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Kwenda EP, Hernandez AD, Di Valerio E, Canales BK. Renal papillary tip biopsy in stone formers: a review of clinical safety and insights. Urolithiasis 2024; 52:93. [PMID: 38888601 DOI: 10.1007/s00240-024-01596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Alexander Randall first published renal papillary tip findings from stone formers in 1937, paving the way for endoscopic assessment to study stone pathogenesis. We performed a literature search to evaluate the safety of papillary tip biopsy and clinical insights gained from modern renal papillary investigations. A search on the topic of renal papillary biopsy provided an overview of Randall's plaques (RP), classification systems for renal papillary grading, and a summary of procedure type, complications, and outcomes. Within 26 identified manuscripts, 660 individuals underwent papillary tip biopsy percutaneously (n = 562), endoscopically (n = 37), or unspecified (n = 23). Post-operative hemoglobin changes were similar to controls. One individual (0.2%) reported fever > 38°, and long-term mean serum creatinine post-biopsy (n = 32) was unchanged. Biopsies during ureteroscopy or PCNL added ~20-30 min of procedure time. Compared to controls, papillary plaque-containing tissue had upregulation in pro-inflammatory genes, immune cells, and cellular apoptosis. Urinary calcium and papillary plaque coverage were found to differ between RP and non-RP stone formers, suggesting differing underlying pathophysiology for these groups. Two renal papillary scoring systems have been externally validated and are used to classify stone formers. Overall, this review shows that renal papillary biopsies have a low complication profile with high potential for further research. Systematic adaption of a papillary grading scale, newer tissue analysis techniques, and the development of animal models of Randall's plaque may allow further exploration of plaque pathogenesis and identify targets for prevention therapies in patients with nephrolithiasis.
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Affiliation(s)
- Elizabeth P Kwenda
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA.
| | | | | | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
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2
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Mavridis C, Bouchalakis A, Tsagkaraki V, Somani BK, Mamoulakis C, Tokas T. Recurrent Urinary Stone Formers: Imaging Assessment and Endoscopic Treatment Strategies: A Systematic Search and Review. J Clin Med 2024; 13:3461. [PMID: 38929988 PMCID: PMC11204450 DOI: 10.3390/jcm13123461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. Methods: We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. Results: No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. Conclusions: The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up.
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Affiliation(s)
- Charalampos Mavridis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Athanasios Bouchalakis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK
| | - Charalampos Mamoulakis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Theodoros Tokas
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria
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Li S, Wu W, Yang B, Liu Z, Duan X, Sun X, Liu H, Zhang S, Zhou Y, Wu W. Histone deacetylase 6 suppression of renal tubular epithelial cell promotes interstitial mineral deposition via alpha-tubulin acetylation. Cell Signal 2024; 116:111057. [PMID: 38242268 DOI: 10.1016/j.cellsig.2024.111057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
Randall's plaque (RP) is derived from interstitial mineral deposition and is highly prevalent in renal calcium oxalate (CaOx) stone disease, which is predictive of recurrence. This study shows that histone deacetylase 6 (HDAC6) levels are suppressed in renal tubular epithelial cells in RP samples, in kidney tissues of hyperoxaluria rats, and in hyper-oxalate-treated or mineralized cultured renal tubular epithelial (MDCK) cells in vitro. Mineral deposition in MDCK cells was exacerbated by HDAC6 inhibition but alleviated by HDAC6 overexpression. Surprisingly, the expression of some osteogenic-associated proteins, were not increased along with the increasing of mineral deposition, and result of single-cell RNA sequencing of renal papillae samples revealed that epithelial cells possess lower calcific activity, suggesting that osteogenic-transdifferentiation may not have actually occurred in tubular epithelial cells despite mineral deposition. The initial mineral depositions facilitated by HDAC6 inhibitor were localized in extracellular dome rather than inside the cells, moreover, suppression of HDAC6 significantly increased the calcium content of co-cultured renal interstitial fibroblasts (NRK49F) and enhanced mineral deposition of indirectly co-cultured NRK49F cells, suggesting that HDAC6 may influence trans-MDCK monolayer secretion of mineral. Further experiments revealed that this regulatory role was partially alpha-tubulinLys40 acetylation dependent. Collectively, these results suggest that hyper-oxalate exposure led to HDAC6 suppression in renal tubular epithelial cells, which may contribute to interstitial mineral deposition by promoting alpha-tubulinLys40 acetylation. Therapeutic agents that influence HDAC6 activity may be beneficial in preventing RP and CaOx stone formation.
