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KMID : 0358320090500101009
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Korean Journal of Urology
2009 Volume.50 No. 10 p.1009 ~ p.1013
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Crystal Deposits on Renal Papillae in Stone Formers
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Kim Sang-Deuk
Kim Myung-Ki
Kim Young-Gon
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Abstract
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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. (Korean J Urol 2009; 50:1009-1013)
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KEYWORD
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Percutaneous nephrolithotomy, Lithotripsy, Urinary calculi, Plaque
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