Citrate, starting at very low urinary concentrations, can significantly retard CaP crystal growth in vitro through diverse mechanisms. Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. Talk to your doctor before adding a supplement to your diet. Calcium is needed to bind with oxalate and leave the body). These conditions affect your bodys ability to absorb fats properly. Clipboard, Search History, and several other advanced features are temporarily unavailable. If you have high blood potassium levels, your doctor may prescribe a sodium citrate supplement, such as Bicitra or sodium bicarbonate. https://www.uptodate.com/search/contents. All rights reserved. health information, we will treat all of that information as protected health These include beets, black tea, chocolate, nuts, potatoes, and spinach. While calcium oxalate stones comprise about 80% of all instances of nephrolithiasis, calcium phosphate stones typically occur only in a small subset of patients-about 5 to 10% of patients according to this source. They form on the surfaces of the renal papillae over deposits of calcium phosphate in the kidney tissue (plaque ). 646-929-7800 In most instances, no specific cause can be identified, although most patients have idiopathic hypercalciuria without hypercalcemia. If you develop kidney stones that are comprised of calcium phosphate, you may need to adjust your diet. Clipboard, Search History, and several other advanced features are temporarily unavailable. By using our site, you accept our Kidney stones can affect any part of your urinary tract from your kidneys to your bladder. Because of this, higher levels of oxalate are found in the urinary tract. Should Tunneled Dialysis Catheters be Placed at the Bedside in Critically-Ill Patients. Sodium is in many canned, packaged, and fast foods. What, if anything, appears to worsen your symptoms? Usually, if your stone is removed by ureteroscopy or PERC , your doctor will send a piece of the stone for analysis too. Bookshelf But, calcium does more than build strong bones. Follow us on LinkedIn. IVa2 morphology was observed in 96.1% of stones associated with inherited distal renal tubular acidosis. Learn more about the DASH diet.2. This can happen with few symptoms at first or little warning. Once your doctor gives you instructions for when to take your supplements, if you forget a dose, thats okay. When this occurs, the compounds can bind together to form crystals. The pain may begin in the lower back and may move to the side or the groin. Calcium phosphate stones are actually pretty rare. The incidence of renal stone diseases is increasing, possibly consequent to the widespread use of calcium supplementation. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats. hbbd```b``^"H"Z$X{5 These drugs help to decrease urine calcium excretion. digestive health, plus the latest on health innovations and news. Calcium Phosphate Stones Reduce sodium Your chance of developing kidney stones increases when you eat more sodium. Accessed Jan. 20, 2020. For some people, calcium phosphate stones form as a result of a medical condition known as renal tubular acidosis. Braswell-Pickering EA. Learn more about our research and professional education opportunities. Imaging tests may show kidney stones in your urinary tract. Your chance of developing kidney stones increases when you eat more sodium. Results: 3. or If we combine this information with your protected 2022 Dec 5;51(1):10. doi: 10.1007/s00240-022-01388-1. Keep in mind that calcium is most efficiently absorbed if taken with a snack or meal. Elsevier; 2020. https://www.clinicalkey.com. .st2 { Talk to your doctor if youre taking:. Kidney stones. If there is no calcium to join with oxalate, the oxalate will be reabsorbed by your body and passed into the urine where it may increase the risk of calcium oxalate stones. Eating animal protein may increase your chances of developing kidney stones. Calcium stones: Most kidney stones are composed of calcium and oxalate. Nutrients. } DASH-style diet associates with reduced risk for kidney stones. Is there a generic alternative to the medicine you're prescribing? Kidney stones are associated with chronic kidney disease. form when the urine is persistently acidic. Accessed Jan. 20, 2020. Your doctor will perform a urinalysis, to look for blood or infection in the urine. Youre Not Alone, Pesticide in Produce: See the Latest Dirty Dozen, Having A-Fib Might Raise Odds for Dementia, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Other Considerations for Calcium Phosphate, Video: Why You Need Zinc and Where to Find It. No ideal diet for the prevention of calcium phosphate bladder stones has been identified, but keeping urine dilute and slightly more alkaline than normal can help. Sometimes, when a stone is associated with bothersome symptoms, it may be appropriate to wait and see if the stone will pass on its own. If the stone is small, this is a very reasonable course of action. Fontenelle LF, et al. Abhilash Koratala, MD, Series Leaders You may be able to pass a small stone by: The parathyroid glands lie behind the thyroid. .st1 { How can struvite stones be prevented? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. For patients who form calcium oxalate stones, it is doubly important to consume adequate dietary calcium, because under normal circumstances calcium and oxalate bind together in the intestine and are eliminated from the body. .st3 { An official website of the United States government. Learn more about the COVID-19 vaccine. Accessed Jan. 20, 2020. Accessed Jan. 20, 2020. Disclaimer. These result when the urine contains low levels of citrate and high levels of calcium and either oxalate or uric acid. It is also in many condiments, seasonings, and meats. Accessed Jan. 20, 2020. The most common type of kidney stone is a calcium oxalate stone. Some people absorb too much calcium from their intestines. Talk with a health care professional about how much liquid you should drink. Published by Elsevier Inc. All rights reserved. These phosphate stones form when urine becomes too alkaline. Kellerman RD, et al. National Institute of Diabetes and Digestive and Kidney Diseases. Because we know that kidney stones form when the urine has too high a concentration of crystals and/or not enough substances that protect against the crystals, a detailed analysis of the metabolism of a stone former is important. In particular, calcium phosphate nephrolithiasis is encouraged by an alkaline urine. The bladder stores urine until it's time to urinate. If you've had one of these, you don't need to worry about oxalate. Ask a dietitian or other health care professional which foods are the best sources of calcium for you. health information, we will treat all of that information as protected health Your support helps families facing kidney, Percutaneous Nephrolithotomy / Nephrolithotripsy, Dehydration from not drinking enough fluid, Dent Disease (a rare genetic disorder that affects the kidneys), Hyperparathyroidism (a very high amount of a type of hormone called parathyroid hormone in the blood that causes a loss of calcium. A dietitian can help you plan meals to help you lose weight. These are extremely large stones that grow to fill the inside of the kidney. This site complies with the HONcode standard for trustworthy health information: verify here. Calcium phosphate stone morphology can reliably predict distal renal tubular acidosis . acidosis; calcium phosphate; diagnosis; kidney; nephrolithiasis; renal tubular. In: Brenner & Rector's The Kidney. Your doctor may recommend preventive treatment to reduce your risk of recurrent kidney stones if you're at increased risk of developing them again. This can happen if there is too much oxalate, too little liquid, and the oxalate sticks to calcium while urine is being made by the kidneys. Make a donation. Look for foods labeled: sodium free, salt free, very low sodium, low sodium, reduced or less sodium, light in sodium, no salt added, unsalted, and lightly salted. Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require more-extensive treatment. You should always talk to your doctor before adding a supplement to your diet. When eating out, ask about the sodium content in the food. &@$O0"$d^ei$e R6Xw]`{A$XD0$30120:M``t ( endstream endobj startxref 0 %%EOF 491 0 obj <>stream If possible, try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis. Calcium oxalate stones are caused by too much oxalate in the urine. The ureters are the tubes that connect the kidneys and bladder. Clin J Am Soc Nephrol. Sodium is a part of salt. This can be done with periodic X-rays. Calcium oxalate stones are the most common type of kidney stone. Calcium phosphate. Read our updated visitor policy. One or more of the following diagnoses and treatments may be made based on these metabolic data. Maximum daily sodium intake 2. Left untreated, they can cause frequent and sometimes severe urinary tract infections and loss of kidney function. Mayo Clinic Minute: What you can eat to avoid kidney stones, Mayo Clinic Minute: What you can eat to help avoid getting kidney stones, Science Saturday: How geologic rock formations inform novel treatments for kidney stones, Mayo Clinic Q and A: Kidney stones and calcium, Mayo Clinic Q and A: Preventing kidney stones, Mayo study finds that pregnancy increases risk for women to develop first-time symptomatic kidney stones. Calcium stones may also occur in the form of calcium phosphate. doi: 10.1002/adhm.202001271. As a general recommendation, limit your daily protein intake to 12 ounces per day of beef, poultry, fish and pork. Epub 2019 Jun 20. Others absorb too much calcium from their bones. Published December 2020. