granulation process is also presented.

[Etiological factors for calculus-associated seminal vesiculitis: Analysis of calculus composition in 6 cases].

OBJECTIVE: To explore the etiological factors for calculus-associated seminal vesiculitis by analyzing the composition of seminal vesicle calculus samples. METHODS: This retrospective study included 6 cases of recurrent hematospermia diagnosed with seminal vesicle calculus by non-contrast pelvic CT. The patients were aged 28 to 69 years, with persistent or recurrent hematospermia for 3 months to 6 years, and 5 of them with a history of acute urethritis. All the patients underwent seminal vesiculoscopy, which confirmed calculus-associated seminal vesiculitis. The calculus samples were obtained with a spiral dislodge and their composition was determined with a second-generation infrared calculus composition analyzer. The patients were followed up for 2 to 12 weeks postoperatively, during which non-contrast pelvic CT was employed for observation of recurrent calculus in the reproductive tract. RESULTS: Pelvic CT scanning indicated recurrence of seminal vesicle calculus in 3 cases at 12 weeks postoperatively, of which, 2 were accompanied with recurrent hematospermia, both observed at 4 weeks after operation. As for the composition of the calculus, the infrared calculus composition analyzer revealed struvite (magnesium ammonium phosphate hexahydrate) in 5 cases and a mixture of calcium oxalate dihydrate, calcium oxalate monohydrate, and carbonate apatite in the other one. CONCLUSIONS: Seminal vesicle calculi are most commonly composed of struvite, and infection is the main etiological factor for calculus-associated seminal vesiculitis.

Micropollutants in source separated wastewater streams and recovered resources of source separated sanitation.

The quality of anaerobic sludge and struvite from black water treatment system, aerobic sludge from grey water treatment system and effluents of both systems was assessed for organic micropollutant content in order to ensure safety when reusing these products. Use of anaerobic black water sludge and struvite as soil amendments is recommended based on the low micropollutant content. Aerobic grey water sludge is recommended for disposal, because of the relatively high micropollutant concentrations, exceeding those in sewage sludge. Effluents of black and grey water treatment systems require post-treatment prior to reuse, because the measured micropollutant concentrations in the effluents are above ecotoxicological thresholds.

Clinical utility of computed tomography Hounsfield characterization for percutaneous nephrolithotomy: a cross-sectional study.

BACKGROUND: Computed Tomography (CT) is considered the gold-standard for the pre-operative evaluation of urolithiasis. However, no Hounsfield (HU) variable capable of differentiating stone types has been clearly identified. The aim of this study is to assess the predictive value of HU parameters on CT for determining stone composition and outcomes in percutaneous nephrolithotomy (PCNL). METHODS: Seventy seven consecutive cases of PCNL between 2011 and 2016 were divided into 4 groups: 40 (52%) calcium, 26 (34%) uric acid, 5 (6%) struvite and 6 (8%) cystine stones. All images were reviewed by a single urologist using abdomen/bone windows to evaluate: stone volume, core (HUC), periphery HU and their absolute difference. HU density (HUD) was defined as the ratio between mean HU and the stone's largest diameter. ROC curves assessed the predictive power of HU for determining stone composition/stone-free rate (SFR). RESULTS: No differences were found based on the viewing window (abdomen vs bone). Struvite stones had values halfway between hyperdense (calcium) and low-density (cystine/uric acid) calculi for all parameters except HUD, which was the lowest. All HU variables for medium-high density stones were greater than low-density stones (p < 0.001). HUC differentiated the two groups (cut-off 825 HU; specificity 90.6%, sensitivity 88.9%). HUD distinguished calcium from struvite (mean ± SD 51 ± 16 and 28 ± 12 respectively; p = 0.02) with high sensitivity (82.5%) and specificity (80%) at a cut-off of 35 HU/mm. Multivariate analysis revealed HUD ≥ 38.5 HU/mm to be an independent predictor of SFR (OR = 3.1, p = 0.03). No relationship was found between HU values and complication rate. CONCLUSIONS: HU parameters help predict stone composition to select patients for oral chemolysis. HUD is an independent predictor of residual fragments after PCNL and may be fundamental to categorize it, driving the imaging choice at follow-up.

Crystallization and demineralization phenomena in washed-rind cheese.

