ESWL-Derived Particle Size Distribution and Fracture Geometries: A Contextual GeoBioMed Framework for Assessment of Kidney Stone Recurrence

Extracorporeal shock wave lithotripsy (ESWL) is a common worldwide clinical treatment for human kidney stones. Yet its 60% success rate is counterbalanced by recurrence rates of 50% within 10 years with no effective treatments currently available. This study has applied GeoBioMed approaches to determine the fracture patterns and grain size distributions of ESWL-derived particles within the context of their original crystalline architecture as revealed by high- and super-resolution autofluorescence (SRAF) microscopy. Calcium oxalate (CaOx) stones were removed from a Mayo Clinic patient using standard percutaneous nephrolithotomy (PCNL) and shock pulse lithotripsy (SPL). This produced ~4-12mm-diameter PCNL-derived fragments that were treated ex vivo to form 100’s of smaller ESWL-derived particles. ESWL-induced fractures propagated in a variety of geometric orientations relative to the original crystalline architecture of each fragment to form rectangular, pointed, concentrically spalled, and irregular, ESWL-derived particles size frequency distributions ranged from very fine silt (4-8m) to very fine pebbles (2-4mm), with a mean of fine sand (125-250m). These particles are smaller than the 3-4mm-diameter detection limit of clinical microcomputed tomography (micro-CT) and are hydrodynamically retained on internal kidney membrane surfaces. ESWL therefore produces small undetectable crystallization seed points distributed throughout the kidney that dramatically increase geochemical reactive surface area and kinetically enhance stone recurrence.

Name thesis:degree_name

M.S.

Level thesis:degree_level

Thesis

Discipline thesis:degree_discipline

Geology

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2022

Author dc:creator

• Todorov, Lauren G

Contributors dc:contributor

• Fouke, Bruce W

• nephrolithiasis
• urolithiasis
• mineralogy
• stratigraphy
• crystalline architecture
• extracorporeal shock wave lithotripsy
• ESWL
• fragments
• particles
• grain size
• reactive surface area
• super-resolution autofluorescence
• SRAF

Statement dc:rights

• Copyright 2022 Lauren Todorov

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/115811

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F115811