Stone Morphology Distinguishes Two Pathways of Idiopathic Calcium Oxalate Stone Pathogenesis

被引:7
作者
Williams, James C., Jr. [1 ]
Al-Awadi, Haider [1 ]
Muthenini, Manognya [2 ]
Bledsoe, Sharon B. [1 ]
El-Achkar, Tarek [2 ]
Evan, Andrew P. [1 ]
Coe, Fredric [3 ]
Lingeman, James E. [4 ]
Worcester, Elaine M. [3 ]
机构
[1] Indiana Univ Sch Med, Dept Anat Cell Biol & Physiol, 635 Barnhill Dr MedSci 5065A, Indianapolis, IN 46202 USA
[2] Indiana Univ Sch Med, Dept Med, Div Nephrol, Indianapolis, IN 46202 USA
[3] Univ Chicago, Dept Med, Div Nephrol, 5841 S Maryland Ave, Chicago, IL 60637 USA
[4] Indiana Univ Sch Med, Dept Urol, Indianapolis, IN 46202 USA
关键词
kidney stones; nephrolithiasis; calcium oxalate; micro CT; infrared spectroscopy; KIDNEY-STONES; RANDALLS PLAQUE; MECHANISM; FORMERS;
D O I
10.1089/end.2021.0685
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: About 1 in 11 Americans will experience a kidney stone, but underlying causes remain obscure. The objective of the present study was to separate idiopathic calcium oxalate stone formers by whether or not they showed positive evidence of forming a stone on Randall's plaque (RP).Materials and Methods: In patients undergoing either percutaneous or ureteroscopic procedures for kidney stone removal, all stone material was extracted and analyzed using micro-CT imaging to identify those attached to RP. Twenty-four-hour urine samples were collected weeks after the stone removal procedure and patients were off of medications that would affect urine composition. The endoscopic video was analyzed for papillary pathology (RP, pitting, plugging, dilated ducts, and loss of papillary shape) by an observer blinded to the data on stone type. The percent papillary area occupied by RP and ductal plugging was quantified using image analysis software.Results: Patients having even one stone on RP (N = 36) did not differ from non-RP patients (N = 37) in age, sex, BMI, or other clinical characteristics. Compared with the non-RP group, RP stone formers had more numerous, but smaller, stones, more abundant papillary RP formation, and fewer ductal plugs, both by quantitative measurement of surface area (on average, three times more plaque area, but only 41% as much plug area as in non-RP patients) and by semiquantitative visual grading. Serum and blood values did not differ between RP and non-RP stone formers by any measure.Conclusions: Growth of many small stones on plaque seems the pathogenetic scheme for the RP stone-forming phenotype, whereas the non-RP phenotype stone pathogenesis pathway is less obvious. Higher papillary plugging in non-RP patients suggests that plugs play a role in stone formation and that these patients have a greater degree of papillary damage. Underlying mechanisms that create these distinctive phenotypes are presently unknown.
引用
收藏
页码:694 / 702
页数:9
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