Distinguishing Characteristics of Idiopathic Calcium Oxalate Kidney Stone Formers with Low Amounts of Randall's Plaque

Background and Hypothesis: Nephrolithiasis currently affects about one-in-eleven people with a recurrence in up to half of those individuals. Formation of calcium oxalate (CaOx) stone is most common. Some CaOx stones are known to form on Randall’s plaque, which is a calcification of the renal papilla, and this kind of stone can be identified by morphology. We divided CaOx stone formers into two groups: Randall’s plaque (RP) stone formers (RPSF) and non-Randall’s plaque stone formers (NRPSF). We hypothesized that renal papillary pathologies would be different between these two groups of stone formers. Experimental Design or Project Methods: Surgical videos were assessed for papillary pathology using a semiquantitative grading system to measure papillary appearance in terms of ductal plugging and dilation, tissue surface pitting, loss of papillary contour, and RP. The second measure computed the papillary percent surface area of Randall’s plaque and ductal plugging using still images of the papilla. The scoring and quantitative measures of the papillae were compared between the two patient groups. All work was done in a manner blinded to the patient group. Results: Two-tailed t-test showed that RPSF group had higher scores of pitting and RP and lower scores for plugging when compared to the NRPSF group. Similarly, the quantitative data showed that RPSF group had a lower percentage of plugging surface area and higher percentage of RP surface area. Conclusion and Potential Impact: These data show that persons forming their CaOx stones primarily on RP have a papillary pathology that differs from CaOx stone formers who make their stones by other mechanisms. RPSF have more RP and less ductal plugging. Since the underlying pathologies existing in RP stone formation are different from other CaOx stone formers, it is possible that certain treatments could be especially effective for this group, and thus these results suggest that clinical trials that separate out this group of CaOx stone formers are warranted.

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Renal Papillary Mapping and Quantification of Randall's Plaque in Pediatric Calcium Oxalate Stone Formers

Journal of Endourology ◽

10.1089/end.2019.0377 ◽

2019 ◽

Vol 33 (10) ◽

pp. 863-867

Author(s):

Anne Darves-Bornoz ◽

Tracy Marien ◽

John Thomas ◽

Gabriel Fiscus ◽

John Brock ◽

...

Keyword(s):

Calcium Oxalate ◽

Calcium Oxalate Stone ◽

Randall’S Plaque ◽

Stone Formers ◽

Randall's Plaque

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MP58-01 DISCOVERY OF RANDALL’S PLAQUE GENE EXPRESSION PROFILING IN CALCIUM OXALATE STONE FORMERS BY IMMUNOHISTOCHEMICAL GENOME-WIDE ANALYSIS

The Journal of Urology ◽

10.1016/j.juro.2016.02.799 ◽

2016 ◽

Vol 195 (4S) ◽

Author(s):

Kazumi Taguchi ◽

Shuzo Hamamoto ◽

Atsushi Okada ◽

Rei Unno ◽

Hideyuki Kamisawa ◽

...

Keyword(s):

Gene Expression ◽

Calcium Oxalate ◽

Gene Expression Profiling ◽

Expression Profiling ◽

Calcium Oxalate Stone ◽

Genome Wide Analysis ◽

Randall’S Plaque ◽

Stone Formers ◽

Genome Wide ◽

Randall's Plaque

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MP19-17 RENAL PAPILLARY MAPPING AND QUANTIFICATION OF RANDALL’S PLAQUE IN PEDIATRIC CALCIUM OXALATE STONE FORMERS

The Journal of Urology ◽

10.1016/j.juro.2017.02.3259 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Annie Darves-Bornoz ◽

John Thomas ◽

Tracy Marien ◽

Gabriel Fiscus ◽

Douglass Clayton ◽

...

Keyword(s):

Calcium Oxalate ◽

Calcium Oxalate Stone ◽

Randall’S Plaque ◽

Stone Formers ◽

Randall's Plaque

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MP07-15 CALCIUM OXALATE STONE FORMERS WHO MAKE EVEN ONE STONE ON RANDALL'S PLAQUE HAVE SMALLER STONE BURDENS AND DISTINCTIVE PAPILLARY MINERAL PATHOLOGY

The Journal of Urology ◽

10.1097/ju.0000000000001980.15 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

James Williams ◽

Haider Al-Awadi ◽

Manognya Muthenini ◽

Sharon Bledsoe ◽

Tarek El-Achkar ◽

...

Keyword(s):

Calcium Oxalate ◽

Calcium Oxalate Stone ◽

Randall’S Plaque ◽

Stone Formers ◽

Randall's Plaque

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IN COMMON CALCIUM OXALATE STONE FORMERS, UNATTACHED STONES SHOW EVIDENCE OF HAVING ORIGINATED AS ATTACHED STONES ON RANDALL'S PLAQUE: A MICRO CT STUDY

The Journal of Urology ◽

10.1016/s0022-5347(08)61723-1 ◽

2008 ◽

Vol 179 (4S) ◽

pp. 587-588 ◽

Cited By ~ 1

Author(s):

Nicole L Miller ◽

James C Williams ◽

Mitchell R Humphreys ◽

Sharon B Bledsoe ◽

Shelly E Handa ◽

...

