Symptomatic urinary stone disease affects approximately 900,000 persons in the United States each year, resulting in an estimated annual medical cost of $4.5 billion. Computed tomography (CT) is the established method for imaging urinary calculi and can provide accurate sub-millimeter details of the size and location of renal stones. However, a complete characterization of renal stones, which includes stone composition and fragility, is critically needed for safe and cost effective management of stone disease, as well as for phenotyping of research subjects. Our long term goal is to use advanced CT methodologies to fully characterize urinary calculi, and to use evolving technology to reliably detect stone precursor lesions. Our objectives in this application are to develop a comprehensive, low-dose, stone-characterization exam using commercially-available dual-energy CT technology, and to detect stone precursor lesions using a prototype CT system equipped with energy resolving detectors. Based on our extensive preliminary results, we know that dual-energy CT can discriminate between several types of renal stones and provide accurate quantification of stone morphology. Our central hypothesis is that this quantitative information can be acquired at reduced dose levels and used to predict stone fragility, which we define as the likelihood of a stone to be broken by SWL or endoscopic methods. We further hypothesize that use of pre-clinical, 225-micron, energy-resolving CT detectors will allow detection of stone precursor lesions such as Randall's plaques, as well as the presence of trace elements having a suspected role in stone formation, such as zinc. We will accomplish these objectives through two specific aims: 1) Aim 1: Develop and validate a comprehensive low-dose stone-characterization exam using clinical dual-energy CT techniques. 2) Aim 2: Develop a pre-clinical spectral CT imaging technique that can detect precursor lesions and trace elements related to the formation of kidney stones.

Public Health Relevance

This proposal will develop imaging techniques that can determine urinary stone type and fragility in patients. The significance of this is that these advanced CT imaging techniques will allow physicians to more efficiently direct patient therapy and perform clinical research, potentially avoiding procedures associated with higher risk or cost.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZDK1-GRB-9)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Mayo Clinic, Rochester
United States
Zip Code
Tang, Xiaojing; Bergstralh, Eric J; Mehta, Ramila A et al. (2015) Nephrocalcinosis is a risk factor for kidney failure in primary hyperoxaluria. Kidney Int 87:623-31
Lieske, John C; Mehta, Ramila A; Milliner, Dawn S et al. (2015) Kidney stones are common after bariatric surgery. Kidney Int 87:839-45
Cabrero, Pablo; Terhzaz, Selim; Romero, Michael F et al. (2014) Chloride channels in stellate cells are essential for uniquely high secretion rates in neuropeptide-stimulated Drosophila diuresis. Proc Natl Acad Sci U S A 111:14301-6
Lieske, John C; Turner, Stephen T; Edeh, Samuel N et al. (2014) Heritability of urinary traits that contribute to nephrolithiasis. Clin J Am Soc Nephrol 9:943-50
Tang, Xiaojing; Lieske, John C (2014) Acute and chronic kidney injury in nephrolithiasis. Curr Opin Nephrol Hypertens 23:385-90
Rodgers, Allen; Gauvin, Daniel; Edeh, Samuel et al. (2014) Sulfate but not thiosulfate reduces calculated and measured urinary ionized calcium and supersaturation: implications for the treatment of calcium renal stones. PLoS One 9:e103602
Meeusen, Jeffrey W; Lieske, John C (2014) Looking for a better creatinine. Clin Chem 60:1036-9
Lieske, John C (2014) New insights regarding the interrelationship of obesity, diet, physical activity, and kidney stones. J Am Soc Nephrol 25:211-2
Singh, Prince; Knoedler, John J; Krambeck, Amy E et al. (2014) Thiazide diuretic prophylaxis for kidney stones and the risk of diabetes mellitus. J Urol 192:1700-4
Jepperson, Maria A; Ibrahim, El-Sayed H; Taylor, Abby et al. (2014) Accuracy and efficiency of determining urinary calculi composition using dual-energy computed tomography compared with Hounsfield unit measurements for practicing physicians. Urology 84:561-4

Showing the most recent 10 out of 11 publications