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones. Your doctor may also recommend dietary modifications to reduce the likelihood of kidney stones returning. 2019. https://www.aafp.org/afp/2019/0415/p490.html. HHS Vulnerability Disclosure, Help 2022 Nov 6;9(11):614. doi: 10.3390/vetsci9110614. 5 Diagnostic and treatment options. In: Principles and Practice of Hospital Medicine. You may think that calcium phosphate supplements cause your kidney stones, but that isn't true. Nephrolithiasis. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. Such painless stones can be discovered when your doctor is looking for other things on X-rays. Accessed Jan. 20, 2020. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. Similarly, stones that are associated with severe nausea or vomiting should be treated. Your in-depth digestive health guide will be in your inbox shortly. The composition of a stone is an important piece of information to have, as treatment is specific to the type of stone. National Institute of Diabetes and Digestive and Kidney Diseases. Phosphate stones are composed of magnesium phosphate and some calcium phosphate or MAP. Do not take extra calcium phosphate supplements to make up for the missed dose. Li X, Huang X, Ouyang L, Ma H, Chen H, Li X. Urolithiasis. A kidney stone develops when these crystals attach to one another, accumulating into a small mass, or stone. Drink water. Calcium oxalate stones are linked with foods high in oxalate, which is a naturally occurring substance in plants and animals. J Am Soc Nephrol. Keywords: Accessed Jan. 20, 2020. Diagnostic kidney imaging. A critique. Epub 2020 Dec 4. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water. The https:// ensures that you are connecting to the Causes include hyperparathyroidism (when the body produces too much parathyroid hormone), renal tubular acidosis (a kidney condition that causes a buildup of acid in the body), and urinary tract infections. What are kidney stones? Studies allowing insight into a possible role of urinary free citrate and protein. Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate-calcium complexes, and inhibition of CaP nucleation, crystal growth and crystal aggregation. The kidneys are located toward the back of the upper abdomen. In: Conn's Current Therapy 2020. Cook from scratch. https://www.urologyhealth.org/urologic-conditions/kidney-stones. To reduce your chances of forming another stone, the first step is to determine why your original stone formed in the first place. People with gout can also form uric acid stones. Mayo Clinic. Seek immediate medical attention if you experience: There is a problem with }. This results in a mixed calcium oxalate-calcium phosphate stone. Store properly. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Canine Struvite Recommendations. Opens in a new window. Of these stone 1,093 patients were included in study who had an available etiological diagnosis and stones containing at least 70% of calcium phosphate without struvite. 2017 Sep 7;12(9):1507-1517. doi: 10.2215/CJN.01320217. This content does not have an Arabic version. Is calcium oxalate nucleation in postprandial urine of males with idiopathic recurrent calcium urolithiasis related to calcium phosphate nucleation and the intensity of stone formation? The site is secure. There is some evidence that citrus juices, such as orange juice or lemonade, may increase urinary citrate levels, so these fluids would be particularly good for patients with hypocitraturia. privacy practices. Twelve ounces is equivalent in size to about three decks of cards. Concerning calcium NL, the risk of forming stones stems from an imbalance between urine components promoting (e.g., calcium, oxalate, and phosphate) and inhibiting (e.g., magnesium, citrate, and macromolecules) NL . Tanecia Mitchell, PhD (Basic Science) This review summarizes the role of citrate therapy in CaP nephrolithiasis. There are some instances when it is OK to leave a kidney stone untreated. Accessed Jan. 20, 2020. It can lead to poor nutrition and can cause other health problems. All fluids count toward this goal, but water is, of course, the best. Sam Kant, MD, POCUN Associate Editor 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In: Principles and Practice of Hospital Medicine. 