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Affiliation(s)
- Shujue Li
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China; Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Wenzheng Wu
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Baotong Yang
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Zezhen Liu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China
| | - Xiaolu Duan
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China
| | - Xinyuan Sun
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China
| | - Hongxing Liu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China
| | - Shike Zhang
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Yuhao Zhou
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Wenqi Wu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Provincial Key Laboratory of Urology, Guangdong Engineering Research Center of Urinary Minimally invasive surgery Robot and Intelligent Equipment, Guangzhou Institute Of Urology, Guangzhou, Guangdong 510230, China; Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China.
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4
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Paz DC, Gunther AC, Higham MC, Stephenson LG, Laporta AJ, Gubler KD, Ryznar RJ. Exploring the relationship of supernumerary recurrent renal calculi formation and tick-borne infections: a case report. Front Cell Infect Microbiol 2024; 14:1194307. [PMID: 38343886 PMCID: PMC10853403 DOI: 10.3389/fcimb.2024.1194307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation.
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Affiliation(s)
- Dean C. Paz
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Abigael C. Gunther
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Michael C. Higham
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Lynne G. Stephenson
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Anthony J. Laporta
- Department of Military Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - K. Dean Gubler
- Department of Military Medicine, Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Rebecca J. Ryznar
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
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Daudon M, Frochot V, Bazin D, Haymann JP, Letavernier E. Medullary sponge kidney: what kind of stones? CR CHIM 2022. [DOI: 10.5802/crchim.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Van de Perre E, Bazin D, Estrade V, Bouderlique E, Wissing KM, Daudon M, Letavernier E. Randall’s plaque as the origin of idiopathic calcium oxalate stone formation: an update. CR CHIM 2022. [DOI: 10.5802/crchim.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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7
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Khan SR. Inflammation and injury: what role do they play in the development of Randall’s plaques and formation of calcium oxalate kidney stones? CR CHIM 2022. [DOI: 10.5802/crchim.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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8
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Sabo AR, Winfree S, Bledsoe SB, Phillips CL, Lingeman JE, Eadon MT, Williams JC, El‐Achkar TM. Label-free imaging of non-deparaffinized sections of the human kidney to determine tissue quality and signatures of disease. Physiol Rep 2022; 10:e15167. [PMID: 35133089 PMCID: PMC8822874 DOI: 10.14814/phy2.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Label-free fluorescence imaging of kidney sections can provide important morphological information, but its utility has not been tested in a histology processing workflow. We tested the feasibility of label-free imaging of paraffin-embedded sections without deparaffinization and its potential usefulness in generating actionable data. Kidney tissue specimens were obtained during percutaneous nephrolithotomy or via diagnostic needle biopsy. Unstained non-deparaffinized sections were imaged using widefield fluorescence microscopy to capture endogenous fluorescence. Some samples were also imaged with confocal microscopy and multiphoton excitation to collect second harmonic generation (SHG) signal to obtain high-quality autofluorescence images with optical sectioning. To adjudicate the label-free signal, the samples or corresponding contiguous sections were subsequently deparaffinized and stained with Lillie's allochrome. Label-free imaging allowed the recognition of various kidney structures and enabled morphological qualification for adequacy. SHG and confocal imaging yielded quantifiable high-quality images for tissue collagens and revealed specific patterns in glomeruli and various tubules. Disease specimens from patients with diabetic kidney disease and focal segmental glomerulosclerosis showed distinctive signatures compared to specimens from healthy controls with normal kidney function. Quantitative cytometry could also be performed when DAPI is added in situ before imaging. These results show that label-free imaging of non-deparaffinized sections provides useful information about tissue quality that could be beneficial to nephropathologists by maximizing the use of scarce kidney tissue. This approach also provides quantifiable features that could inform on the biology of health and disease.
