Document Detail


Randall's plaque: pathogenesis and role in calcium oxalate nephrolithiasis.
MedLine Citation:
PMID:  16614720     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of these studies was to test the hypothesis that Randall's plaque develops in unique anatomical sites of the kidney and their formation is conditioned by specific stone-forming pathophysiologies. We performed intraoperative papillary biopsies from kidneys of idiopathic-calcium oxalate (CaOx), intestinal bypass for obesity, brushite (BR) and cystine stone formers (SF) during percutaneous nephrolithotomy. Tissues were examined by infrared analysis and light and electron microscopy. Our analysis revealed a distinct pattern of mineral deposition and papillary pathology for each type of SF. CaOx SF had interstitial apatite crystals beginning at thin loops of Henle. These deposits termed Randall's plaque are thought to serve as sites for stone attachment. No tubular injury was noted. Intestinal bypass patients possessed intraluminal apatite deposits in inner medullary collecting ducts (IMCD) with associated cell injury. BR SF showed the most severe form of cortical and medullary changes with sites of Randall's plaque, and yellowish intraluminal deposits of apatite in IMCD. Cystine SF had plugging of ducts of Bellini with cystine crystals and apatite deposits in IMCD and loops of Henle. Intratubular sites of crystalline deposits were always associated to adjacent regions of interstitial fibrosis. The metabolic, anatomic, and surgical pathologic findings in four distinct groups of SF clearly show that 'the histology of the renal papilla from a stone former, is particular to the clinical setting'. We believe our approach to studying stone disease will provide insights into the pathogenesis of stone formation for each type of SF that will lead to improved clinical treatment.
Authors:
A Evan; J Lingeman; F L Coe; E Worcester
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Kidney international     Volume:  69     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-14     Completed Date:  2006-06-22     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1313-8     Citation Subset:  IM    
Affiliation:
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, 46220, USA. evan@anatomy.iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Biopsy
Calcium Oxalate / metabolism*
Endoscopy
Humans
Kidney Calculi / etiology*,  metabolism,  pathology*
Urinary Calculi / etiology*,  metabolism,  pathology*
Grant Support
ID/Acronym/Agency:
P01 DK43881/DK/NIDDK NIH HHS; P01 DK56788/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
25454-23-3/Calcium Oxalate
Comments/Corrections
Comment In:
Kidney Int. 2007 Jan;71(1):83; author reply 83-4   [PMID:  17167510 ]
Kidney Int. 2007 Jan;71(1):83; author reply 83-4   [PMID:  17167508 ]

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