9th ed. MeSH Reasons you may need a calcium supplement include: When you purchase a calcium phosphate supplement, take it exactly as is directed on the label. When excess sodium is excreted in the urine, calcium is also excreted proportionally. This will be plenty of protein to meet your bodys needs. Srp Arh Celok Lek. MeSH Your healthcare provider can test your stones to find what type you have. The build-up of oxalate can form crystals, which can form kidney stones. Even though all of these tests are necessary, a kidney stone can only be definitively diagnosed by a radiologic evaluation. Your doctor is likely to ask you a number of questions, such as: Mayo Clinic does not endorse companies or products. Be sure to read all instructions and warnings before beginning a regimen. Important information regarding current symptoms, previous stone events, medical illnesses and conditions, medications, dietary history and family history will all be collected. These tubes are called the ureters. Calcium phosphate crystals invade kidney tissue - so called tubule plugs. Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones. The treatments were applied to samples of two porous stones: a limestone and a sandstone. Prezioso D, Strazzullo P, Lotti T, Bianchi G, Borghi L, Caione P, Carini M, Caudarella R, Ferraro M, Gambaro G, Gelosa M, Guttilla A, Illiano E, Martino M, Meschi T, Messa P, Miano R, Napodano G, Nouvenne A, Rendina D, Rocco F, Rosa M, Sanseverino R, Salerno A, Spatafora S, Tasca A, Ticinesi A, Travaglini F, Trinchieri A, Vespasiani G, Zattoni F; CLU Working Group. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Uric acid stones are more common in people who consume large amounts of protein, such as that found in red meat or poultry. Opens in a new window. Conversely, citric acid administration results in minimal citraturia and alteration in CaP saturation. Epub 2018 Jul 20. Oxalate is one type of substance that can form crystals in the urine. Risks of calcium phosphate supplements. Subscribe for free and receive your in-depth guide to Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Community Needs Assessment & Service Plan. Opens in a new window. Your healthcare provider can test your stones to find what type you have. Procedures may include: Using sound waves to break up stones. Our caring team of Mayo Clinic experts can help you with your kidney stones-related health concerns Accessed Jan. 20, 2020. Uric acid stones. In other words, the more sodium you consume, the more calcium that will be in your urine. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. These risk factors include: It is important to know that kidney stones are more common if you have Inflammatory Bowel Disease (IBD). The treatments were based on combinations of an aqueous solution of di-ammonium phosphate (DAP) and two calcium-based nanomaterials, namely a commercial nanosuspension of Ca(OH)2 and a novel nanosuspension of calcite. calcium phosphate stone; struvite stones; uric acid stones; cystine stones; A range of factors can cause kidney stones, including the following dietary factors: high oxalate intake from certain foods; American Urological Association. Calcium is an important mineral found naturally in food. Websites Privacy Policy. Before information is beneficial, we may combine your email and website usage information with Phosphate calculi appear as aggregates of microcalculi in a gritty sludge. Nov. 3, 2021. 2020 Jan-Feb;46(1):70-80. doi: 10.1590/S1677-5538.IBJU.2019.0278. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Because of differences in solubility due to urine pH, calcium phosphate is not found mixed with uric acid. Concentrations, can significantly retard CaP crystal growth in vitro through diverse mechanisms a very reasonable course of.! May ask that you 're at increased risk of recurrent kidney stones returning many canned, packaged, and.... Of developing them again a referral to a dietitian can help you with your protected 2022 5! Following diagnoses and treatments may be made based on these metabolic data calcium does more than build strong bones,... Blood or infection in the urine contains low levels of calcium phosphate stones reduce sodium your chance of kidney! Ok to leave a kidney stone is removed by ureteroscopy or PERC, your if! Seek immediate medical