尿酸結石,とくに蔭酸カルシウムとの混合結石の構築 - 薄切標本の偏光顕微鏡による観察 -

Abstract

薄切標本の偏光顕微鏡的観察によって検討した.1)尿酸と蓚酸カルシウムの混合結石には, 蓚酸カルシウム結石を核とするもの, 蓚酸カルシウムの結晶群が核部に混在するもの, 内部に含むもの, 外層を覆うものなど多彩であった.2)尿酸と蓚酸の混合結石では粒状の蓚酸カルシウム1水化物の結晶は粒状の尿酸結晶と混在し, 菱形の2水化物の結晶は核部および外層の尿酸の層を溶蝕して混在する傾向がみられた.以上より蓚酸カルシウム1水化物は尿酸とほぼ同じ条件で析出し, 2水化物は異なる条件で析出し易い

The architecture of mixed uric acid and calcium oxalate stones was studied by polarized light microscopy. Some uric acid stones contained calcium oxalate stones (whewellite or weddellite) as a nucleus. Other uric acid stones contained calcium oxalate crystals in the nucleus or inner portion. A uric acid stone covered with layers of calcium oxalate was also found. In the mixed stones, nuclei of randomly mixed fine grained whewellite and uric acid were seen and both crystals appeared in alternating sequence in the outer layers. Weddellite crystals dissolved layers of uric acid and invaded into them in the nuclear or peripheral zones. Whewellite may precipitate in the same or a similar condition as uric acid precipitates, whereas weddellite may precipitate in a different condition. We discussed the pathogenesis of mixed uric acid and calcium oxalate stones, heterogeneous nucleation and epitaxial growth based on a morphologic study of the mixed stones.