Pediatric Urology
Melamine Urinary Bladder Stone
F. Grases, A. Costa-Bauzá, I. Gomila, S. Serra-Trespalle, F. Alonso-Sainz,
and J. M. del Valle
We report a unique case of a melamine bladder urinary stone. A physiopathologic mechanism of formation is proposed
and discussed. UROLOGY 73: 1262–1263, 2009. © 2009 Elsevier Inc.
CASE REPORT
T
he patient, an 11-month-old girl, was born in
Yangjiang, China in the latter half of 2007.
The adoptive parents were advised by the Chi-
nese health authorities that the child had ingested
melamine-contaminated milk during her stay in the
orphanage and recommended an urgent hospital ex-
amination. The examination revealed that her renal
function and coagulation and serum biochemistry find-
ings were normal. However, the patient presented with
acute microcytosis. On ultrasonography, the existence
of a vesical lithiasis of 5 ⫻ 7 mm without nephrocal-
cinosis was confirmed. The calculus was mechanically
extracted by cystoscopy (using a basket). The patient
was discharged from the hospital after 24 hours, with
prophylaxis of amoxicillin/clavulanic acid and ibupro-
fen, without any further complications. All biochem-
ical urinary parameters were normal, but the urinary
pH was 5.0. The obtained calculus was studied by
Fourier transform infrared (FTIR) spectrometry and
scanning electron microscopy, coupled with x-ray mi-
croanalysis. Pure solutions of melamine, cyanuric acid,
and uric acid were prepared and used to obtain “in
vitro” pure and mixed crystals. The “in vitro” obtained
crystals were also submitted to analysis by FTIR spec-
trometry and scanning electron microscopy and x-ray
microanalysis. Only the mixed melamine-uric acid
crystals obtained “in vitro” exhibited FTIR spectra and
scanning electron microscopy features identical to
those obtained for the calculus. The FTIR spectrum is
considered the fingerprint of a compound (identical
FTIR spectra must correspond to the same chemical
compound). Therefore, it was concluded without any
doubt that the calculus was composed of melamine-
uric acid crystals.
From the Laboratory of Renal Lithiasis Research, Universitary Institute of Health
Science Research, University of Balearic Islands; and Clinica Rotger, Palma de Mal-
lorca, Spain
Reprint requests: F. Grases, Ph.D., Laboratory of Renal Lithiasis Research, Uni-
versitary Institute of Health Science Research, University of Balearic Islands, Ctra. de
Valldemossa km 7.5, Palma de Mallorca 07122 Spain. E-mail: fgrases@uib.es
Submitted: November 19, 2008, accepted (with revisions): December 12, 2008
1262 © 2009 Elsevier Inc.
All Rights Reserved
COMMENT
It has been recently reported that 4 infants in China
have died and at least 53 000 were seriously ill because
of consumption of milk powder contaminated with
melamine. A dramatic increase in cases of acute renal
failure in cats and dogs has been reported and was
attributed to the combination of melamine and cya-
nuric acid in pet food.1 Thus, melamine seems to be
not toxic by itself; however, when it reacts with cya-
nuric acid, it can cause fatal kidney stones because of
the formation of an insoluble melamine cyanurate.2
Nevertheless, the problem of melamine in the food
chain continues to be discussed and the mechanism
whereby melamine, or melamine plus another sub-
stance, causes the renal troubles still remains unclear.
According to the findings from the bladder calculus
presented in our study, its composition corresponded
mainly to an insoluble compound formed between
melamine and uric acid (Figs. 1 and 2). It is important
to emphasize that cyanuric acid was not found in such
a calculus. Our “in vitro” studies demonstrated that at
acidic urinary pH values (⬍5.0), melamine and uric
acid form an insoluble compound, probably with a
structure similar to that of the insoluble compound
formed between melamine and cyanuric acid.3,4 Nev-
ertheless, according our studies, when uric acid and
melamine were mixed in aqueous media at higher pH
values (⬎5.5), no crystals formed. Similar to mel-
amine-cyanuric acid crystals, melamine-uric acid crys-
tals are composed of a hydrogen-bond bimolecular
network formed by melamine and neutral uric acid
molecules. Melamine is highly soluble in water, and at
pH values ⬎5.5, uric acid is in an anionic form.5
Consequently, the formation of the mixed insoluble
solid would take place only at acidic pH values. In fact,
as indicated, the urinary pH of our patient was 5.0.
We believe the presented data permit the use of easy
prophylactic measures to avoid the formation of this
type of calculi. Thus, alkalinization of urine, for ex-
ample by citrate administration, could be an easy mea-
sure to avoid the formation of insoluble melamine-uric
acid crystals. With such alkalinizing measures, it is
easy to achieve urinary pH values ⬎6, and, at such pH
0090-4295/09/$34.00
doi:10.1016/j.urology.2008.12.041
 1 mm

Figure 1. Optical microscope and scanning electron microscopy images of calculus. On scanning electron microscopy,
image of mixed melamine-uric acid crystals is seen.
100
80
Transmittance [%]
60
40
20

4000 3500 3000 2500 2000 1500 1000 500

Wavenumber cm-1

Figure 2. Concordance of Fourier transform infrared spectra of bladder calculus of patient (red line) with corresponding “in
vitro”-formed melamine-uric acid crystals (blue line).

values, no insoluble melamine-uric acid crystals will
form.
References
1. Brown CA, Jeong K-S, Poppenga RH, et al. Outbreaks of renal
failure associated with melamine and cyanuric acid in dogs and cats
in 2004 and 2007. J Vet Diagn Invest. 2007;19:525-531.
2. Maxie G, Hoff B, Martos P, et al. The melamine-cyanuric acid pet
food recall. AHL Newsletter. 2007;11:20.
3. Sherrington DC, Taskinen KA. Self-assembly in synthetic macro-
molecular systems via multiple hydrogen bonding interactions. Chem
Soc Rev. 2001;30:83-93.
4. Perdigao LM, Champness NR, Beton PH. Surface self-assembly of
the cyanuric acid-melamine hydrogen bonded network. Chem Com-
mun. 2006;5:538-540.
5. Grases F, Villacampa AI, Costa-Bauza A, et al. Uric acid calculi:
types, etiology and mechanisms of formation. Clin Chim Acta. 2000;
302:89-104.

UROLOGY 73 (6), 2009 1263