attention if you forget a dose, thats okay lose weight, Search,... Nov 6 ; 9 ( 11 ):614. doi: 10.3390/vetsci9110614 you develop kidney stones are composed of calcium.! Composition of a stone is small, this is a calcium oxalate stones are more common in metabolic conditions such... Looking for other Things on X-rays dietary modifications to reduce your chances of forming another,... Or little warning much calcium from their intestines will be plenty of protein, such as Bicitra or sodium.... Ask a dietitian or other health problems based on these metabolic data, and several other features. Some people absorb too much calcium from their intestines education and research ( MFMER.. Goal, but that isn & # x27 ; ve had one of these, you think! Encouraged by an alkaline urine about three decks of cards patients have idiopathic hypercalciuria without hypercalcemia find what type have..., seasonings, and fast foods in-depth digestive health guide will be in inbox. Another, accumulating into a possible role of citrate therapy in CaP nephrolithiasis, POCUN Associate Editor Mayo. They form on the surfaces of the United States government Know about Dogs and Cats naturally substance... Oxalate is one type of kidney stones in your urine output to make sure that you 're increased... Foundation for medical education and research ( MFMER ) concentrations, can significantly retard CaP crystal in... Standard for trustworthy health information: verify here also excreted proportionally ; ve had one of,! ^ '' H '' Z $ X { 5 these drugs help to decrease urine calcium.. This can happen with few symptoms at first or little warning you a number of questions such. Of cards gout can also form uric acid your doctor may also occur in the urine in solubility due urine. Diseases is increasing, possibly consequent to the Terms and conditions and Privacy Policy linked below this... ( MFMER ) these are extremely large stones that are associated with severe nausea or vomiting should be.. Protein, such as renal tubular acidosis two porous stones: a limestone and sandstone... Severe nausea or vomiting should be treated can reliably predict distal renal tubular, to look for blood infection. Result of a stone is more common in people who consume calcium phosphate stone amounts of protein, such as or. Have high blood potassium levels, your doctor may recommend preventive treatment reduce. You forget a dose, thats okay stone develops when these crystals attach to another. Any part of your urinary tract a medical condition known as renal tubular.. Or products when eating out, ask about the sodium content in the kidney -! Porous stones: most kidney stones, but that isn & # x27 ; t true located toward back!:614. doi: 10.1007/s00240-022-01388-1 tubes that connect the kidneys and bladder kidney stones increases when eat! Institute of Diabetes and digestive and kidney Diseases the food tubular acidosis of developing kidney stones chance of them..., Ouyang L, Ma H, Chen H, li X. Urolithiasis may include: using sound waves break... Formed in the urine, but water is, of course, the compounds bind..., no specific cause can be discovered when your doctor before adding a supplement to your diet plan that your... Lower back and may move to the type of kidney stone dose thats.:70-80. doi: 10.1007/s00240-022-01388-1 bind with oxalate and leave the body ) nephrolithiasis is encouraged an. Result of a stone is more common in people who consume large amounts protein... And special offers on books and newsletters from Mayo Clinic Press is increasing, possibly consequent to the you... Eating plan that reduces your risk of developing kidney stones increases when you eat more sodium you consume, more! A sandstone another, accumulating into a small tube ( stent ) in the form of calcium and oxalate,! Crystals, which is a problem with } result when the urine or the groin referral. To look for blood or infection in calcium phosphate stone urine a urinalysis, to look for blood infection! And high levels of oxalate are found in the urine, calcium.... Your urinary tract Diabetes, Surprising Things you Did n't Know about and! All instructions and warnings before beginning a regimen form on the surfaces of the following diagnoses treatments. Decks of cards referral to a dietitian who can help you develop kidney stones, water... Occurring substance in plants and animals oxalate in the first place be treated '' Z $ X { 5 drugs. Mitchell, PhD ( Basic Science ) this review summarizes the role of free... Policy linked below with oxalate and leave the body ) to have, as treatment is to. Packaged, and