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Affiliation(s)
- Angela R. Sabo
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Seth Winfree
- Department of Pathology and MicrobiologyEppley InstituteUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Sharon B. Bledsoe
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Carrie L. Phillips
- Department of PathologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - James E. Lingeman
- Department of UrologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michael T. Eadon
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - James C. Williams
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tarek M. El‐Achkar
- Department of Anatomy, Cell Biology, and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Indianapolis VA Medical CenterIndianapolisIndianaUSA
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9
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Randall's plaque and calcium oxalate stone formation: role for immunity and inflammation. Nat Rev Nephrol 2021; 17:417-433. [PMID: 33514941 DOI: 10.1038/s41581-020-00392-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 01/30/2023]
Abstract
Idiopathic calcium oxalate (CaOx) stones often develop attached to Randall's plaque present on kidney papillary surfaces. Similar to the plaques formed during vascular calcification, Randall's plaques consist of calcium phosphate crystals mixed with an organic matrix that is rich in proteins, such as inter-α-trypsin inhibitor, as well as lipids, and includes membrane-bound vesicles or exosomes, collagen fibres and other components of the extracellular matrix. Kidney tissue surrounding Randall's plaques is associated with the presence of classically activated, pro-inflammatory macrophages (also termed M1) and downregulation of alternatively activated, anti-inflammatory macrophages (also termed M2). In animal models, crystal deposition in the kidneys has been associated with the production of reactive oxygen species, inflammasome activation and increased expression of molecules implicated in the inflammatory cascade, including osteopontin, matrix Gla protein and fetuin A (also known as α2-HS-glycoprotein). Many of these molecules, including osteopontin and matrix Gla protein, are well known inhibitors of vascular calcification. We propose that conditions of urine supersaturation promote kidney damage by inducing the production of reactive oxygen species and oxidative stress, and that the ensuing inflammatory immune response promotes Randall's plaque initiation and calcium stone formation.
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10
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Zhu Z, Huang F, Xia W, Zeng H, Gao M, Li Y, Zeng F, He C, Chen J, Chen Z, Li Y, Cui Y, Chen H. Osteogenic Differentiation of Renal Interstitial Fibroblasts Promoted by lncRNA MALAT1 May Partially Contribute to Randall's Plaque Formation. Front Cell Dev Biol 2021; 8:596363. [PMID: 33505960 PMCID: PMC7829506 DOI: 10.3389/fcell.2020.596363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022] Open
Abstract
Background The current belief is that Randall's plaques (RP) constitute a nidus for the formation of idiopathic calcium oxalate stones, but the upstream events in RP formation remain unclear. The present study aimed to investigate whether RP formation shares similarities with biomineralization and to illustrate the potential role played by the lncRNA MALAT1 in osteogenic differentiation of human renal interstitial fibroblasts (hRIFs). Materials and Methods Biomineralization and MALAT1 expression were assessed in RP, and hRIFs were isolated and induced under osteogenic conditions for further experiments. The transcription initiation and termination sites in MALAT1 were identified by 5' and 3' RACE. RNA immunoprecipitation assays and luciferase assays were used to validate the interactions among MALAT1, Runx2 and miRNAs. Results Upregulated expression of osteogenic markers and MALAT1 was observed in RP and hRIFs induced with osteogenic medium. Biomineralization in RP and calcium phosphate (CaP) deposits in induced hRIFs were further verified by electron microscopy. Furthermore, overexpression of MALAT1 promoted the osteogenic phenotype of hRIFs, while treatment with a miR-320a-5p mimic and knockdown of Runx2 significantly suppressed the osteogenic phenotype. Further analysis showed that MALAT1 functioned as a competing endogenous RNA to sponge miR-320a-5p, leading to upregulation of Runx2 and thus promoting osteogenic differentiation of hRIFs. Conclusion Ectopic calcification and MALAT1 partially contributed to the formation of RP, in which MALAT1 might promote Runx2 expression to regulate osteogenic differentiation of hRIFs by sponging miRNA-320a-5p. The current study sheds new light on the lncRNA-directed mechanism of RP formation via a process driven by osteogenic-like cells.
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Affiliation(s)
- Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Weiping Xia
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huimin Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Meng Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yongchao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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11
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Chen Y, Li T, Cheng J. Ambiguous clear cell carcinoma in medullary sponge kidney: A case report. Asian J Urol 2020; 7:369-372. [PMID: 32995283 PMCID: PMC7498938 DOI: 10.1016/j.ajur.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/16/2019] [Accepted: 04/16/2019] [Indexed: 11/08/2022] Open
Abstract
Medullary sponge kidney (MSK) is a characteristic renal malformation, with a relatively low incidence. Radiologically, identification of MSK is sometimes ambiguous when compared to a renal mass. Here, we report a novel renal clear cell carcinoma in MSK, and discuss our approach to treatment. We recommended that a preoperative biopsy should be performed, followed by a comprehensive discussion regarding the appropriate perioperative preparations and careful surgical techniques that should be performed for this complex disease.
