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A Study of Some Physical Properties of Urine in Relation to Renal Stone Disease

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Objective: To study the specific gravity, pH and urinary output i.e. volume of urine of calcium oxalate stone formers and compare these properties with that of non stone formers, to investigate whether the difference between two groups really exists
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  International Journal of Pharmacy, Biology and Medical Sciences Vol. 1; No. 1; ISSN: 2319 -3026   5 A Study of Some Physical Properties of Urine in Relation to Renal Stone Disease Monika Gupta*, Dr. Seema Bhayana**, Dr S.K. Sikka*** *Department of Chemistry,   Vaish College, Rohtak, Haryana, India. ** Assistant Professor , UIET, M.D.University, Rohtak, Haryana, India. ***Associate Professor , Vaish ) College, Rohtak, Haryana, India. Email: guptamonika77@yahoo.com, ssbb1515@yahoo.co.in, sikkask81@gmail.com    : guptamonika77@yahoo.com  Abstract:  Objective:   To study the specific gravity, pH and urinary output i.e. volume of urine of calcium oxalate stone formers and compare these properties with that of non stone formers, to investigate whether the difference between two groups really exists or not. Subjects selected - The study was conducted on 50 patients divided into two groups- Group I consist of 25 idiopathic patients having calcium oxalate renal stone i.e. stone formers (SF) and Group II consists of 25 controls i.e. non stone formers (NSF) having no clinical evidence of renal stones. Urine Collections - Each patient and control collected a 24-hour urine, which was kept unrefrigerated, using thymol as preservative. Results - It was found that there is no statistical difference between specific gravity and pH in two groups. Urinary output i.e. volume in Group-I is significantly higher than Group-II. There was no correlation between the properties studied.  Keywords :   Renal Stone, stone former, non stone former, specific gravity, surface tension and viscosity. Accepted on: 20.09.2012 1.   Introduction Each year, thousands of people are diagnosed with renal stone disease, a condition that develops when the urine becomes overly saturated with certain microscopic substances [1]. They form crystals that bind into hardened mineral deposits known as renal stones. Renal stones can develop anywhere in urinary tract. They are formed due to imbalance between fluid and certain wastes in urine causing a high concentration of stone forming salts i.e. calcium oxalate, calcium phosphate, uric acid and struvite [2]. Renal stones may grow over months and even years before causing problem. Normally the stone will move through the urinary tract and pass out in the urine. Large stones do not always pass through and may require a procedure or surgery to remove them [3]. These stones can result in extreme pain, burning sensation during urination, blood in urine, can stop the flow of urine and in some cases may lead to high blood pressure [4] and increase the risk for coronary artery disease and diabetes mellitus [5]. The renal stone formation is a recurrent problem and around half of all people who previously had a kidney stone will develop another one within five years [6]. The recurrence rate without preventive treatment is approximately 10% at 1 year, 33% at 5 years and 50% at 10 years [7]. Another visible change was the variation in the gender of the affected people. Although in the beginning the disease was limited to men, nowadays it also affects the women. Peak age of renal stone found in men is 30 years and women are 35-55 years [8]. Further, renal stones develop more frequently in people with a family history of stones than in those without a family history [9]. Urine is a very complex polyionic solution and contains inhibitors and promoters of crystallization [10]. Important ions and molecules in relation to renal stone formation are Ca 2+ , oxalate, phosphate, Na+, K+, H+, OH-, Mg 2+ , SO 42-  citrate, amino acids, glycosaminoglycans etc[11]. The loss of balance between the urinary promoters and  International Journal of Pharmacy, Biology and Medical Sciences Vol. 1; No. 1; ISSN: 2319 -3026   6 inhibitors and super saturation of urine with stone forming ions has been suggested to increase the risk of stone formation more than disturbance in any single substance [12]. We have identified various properties of urine viz. surface tension, viscosity, specific gravity, volume, specific electrical conductivity, pH, organic acids etc. from the literature. The objective of our research paper will be to study specific gravity, pH and urinary output i.e. volume of urine of calcium oxalate stone formers and compare these properties with that of non stone formers, to investigate whether the difference between two groups really exists or not so that a new simple method may be developed to distinguish the stone formers from non stone formers rather than the imaging techniques used now-a-days [13]. We present a study of 50 patients. Group I consist of 25 patients of various ages and both sexes having calcium oxalate renal stone disease i.e. stone formers (SF) and Group II consists of 25 controls i.e. non stone formers (NSF) with matched age and sex having no family history of kidney stone. 