This report documents an observational study of a high-moisture washed-rind cheese. Three batches of cheese were sampled on a weekly basis for 6 wk and again at wk 10. Center, under-rind, rind, and smear samples were tested for pH, moisture, and selected mineral elements. Powder x-ray diffractometry and petrographic microscopy were applied to identify and image the crystal phases. The pH of the rind increased by over 2 pH units by wk 10. The pH of the under-rind increased but remained below the rind pH, whereas the center pH decreased for most of aging and only began to rise after wk 5. Diffractograms of smear material revealed the presence of 4 crystal phases: brushite, calcite, ikaite, and struvite. The phases nucleated in succession over the course of aging, with calcite and ikaite appearing around the same time. A very small amount of brushite appeared sporadically in center and under-rind samples, but otherwise no other crystallization was observed beneath the rind. Micrographs revealed that crystals in the smear grew to over 250 µm in length by wk 10, and at least 2 different crystal phases, probably ikaite and struvite, could be differentiated by their different optical properties. The surface crystallization was accompanied by a mineral diffusion phenomenon that resulted, on average, in a 217, 95.7, and 149% increase in calcium, phosphorus, and magnesium, respectively, in the rind by wk 10. The diffusion phenomenon caused calcium, phosphorus, and magnesium to decrease, on average, by 55.0, 21.5, and 36.3%, respectively, in the center by wk 10. The present study represents the first observation of crystallization and demineralization phenomena in washed-rind cheese.

Multivariate Analyses of Urinary Calculi Composition: A 13-Year Single-Center Study.

BACKGROUND: The incidence and prevalence of urinary stone are increasing throughout the world. Compared to the past, recent demographics of patient with urolithiasis compositions are strikingly different. Furthermore, recent clinical studies implied that seasonal cyclicity might influence the distribution of stone composition. METHODS: We sought to determine the trends in pathogenesis of urolithiasis based on urinary stone analyses. Between 2002 and 2014, a total of 2,383 eligible urinary stone samples from different patients were collected in our center. Infrared spectroscopy was used for urinary calculi analysis. A logistic regression analysis was used to investigate the relationship between urinary calculi composition and calendar month (season), gender, and age in north China during the past 13 years. RESULTS: Calcium-containing calculi were the most frequent with an overall incidence of 84.1%. Calcium phosphate (CaP) or magnesium ammonium phosphate (MAP) stones were more frequent in females, while monohydrate calcium oxalate (COM), dihydrate calcium oxalate (COD), or uric acid (UA) stones were more common in males. Older individuals were associated with an increased risk of UA stones and a decreased risk of COD, CaP, or cystine stones. Additionally, from 2002 to 2014, the frequency of COD and MAP stone increased, whereas the trend of CaP, UA and cystine stones decreased. However, calendar month (season) was not significantly associated with differences in composition. CONCLUSION: This study provides the present distribution of urolithiasis compositions in China. From 2002 to 2014, age and gender were significantly associated with stone composition, whereas calendar month was not.

Infrared spectroscopic analysis of staghorn calculi obtained after open renal surgery in a urology unit of Sri Lanka.

The composition of renal stones varies widely among populations. The aim of our study was to determine the composition of staghorn renal stones using Fourier transform infrared (FTIR) spectroscopy in a cohort of Sri Lankan patients. Forty two staghorn calculi removed from kidneys of adult patients during open surgery were analysed. There were 32 men. Nineteen (45%) were calcium oxalate monohydrate (whewellite) stones. Stones containing a mixture of calcium oxalate and calcium hydroxyl phosphate (apatite) were found in 16 (38%). Only 4 (10%) staghorn calculi were coposed of struvite. Three (7%) were uric acid stones. So most staghorn renal stones in Sri Lanka are calcium oxalate. Contrary to the traditional view based on studies done in the western world, only 10% of staghorn calculi removed from patients in Sri Lanka are struvite or infection stones. This could be the reason for kidneys with staghorn calculi in Sri Lanka to retain their function.

[Uroliths of cats in Switzerland from 2002 to 2009]. / Urolithen bei Katzen in der Schweiz von 2002 bis 2009.

INTRODUCTION: In this study data on composition of uroliths collected from cats and epidemiologic data of affected cats in Switzerland from 2002 to 2009 are summarised. Of 884 stones analysed 50% (n=441) were composed of calcium oxalate, 45% (n=398) of struvite, 3% (n=18) of ammonium urate, 1% (n=12) were mixed stones, 1% (n=9) were composed of silica, 3 stones were solidified blood, 2 consisted of cystine and 1of xanthine. 40% of the ureteral stones were composed of struvite. Domestic cats had significantly less calcium oxalate stones compared to British Shorthair or Persian cats. Cats with calcium oxalate stones were older and cats with struvite stones were younger than other affected cats. Female and male cats were equally affected with stones. Compared to studies from other countries, in Switzerland silica stones occurred more often and ureteral stones were more often composed of Struvite. The present study shows that occurrence and prevalence of urinary calculi of cats from Switzerland exhibited only slight differences to studies from other countries.