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Affiliation(s)
- Yang Chen
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyu Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Cui Y, Zeng F, Zhu Z, Huang F, Chen J, He C, Li Y, Chen Z, Yang Z, Zu X, Chen H. Suppression of osteogenic-like differentiation in human renal interstitial fibroblasts by miRNA-410-3p through MSX2. Transl Androl Urol 2020; 9:2082-2093. [PMID: 33209671 PMCID: PMC7658140 DOI: 10.21037/tau-20-607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this stay was to determine the effect of calcium ions in promoting osteogenic-like differentiation in human renal interstitial fibroblasts (hRIFs). The role of miRNA-410-3p in upregulating Msh homeobox 2 (MSX2) level in hRIFs was also investigated. Methods Quantitative polymerase chain reaction (qPCR) analysis was used to assess the expression levels of miRNA-410-3p in Randall’s plaque (RP) and normal renal papillary (nRP) tissues. Furthermore, the expression levels of osteogenesis-related protein in the RP and nRP tissues were assessed with qPCR and immunohistochemistry (IHC). hRIFs were cultured from isolated human kidney papilla before treatment with calcium chloride or osteogenic medium, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed at 1, 5, 9, and 14 days post-treatment. Alizarin red staining was used to estimate the deposits of calcium aggregates. After the overexpression or knockdown of miRNA-410-3p, we evaluated the changes in the osteogenic-like differentiation and osteogenesis-related protein by alizarin red staining and qPCR, respectively. A binding relationship between miRNA-410-3p and MSX2 was established through a dual-luciferase reporter gene assay. Rescue experiments demonstrated that miRNA-410-3p regulated the osteogenic-like differentiation by targeting MSX2. Results miRNA-410-3p levels were lower in RP tissue than in control nRP tissues. qPCR and IHC showed that the level of runt-related transcription factor 2 (Runx2), osteocalcin (OCN), and osteopontin (OPN) were higher in RP tissues. The calcium deposition of hRIFs showed a time-dependent trend when treated with osteogenic medium or calcium chloride. The overexpression of miRNA-410-3p downregulated the levels of osteogenesis-related expression and attenuated mineralization. The knockdown of miRNA-410-3p yielded the opposite trend. Dual-luciferase reporter gene assay and rescue experiments indicated that miRNA-410-3p could target MSX2, while the overexpression of MSX2 reversed the effects of miRNA-410-3p on osteogenic-like differentiation. Conclusions The current findings suggest that calcium ions could promote the osteogenic-like differentiation of hRIFs and miRNA-410-3p regulates hRIFs osteogenic-like differentiation by inhibiting MSX2.
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Affiliation(s)
- Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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13
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Pless MS, Williams JC, Andreassen KH, Jung HU, Osther SS, Christensen DR, Osther PJS. Endoscopic observations as a tool to define underlying pathology in kidney stone formers. World J Urol 2019; 37:2207-2215. [PMID: 30610358 PMCID: PMC6679988 DOI: 10.1007/s00345-018-02616-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/23/2018] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Advancements in endoscopy offer the possibility of inspection of intrarenal anatomy and pathology. The aim of the study was to evaluate renal papillary appearance in kidney stone formers and to correlate papillary findings with stone type and patient metabolic data. MATERIALS AND METHODS A consecutive cohort of 46 kidney stone formers undergoing retrograde intrarenal surgery was enrolled. During surgery, renal papillae were characterized in the domains of ductal Plugging (DP), surface Pitting, Loss of papillary contour, and Amount of Randall's plaque (RP, PPLA scoring). Stone material was analyzed using micro-CT and infrared spectroscopy, and blood and urine were collected for metabolic evaluation. RESULTS In all patients, renal papillae had changes in at least one of the domains of the PPLA score. Examining the total population, it was evident that patients with predominantly plugging (DP > 0) all had very low RP scores. There were no significant trends between mean PPLA scores and urinary analytes for the total group. CONCLUSION Efforts to prevent renal stone formation have so far been insufficient in majority of patients. Digital endoscopy reveals that kidney stone formers have different and distinct papillary morphologies that seem to be linked to specific stone-forming pathways. Since renal papillary abnormalities may be easily identified during endoscopy, this may in the future prove to be an important method for tailoring prevention strategies in kidney stone patients.
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Affiliation(s)
- Maria Sloth Pless
- Urological Research Center (URC), Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - James Caldwell Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kim Hovgaard Andreassen
- Urological Research Center (URC), Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Department of Urology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark
| | - Helene Ulrich Jung
- Urological Research Center (URC), Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Department of Urology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark
| | | | | | - Palle Jörn Sloth Osther
- Urological Research Center (URC), Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
- Department of Urology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark.
