Cystine Urinary Lithiasis in Thailand : A Report of Five
Cases
SUCHART CHAIMUANGRAJ, MD*, KAMOLKANT JAMA VAN, BEd**,
CHINTANA MOKKHA VESA, MEd**, CHUCHART TIMVIPAK, BSc**,
NARUMON JUNVIMALAUNG, BSc**, WAS ANA STITCHANTRAKUL, MSc***,
W ACHIRA KOCHAKARN, MD*, PHAITUN GOJASENI, MD*
Affiliation : *Urological Section, Department of Surgery,
**Clinical Pathology, Department of Pathology,
***Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
AbstractCystine urinary stone is an autosomal recessive hereditary disease, frequently recurring and
resisting fragmentation by Shockwave lithotripsy. As cases have never been reported before in Thai
land, five cases of renal cystine stones at Ramathibodi Hospital were reported. Two were in the same
family. In all cases the stones were removed by open surgery or percutaneous nephrolithotomy. Post
operatively, all the stones were analyzed by infrared spectroscopy for cystine. In two cases, cystine
stones were also identified by scanning electron microscopy. Urine was analyzed for cystine by sodium
cyanide-nitroprusside test, its concentration by spectrophotometry and cystine crystals were identified
by the new crystal induction technique under light microscopy. By high-performance liquid chromato
graphy (HPLC) test, urinary dibasic amino acids (ornithine, lysine, arginine) in these cases were also
found to be significantly elevated. Clinical findings, diagnosis, treatment and prevention of cystine
stones are reviewed.
Keywords : Cystine Stone, Crystal, Cystinuria, Infrared Spectroscopy, Sodium Cyanide Niroprusside,
Spectrophotometry, Scanning Electronmicroscopy, Urinary Dibasic Amino Acids, Litho
triptor
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