Keyword(s):

Calcium Oxalate ◽

Micro Ct ◽

Calcium Oxalate Stone ◽

Randall’S Plaque ◽

Stone Formers ◽

Show Evidence ◽

Randall's Plaque

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Excretion of urine extracellular vesicles bearing markers of activated immune cells and calcium/phosphorus physiology differ between calcium kidney stone formers and non-stone formers

BMC Nephrology ◽

10.1186/s12882-021-02417-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jiqing Zhang ◽

Sanjay Kumar ◽

Muthuvel Jayachandran ◽

Loren P. Herrera Hernandez ◽

Stanley Wang ◽

...

Keyword(s):

Urinary Excretion ◽

Calcium Oxalate ◽

Extracellular Vesicles ◽

Immune Cells ◽

Kidney Stone ◽

Fibroblast Growth Factor 23 ◽

Pathogenic Mechanisms ◽

Phosphorus Excretion ◽

Stone Formers ◽

Calcium Phosphorus

Abstract Backgrounds: Previous studies have demonstrated that excretion of urinary extracellular vesicles (EVs) from different nephron segments differs between kidney stone formers and non-stone formers (NSFs), and could reflect pathogenic mechanisms of urinary stone disease. In this study we quantified selected populations of specific urinary EVs carrying protein markers of immune cells and calcium/phosphorus physiology in calcium oxalate stone formers (CSFs) compared to non-stone formers (NSFs). Methods Biobanked urine samples from CSFs (n = 24) undergoing stone removal surgery and age- and sex- matched NSFs (n = 21) were studied. Urinary EVs carrying proteins related to renal calcium/phosphorus physiology (phosphorus transporters (PiT1 and PiT2), Klotho, and fibroblast growth factor 23 (FGF23); markers associated with EV generation (anoctamin-4 (ANO4) and Huntington interacting protein 1 (HIP1)), and markers shed from activated immune cells were quantified by standardized and published method of digital flow cytometry. Results Urine excretion of calcium, oxalate, phosphorus, and calcium oxalate supersaturation (SS) were significantly higher in CSFs compared to NSFs (P < 0.05). Urinary excretion of EVs with markers of total leukocytes (CD45), neutrophils (CD15), macrophages (CD68), Klotho, FGF23, PiT1, PiT2, and ANO4 were each markedly lower in CSFs than NSFs (P < 0.05) whereas excretion of those with markers of monocytes (CD14), T-Lymphocytes (CD3), B-Lymphocytes (CD19), plasma cells (CD138 plus CD319 positive) were not different between the groups. Urinary excretion of EVs expressing PiT1 and PiT2 negatively (P < 0.05) correlated with urinary phosphorus excretion, whereas excretion of EVs expressing FGF23 negatively (P < 0.05) correlated with both urinary calcium and phosphorus excretion. Urinary EVs with markers of HIP1 and ANO4 correlated negatively (P < 0.05) with clinical stone events and basement membrane calcifications on papillary tip biopsies. Conclusions Urinary excretion of EVs derived from specific types of activated immune cells and EVs with proteins related to calcium/phosphorus regulation differed between CSFs and NSFs. Further validation of these and other populations of urinary EVs in larger cohort could identify biomarkers that elucidate novel pathogenic mechanisms of calcium stone formation in specific subsets of patients.

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Association of urinary sex steroid hormones with urinary calcium, oxalate and citrate excretion in kidney stone formers

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa360 ◽

2020 ◽

Author(s):

Daniel G Fuster ◽

Gaétan A Morard ◽

Lisa Schneider ◽

Cedric Mattmann ◽

David Lüthi ◽

...

Keyword(s):

Calcium Oxalate ◽

Kidney Stone ◽

Urinary Calcium ◽

Sex Hormone ◽

Urinary Oxalate ◽

Oxalate Excretion ◽

Stone Formers ◽

17Β Estradiol ◽

Urinary Citrate ◽

Urinary Oxalate Excretion

Abstract Background Sex-specific differences in nephrolithiasis with respect to both distribution of prevalence and stone composition are widely described and may be influenced by sex hormones. Methods We conducted a cross-sectional analysis of the relationship between 24-hour urinary sex hormone metabolites measured by gas chromatography–mass spectrometry with urinary calcium, oxalate and citrate excretion in a cohort of 628 kidney stone formers from a tertiary care hospital in Switzerland, taking demographic characteristics, kidney function and dietary factors into account. Results We observed a positive association of urinary calcium with urinary testosterone and 17β-estradiol. Positive associations of urinary calcium with dehydroepiandrosterone, 5α-DH-testosterone, etiocholanolone, androsterone, and estriol were modified by net gastrointestinal alkali absorption or urinary sulfate excretion. As the only sex hormone, dehydroepiandrosterone was inversely associated with urinary oxalate excretion in adjusted analyses. Urinary citrate correlated positively with urinary testosterone. Associations of urinary citrate with urinary androsterone, 17β-estradiol and estriol were modified by urinary sulfate or sodium, or by sex. Conclusions Urinary androgens and estrogens are significantly associated with urinary calcium and citrate excretion, and associations are in part modified by diet. Our data furthermore reveal dehydroepiandrosterone as a novel factor associated with urinary oxalate excretion in humans.

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