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14
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Imam TH, Patail H, Patail H. Medullary Sponge Kidney: Current Perspectives. Int J Nephrol Renovasc Dis 2019; 12:213-218. [PMID: 31576161 PMCID: PMC6769051 DOI: 10.2147/ijnrd.s169336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022] Open
Abstract
Medullary Sponge Kidney (MSK) disease is a rare congenital malformation of the distal nephron where cystic dilatation is appreciable in the collecting ducts and renal papillae. Most cases of the malformation are thought to arise from a malfunction within neurotrophic factor and tyrosine kinase interactions. Presentation and prognosis are usually indolent; however, they include urinary tract infections (UTI), nephrolithiasis and nephrocalcinosis, distal renal tubular acidosis (dRTA) and hypocitraturia. With an insidious and asymptomatic onset, MSK is a difficult renal manifestation to both diagnose and treat. Difficulty diagnosing MSK today arises from clinical settings deviating from the usage of contrast methods when assessing the urogenital tract. Many healthcare standards for kidney disorders center diagnosis around imaging techniques rather than contrast methods. This ultimately leads to a decrease in the total number of confirmed cases of MSK. Though intra-venous urogram (IVU) remains as the current gold standard to diagnose MSK, other methods such as endoscopy and Multi-detector computed tomography (MDCT) are being put into place. Endoscopic examination and renal biopsy may allow definitive diagnosis; however, such invasive methods may be considered excessive. Moving forward, differential diagnoses for MSK can be made more precisely when patients present with other renal manifestations, especially in groups at risk. These groups include patients between the age of 20 and 30, patients with other renal malformations, high sodium diet patients, hyperparathyroid patients, and patients with family history of MSK. Basic treatment is aimed at controlling stone formation by stabilizing urinary pH. Treatment for patients, especially those prone to forming stones, includes the application of potassium citrate compounds, prophylactic water and diet control, surgical intervention or lithotripsy for removal of symptomatic kidney stones.
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Affiliation(s)
- Talha H Imam
- Division of Nephrology, Kaiser Permanente, Fontana, CA, USA
| | - Haris Patail
- St. George's University School of Medicine, West Indies, Grenada
| | - Hassan Patail
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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15
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Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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16
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Wu Z, Wu H, Md S, Yu G, Habib SL, Li B, Li J. Tsc1 ablation in Prx1 and Osterix lineages causes renal cystogenesis in mouse. Sci Rep 2019; 9:837. [PMID: 30696882 PMCID: PMC6351533 DOI: 10.1038/s41598-018-37139-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/28/2018] [Indexed: 02/02/2023] Open
Abstract
Tuberous Sclerosis Complex (TSC) is caused by mutations in TSC1 or TSC2, which encode negative regulators of the mTOR signaling pathway. The renal abnormalities associated with TSC include angiomyolipoma, cysts, and renal cell carcinoma. Here we report that specific ablation of Tsc1 using the mesenchymal stem cell-osteoblast lineage markers induced cystogenesis in mice. Using Rosa-tdTomato mice, we found that Prx1- or Dermo1-labeled cells were present in the nephron including glomerulus but they were not stained by markers for podocytes, mesangial cells, endothelial cells, or proximal or loop of Henle tubular cells, while Osx is known to label tubular cells. Tsc1 deficiency in Prx1 lineage cells caused development of mild cysts that were positive only for Tamm-Horsfall protein (THP), a loop of Henle marker, while Tsc1 deficiency in Osx lineage cells caused development of cysts that were positive for Villin, a proximal tubular cell marker. On the other hand, Tsc1 deficiency in the Dermo1 lineage did not produce detectable phenotypical changes in the kidney. Cyst formation in Prx1-Cre; Tsc1f/f and Osx-Cre; Tsc1f/f mice were associated with increase in both proliferative and apoptotic cells in the affected tissue and were largely suppressed by rapamycin. These results suggest that Prx1 and Osx lineages cells may contribute to renal cystogenesis in TSC patients.
