Korean J Urol.  2009 Oct;50(10):1009-1013.

Crystal Deposits on Renal Papillae in Stone Formers

• Kim SD
• Kim MK
• Kim YG

Abstract

PURPOSE
Papillary "Randall's plaques" are theorized to act as nidi for urinary stone formation. In this study, we used endoscopic examination and intraoperative biopsy of renal papilla in stone formers undergoing percutaneous nephrolithotomy (PNL) to investigate the correlation between Randall's papillary plaque and primary stone composition and metabolic risk factors.
MATERIALS AND METHODS
A total of 34 patients with renal stones were enrolled. During PNL performed for stone removal, biopsy specimens were taken from selected papilla. We evaluated constituents such as volume, sodium, uric acid, calcium, oxalate, and citrate from 24-hour urine samples, and calcium, sodium, uric acid, phosphate, potassium, and chloride from serum samples 1 month after PNL.
RESULTS
We identified Randall's plaque in 26 patients as irregular, whitish lesions, generally located on the papillary tip. We performed intraoperative biopsies of papilla in the kidneys of stone formers and of known regions of crystal deposits in the interstitial tissue surrounding the ducts. There was no correlation between serum variables, 24-hour urine constituents, and presence of plaque. However, 24-hour urine volume was negatively correlated with the presence of plaque. The incidence of papillary plaques varied with the primary composition of extracted stones and was 80% for calcium oxalate, 92% for calcium phosphate, 50% for uric acid, and 25% for struvite stones (p=0.035).
CONCLUSIONS
The incidence of papillary Randall's plaques in patients with nephrolithiasis varied with the primary composition of formed urinary stones. Randall's plaques are found in most patients with calcium stones. Our findings suggest that the presence of papillary plaque is associated with calcium nephrolithiasis and may contribute to the pathogenesis, treatment, and prevention of calcium urinary stones.

Keyword

Percutaneous nephrolithotomy; Lithotripsy; Urinary calculi; Plaque

MeSH Terms

Biopsy
Calcium
Calcium Oxalate
Calcium Phosphates
Citric Acid
Humans
Incidence
Kidney
Lithotripsy
Magnesium Compounds
Nephrolithiasis
Nephrostomy, Percutaneous
Phosphates
Potassium
Risk Factors
Sodium
Uric Acid
Urinary Calculi
Calcium
Calcium Oxalate
Calcium Phosphates
Citric Acid
Magnesium Compounds
Phosphates
Potassium
Sodium
Uric Acid

Figure

• 

  Fig. 1. Endoscopic and histologic images of Randall’s plaques in stone formers. In (A), an example of a papilla from a stone former that was videotaped at the time of the mapping is shown. Several sites of Randall’s plaque (arrows) appear as irregular white areas beneath the urothelium. In addition, a plaque site was noted that lacked a urothelial layer and was thought to be a site where a stone had been attached to the side of the papilla (arrows). In (B), a low-magnification light-microscopic image of a papillary biopsy specimen from a patient is shown; the sites of calcium deposits are indicated with arrows. (C) A light micrograph shows large regions of crystal deposits in the interstitial tissue surrounding the ducts (arrows). H&E stain, magnification, x100 (B); x400 (C).

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