Predicting the risk of kidney stone formation in the nephron by ‘reverse engineering’

Although most kidney stones are found in the calyx, they are usually initiated upstream in the nephron by precipitation there of certain incipient mineral phases. The risk of kidney stone formation can thus be indicated by changes in the degree of saturation of these minerals in the nephron fluid. To this end, relevant concentration profiles in the fluid along the nephron have been calculated by starting with specified urine compositions and imposing constraints from the corresponding, much less variable, blood compositions. A model for supersaturation within ten sections of both long and short nephrons has accordingly been developed based on this ‘reverse engineering’ of the necessary substance concentrations coupled with chemical speciation distributions calculated by our Joint Expert Speciation System (JESS). This allows the likelihood of precipitation to be assessed based on Ostwald’s ‘Rule of Stages’. Differences between normal and stone-former profiles have been used to identify sections in the nephron where conditions seem most likely to induce heterogeneous nucleation.