INTRODUCTION: Dans le présent travail, on résume les données relatives à la composition des calculs urinaires chez les chats en Suisse ainsi que les données épidémiologiques de ces animaux entre 2002 et 2009. Parmi les 884 calculs analysés, 50% (n=441) étaient composés d'oxalate de calcium, 45% (n=398) de struvite, 3% (n=18) d'urate d'ammonium, 1% (n=12) étaient des calculs mixtes 1% (n=9) se composaient de silicate, 3 calculs étaient formé de sang aggloméré, 2 étaient composés de cystine et un de xanthine. 40% des calculs urétraux se composaient de struvite. Les chats de maison avaient significativement moins de calculs d'oxalate de calcium que les British Shorthair ou les Persans. Les chats présentant des calculs d'oxalate de calcium étaient plus âgés et ceux présentant des struvites plus jeunes que tous les autres chats atteints. Les femelles et les mâles souffraient de calculs de façon équivalente. En comparaison avec des études menées dans d'autres pays, les calculs de silicate étaient plus fréquents en Suisse et les calculs urétraux se composaient plus souvent de struvite. Cette étude démontre que la survenue et la fréquence de calculs urinaires chez les chats en Suisse ne présente que peu de différence avec les études faites dans d'autres pays.

Composition analysis of 1,495 cases of upper urinary tract calculi: the role of age and gender.

OBJECTIVE: This study aimed to quantitatively analyze the calculi components of upper urinary tract calculi and to explore the relationship between calculus components, demographic characteristics, and underlying diseases. PATIENTS AND METHODS: Clinical data of 1,495 patients with upper urinary tract calculi were retrospectively collected. The calculi were divided into simple calcium oxalate, calcium oxalate mixed, calcium phosphate mixed, uric acid, magnesium ammonium phosphate, and other components. Statistical software SPSS 22.0 was used to analyze the differences between the stone compositions and various factors. The influencing factors (p < 0.05) were analyzed using multiple logistic regression analysis. RESULTS: Among 1,495 patients with upper urinary tract calculi, simple calcium oxalate calculi were the most common component (39.7%), followed by calcium oxalate mixed calculi (30.4%), uric acid calculi (13.6%), calcium phosphate mixed calculi (10.4%), magnesium ammonium phosphate calculi (5.8%) and other component calculi (0.1%). Univariate analysis revealed statistically significant differences in stone composition according to gender, age, and hyperuricemia (p < 0.05). Multiple logistic regression analysis showed that compared to men, the odds ratio (OR) values of calcium oxalate mixed stones, calcium phosphate mixed stones, and magnesium ammonium phosphate stones in women were 1.61, 2.50, and 4.17, respectively (p < 0.001). Compared with elderly patients, the OR values of calcium phosphate mixed stones in young and middle-aged patients were 3.14 and 2.70, respectively (p < 0.05). CONCLUSIONS: Patients with different stone components had different demographic characteristics, and stone components were significantly different between gender and age. Calcium oxalate mixed stones were more common in females, and calcium phosphate mixed stones and magnesium ammonium phosphate stones were more common in females, young patients, and middle-aged patients.

Implementation of a Technique Based on Hounsfield Units and Hounsfield Density to Determine Kidney Stone Composition.

Hounsfield units (HU) are a measure of radiodensity, related to the density of a tissue and the composition of kidney stones. Hounsfield density is what is related to the composition of kidney stones. In the standard acquisition method, these measures are arbitrary and dependent on the operator. This study describes the implementation of a technique based on the HU and Hounsfield density to predict the stone compositions of patients with nephrolithiasis. By conventional percutaneous nephrolithotomy, thirty kidney stone samples corresponding to the cortex, middle, and nucleus were obtained. The HU were obtained by CT scanning with a systematic grid. Hounsfield density was calculated as the HU value divided by the stone's greatest diameter (HU/mm). With that method and after analyzing the samples by IR-spectroscopy, anhydrous uric acid and ammonium magnesium phosphate were identified as the compounds of kidney stones. Additionally, anhydrous uric acid, magnesium ammonium phosphate, and calcium oxalate monohydrate were identified via Hounsfield density calculation. The study identified HU ranges for stone compounds using a systematic technique that avoids bias in its analysis. In addition, this work could contribute to the timely diagnosis and development of personalized therapies for patients with this pathology.

Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy.

PURPOSE: This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression. RESULTS: Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive. CONCLUSIONS: Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.

Large database study of urinary stone composition in South Korea: Korean Society of Endourology and Robotics (KSER) research series.