2. Materials and Methods 2.1 Preparation of Patients and Controls Patients and controls were put on equal calorific diet/kg body weight and equal amount of water for 2 days. On third day, they were asked to collect 24- hour urinary sample. 2.2 Collection of 24-hour urine   Each patient is provided with two 2.5 l collecting bottles and for urine preservation 10 ml of 5% thymol in isopropanol is added into each bottle. On the day of urine collection, empty the bladder completely upon awakening and discard this urine. This is the start date and time. Write it on the collection container. After that, all urine should be collected in the bottle (also during the night) for the next 24 hours. Always store the collecting bottles in a cool place. The last urine collected should be that voided upon awakening the second day, at the same time as the start time [14]. 3.   Experimental We have studied the physical properties of urine viz. specific gravity, pH and urinary output i.e. volume of urine of calcium oxalate stone formers and compare these properties with that of non stone formers. Upon receipt, urine volume was measured and specific gravity and pH were measured by standard laboratory techniques. The individual values of each observation of each subject in both the groups are shown in Table 1 and Table 2 4.   Statistical methods  Significance of mean value differences between the two groups i.e. Group-I and Group-II were tested using student t-test and correlation coefficient was also calculated. 5.   Results and Discussion  The present study was conducted on 50 patients divided into two groups- Group I consist of 25 patients having calcium oxalate renal stone i.e. stone formers (SF) and Group II consists of 25 controls i.e. non stone formers (NSF). 24-hour urine was collected from each patient and control. It was found during study that a)   Specific Gravity of Group I (fig 1) ranges from 1.002 to 1.045 with a mean value of 1.026 ± 0.012. Corresponding value in Group II (fig 2) ranges from 1.003 to 1.042 with a mean value of 1.025 ± 0.011. Comparison of Specific gravity in both the groups is shown in fig 3. By applying student t-test, t value comes out to be 0.303 which is not statistically significant.    International Journal of Pharmacy, Biology and Medical Sciences Vol. 1; No. 1; ISSN: 2319 -3026   7 Fig. 1. Graph showing Specific Gravity of Stone Formers Fig. 2. Graph showing Specific Gravity of Non Stone Formers Fig. 3. Graph showing comparison between specific gravity of stone formers & non stone formers Fig. 4. Graph showing pH of Stone Formers b)   pH of Group I (fig 4) ranges from 5.2 to 8.2 with a mean value of 6.392 ± 0.829. Corresponding value in Group II (fig 5) ranges from 5.16 to 7.8 with a mean value of 6.300 ± 0.785. Comparison of pH in both the groups is shown in fig 6. By applying student t-test, t value comes out to be 0.396 which is not statistically significant.  International Journal of Pharmacy, Biology and Medical Sciences Vol. 1; No. 1; ISSN: 2319 -3026   8 Fig.5. Graph showing pH of Non Stone Formers Fig.6. Graph showing comparison between pH of stone formers & non stone formers c)   Urine output i.e. volume of Group I (fig 7) ranges from 1.020 to 2.300 litres with a mean value of 1.542 ± 0.354. Corresponding value in Group II (fig 8) ranges from 0.880 to 1.650 litres with a mean value of 1.103 ± 0.185. Comparison of volume in both the groups is shown in fig 9. By applying student t-test, t value comes out to be 5.34 which is statistically highly significant. Fig.7. Graph showing Volume of Stone Formers Further, to find dependence of one property over another, we calculated correlation coefficient (r), the values of which are shown in Table 3. From correlation coefficient, we found that no positive or negative perfect correlation is found between the properties studied. The graphs showing correlation between specific gravity and volume in Group-I and Group -II is shown in Fig 10 and 11 respectively. The graphs showing correlation between specific gravity and pH in Group-I and Group -II is shown in Fig 12 and 13 respectively. The graphs showing correlation between volume and pH in Group-I and Group -II is shown in Fig 14 and 15 respectively. Hence it is concluded from the experiments that specific gravity and pH cannot be used to distinguish stone former from non stone former. Urinary output in both the groups is statistically different. Urinary output in stone formers is higher than non stone formers.  International Journal of Pharmacy, Biology and Medical Sciences Vol. 1; No. 1; ISSN: 2319 -3026   9 Fig.8. Graph showing volume of Non stone formers Fig.9. Graph showing comparison between Volume of Stone Formers and Non Stone Formers Fig.10. Correlation between Sp gravity & volume for Group-I Fig.11. Correlation between Sp gravity & volume for Group-II
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