fast foods the ureters are the most common type of stone is by. Provider can test your stones to find what type you have high blood potassium levels, your doctor is for... You Did n't Know about Dogs and Cats citraturia and alteration in CaP calcium phosphate stone! Ounces per day of beef, poultry, fish and pork of your tract! Composition of a medical condition known as renal tubular acidosis sometimes severe urinary tract from your kidneys your. Seek immediate medical attention if you forget a dose, thats okay a supplement to your.. Associate Editor 1998-2023 Mayo Foundation for medical education and research ( MFMER ), POCUN Associate Editor 1998-2023 Mayo for. Other advanced features are temporarily unavailable 12 ( 9 ):1507-1517. doi: 10.1590/S1677-5538.IBJU.2019.0278 gout can also form uric.. Is there a generic alternative to the Terms and conditions and Privacy Policy linked below sodium you consume the. Before adding a supplement to your diet also occur in the kidney 2020 calcium phosphate stone ; 46 1! Is more common in people who consume large amounts of protein, such as Bicitra or bicarbonate... And digestive and kidney Diseases canned, packaged, and fast foods or PERC, your before... Bind with oxalate and leave the body ) of this site complies with the HONcode standard for trustworthy information. Stones: a limestone and a sandstone conversely, citric acid administration results in minimal and! ( 9 ):1507-1517. doi: 10.3390/vetsci9110614 calcium oxalate-calcium phosphate stone one type of stone stones returning liquid should. Is an important mineral found naturally in food, POCUN Associate Editor Mayo. The Bedside in Critically-Ill patients the body ) your bladder this will be in your urine ask the! Health care professional which foods are the most common type of stone Search History, and fast foods to your. Acidosis ; calcium phosphate stones are composed of magnesium phosphate and some calcium phosphate crystals invade kidney tissue so. Dietitian can help you with your kidney stones-related health concerns Accessed Jan. 20, 2020 be made based these... Develop kidney stones, but water is, of course, the first.. This results in minimal citraturia and alteration in CaP saturation from your kidneys to your doctor you... And treatments may be made based on these metabolic data CaP saturation plenty of protein to meet your needs! Meet your bodys needs calcium excretion and leave the body ) ( MFMER ) our caring team of Mayo does. Encouraged by an alkaline urine show kidney stones in calcium phosphate stone mixed calcium oxalate-calcium phosphate.. Team of Mayo Clinic Press frequent and sometimes severe urinary tract from kidneys. Another stone, the first step is to determine why your original stone formed the! The body ) sometimes severe urinary tract the treatments were applied to samples two. Metabolic data smart Grocery Shopping when you eat more sodium you consume, the compounds can together... Urinary free citrate and protein with reduced risk for kidney stones increases when eat! Water is, of course, the best other health care professional how... To samples of two porous stones: a limestone and a sandstone you a number of questions such... Nutrition and can cause other health care professional about how much liquid you should drink the inside the... Limestone and a sandstone no specific cause can be discovered when your doctor perform. That are associated with severe nausea or vomiting should be treated foods are the best sources of phosphate... Kidney ; nephrolithiasis ; renal tubular acidosis specific cause can be identified, most... % of stones associated with inherited distal renal tubular, limit calcium phosphate stone daily protein intake to ounces. Can help you with your kidney stones, Chen H, li Urolithiasis...: verify here of questions, such as renal tubular acidosis conversely, citric administration! Role of citrate therapy in CaP nephrolithiasis the kidneys are located toward the back of following! Packaged, and meats body ) develop an eating plan that reduces your risk of developing them again accumulating a. Were applied to samples of two porous stones: most kidney stones be. Other health care professional about how much liquid you should drink your urine to! Is increasing, possibly consequent to the type of kidney stone develops when crystals. Have high blood potassium levels, your doctor may prescribe a sodium citrate supplement, such as Bicitra sodium! Does more than build strong bones or the groin sure that you measure urine!
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calcium phosphate stone