PURPOSE: To evaluate the characteristics of urinary stone composition in a Korean population using a large database of stone composition. MATERIALS AND METHODS: From January 1, 2014, to June 30, 2019, a total of 33,078 urinary stone composition data were analyzed. Stone composition was classified into four main groups: calcium oxalate (CaOx), struvite, uric acid (UA), and calcium phosphate (CaP). We examined the relationship between stone composition and sex, age, geographic region, calendar month, and season. RESULTS: The CaOx group (46.41%) was the largest, followed by the struvite group (29.66%), UA group (19.61%), and CaP group (4.32%). The CaOx group tended to decrease with age, but the UA group increased with age. Also, the CaOx group had the highest percentage in summer and the lowest in spring (p<0.001). The struvite and CaP groups had higher percentages of females than males (struvite: 36.6% vs. 25.7%, p<0.001; CaP: 6.2% vs. 3.3%, p<0.001). Conversely, the UA stones were more common in males than in females (24.5% vs. 11.0%, p<0.001). The UA group had the lowest percentage in the capital region (p<0.001). The total male-to-female ratio decreased over time from 1.95:1 in 2014 to 1.67:1 in 2018 (p<0.001). CONCLUSIONS: There were differences for each stone composition in the percentages according to sex, age, geographic region, month, and season. Identifying these differences based on the stone composition is vital for the treatment and prevention of urinary stones.

Urinary stone composition analysis of 3684 patients in the eastern Shandong region of China.

OBJECTIVE: There has not been a study that analyzed the composition of urinary stones from patients in the eastern Shandong region of China. Thus, we explored the composition of urinary stones in the eastern Shandong region of China and discuss the clinical significance of the findings. METHODS: A total of 3684 urinary calculi from the eastern Shandong region were collected in our study. Compositions of the stones were analyzed using an Automatic Infrared Spectrum Analysis System (type LIIR-20). The results were verified through manual analysis of the spectrograms, which was accompanied by polarizing microscopy and chemical analysis if necessary. RESULTS: Among the 3684 specimens, there were 1767 single-component stones and 1917 mixed-component stones. According to the main components of the stones, the stones were divided into the following types: calcium oxalate monohydrate stones (1779, 48.3%), anhydrous uric acid stones (1105, 30.0%), carbonate apatite stones (590, 16.0%), ammonium magnesium phosphate hexahydrate stones (143, 3.9%), calcium oxalate dihydrate stones (36, 1.0%), and cystine stones (31, 0.8%). CONCLUSIONS: There was a relatively high rate of uric acid stones in patients from the eastern Shandong region of China.

Association of Impaired Renal Function With Changes in Urinary Mineral Excretion and Stone Composition.

OBJECTIVE: To investigate the effect of kidney function on stone composition and urinary mineral excretion in patients undergoing surgical intervention for nephrolithiasis. METHODS: Using our institutional kidney stone database, we performed a retrospective review of stone patients who underwent surgical intervention between 2004 and 2015. Patients' demographic information, 24-hour urinary mineral excretion, and stone characteristics were reported. The patients' estimated glomerular filtration rates (eGFR) were compared with their stone compositions and 24-hour urine mineral excretions. RESULTS: A statistically significant difference was noted between the groups, with uric acid stones being associated with lower eGFR and calcium phosphate stones associated with higher eGFR. No relationship could be demonstrated between eGFR and calcium oxalate or struvite stones. Patients with lower eGFR also demonstrated a statistically significant association with lower urinary pH as well as lower urinary excretion of calcium and citrate. CONCLUSION: While various factors have been found to play significant roles in kidney stone formation and composition, our findings demonstrate a definite relationship between these and renal function. This paper highlights the fact that renal function evaluation should be considered an important component in the evaluation, counseling, and management of patients with nephrolithiasis.

Phosphorous in the environment: characteristics with distribution and effects, removal mechanisms, treatment technologies, and factors affecting recovery as minerals in natural and engineered systems.

Phosphorus (P), an essential element for living cells, is present in different soluble and adsorbed chemical forms found in soil, sediment, and water. Most species are generally immobile and easily adsorbed onto soil particles. However, P is a major concern owing to its serious environmental effects (e.g., eutrophication, scale formation) when found in excess in natural or engineered environments. Commercial chemicals, fertilizers, sewage effluent, animal manure, and agricultural waste are the major sources of P pollution. But there is limited P resources worldwide. Therefore, the fate, effects, and transport of P in association with its removal, treatment, and recycling in natural and engineered systems are important. P removal and recycling technologies utilize different types of physical, biological, and chemical processes. Moreover, P minerals (struvite, vivianite, etc.) can precipitate and form scales in drinking water and wastewater systems. Hence, P minerals (e.g., struvite, vivianite etc.) are problems when left uncontrolled and unmonitored although their recovery is beneficial (e.g., slow release fertilizers, sustainable P sources, soil enhancers). Sources like wastewater, human waste, waste nutrient solution, etc. can be used for P recycling. This review paper extensively summarizes the importance and distribution of P in different environmental compartments, the effects of P in natural and engineered systems, P removal mechanisms through treatment, and recycling technologies specially focusing on various types of phosphate mineral precipitation. In particular, the factors controlling mineral (e.g., struvite and vivianite) precipitation in natural and engineered systems are also discussed.