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Affiliation(s)
- Zhixiang Wu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hongguang Wu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Shafiquzzaman Md
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Guo Yu
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Samy L Habib
- Department of Cellular and Structural Biology, South Texas Veterans Health Care System, San Antonio, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Baojie Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jing Li
- Department of Ophthalmology, XinHua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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17
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Shan D, Rezonzew G, Mullen S, Roye R, Zhou J, Chumley P, Revell DZ, Challa A, Kim H, Lockhart ME, Schoeb TR, Croyle MJ, Kesterson RA, Yoder BK, Guay-Woodford LM, Mrug M. Heterozygous Pkhd1 C642* mice develop cystic liver disease and proximal tubule ectasia that mimics radiographic signs of medullary sponge kidney. Am J Physiol Renal Physiol 2019; 316:F463-F472. [PMID: 30600684 PMCID: PMC6442377 DOI: 10.1152/ajprenal.00181.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Heterozygosity for human polycystic kidney and hepatic disease 1 ( PKHD1) mutations was recently associated with cystic liver disease and radiographic findings resembling medullary sponge kidney (MSK). However, the relevance of these associations has been tempered by a lack of cystic liver or renal disease in heterozygous mice carrying Pkhd1 gene trap or exon deletions. To determine whether heterozygosity for a smaller Pkhd1 defect can trigger cystic renal disease in mice, we generated and characterized mice with the predicted truncating Pkhd1C642* mutation in a region corresponding to the middle of exon 20 cluster of five truncating human mutations (between PKHD1G617fs and PKHD1G644*). Mouse heterozygotes or homozygotes for the Pkhd1C642* mutation did not have noticeable liver or renal abnormalities on magnetic resonance images during their first weeks of life. However, when aged to ~1.5 yr, the Pkhd1C642* heterozygotes developed prominent cystic liver changes; tissue analyses revealed biliary cysts and increased number of bile ducts without signs of congenital hepatic fibrosis-like portal field inflammation and fibrosis that was seen in Pkhd1C642* homozygotes. Interestingly, aged female Pkhd1C642* heterozygotes, as well as homozygotes, developed radiographic changes resembling MSK. However, these changes correspond to proximal tubule ectasia, not an MSK-associated collecting duct ectasia. In summary, by demonstrating that cystic liver and kidney abnormalities are triggered by heterozygosity for the Pkhd1C642* mutation, we provide important validation for relevant human association studies. Together, these investigations indicate that PKHD1 mutation heterozygosity (predicted frequency 1 in 70 individuals) is an important underlying cause of cystic liver disorders and MSK-like manifestations in a human population.
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Affiliation(s)
- Dan Shan
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Gabriel Rezonzew
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Sean Mullen
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Ronald Roye
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Juling Zhou
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Phillip Chumley
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Dustin Z Revell
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Anil Challa
- Department of Genetics, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Harrison Kim
- Department of Radiology, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Mark E Lockhart
- Department of Radiology, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Trenton R Schoeb
- Department of Genetics, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Mandy J Croyle
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Robert A Kesterson
- Department of Genetics, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Bradley K Yoder
- Department of Cell, Developmental and Integrative Biology, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Lisa M Guay-Woodford
- Center for Translational Science, Children's National Health System , Washington, District of Columbia
| | - Michal Mrug
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama.,Department of Veterans Affairs Medical Center , Birmingham, Alabama
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18
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Evan AP, Coe FL, Lingeman J, Bledsoe S, Worcester EM. Randall's plaque in stone formers originates in ascending thin limbs. Am J Physiol Renal Physiol 2018; 315:F1236-F1242. [PMID: 30066583 DOI: 10.1152/ajprenal.00035.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Randall's plaque, an attachment site over which calcium oxalate stones form, begins in the basement membranes of thin limbs of the loop of Henle. The mechanism of its formation is unknown. Possibly, enhanced delivery of calcium out of the proximal tubule, found in many stone formers, increases reabsorption of calcium from the thick ascending limb into the interstitium around descending vasa recta, which convey that calcium into the deep medulla, and raises supersaturations near thin limbs ("vas washdown"). According to this hypothesis, plaque should form preferentially on ascending thin limbs, which do not reabsorb water. We stained serial sections of papillary biopsies from stone-forming patients for aquaporin 1 (which is found in the descending thin limb) and the kidney-specific chloride channel ClC-Ka (which is found in the ascending thin limb). Plaque (which is detected using Yasue stain) colocalized with ClC-Ka, but not with aquaporin 1 (χ2 = 464, P < 0.001). We conclude that plaque forms preferentially in the basement membranes of ascending thin limbs, fulfilling a critical prediction of the vas washdown theory of plaque pathogenesis. The clinical implication is that treatments such as a low-sodium diet or thiazide diuretics that raise proximal tubule calcium reabsorption may reduce formation of plaque as well as calcium kidney stones.
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Affiliation(s)
- Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Fredric L Coe
- Nephrology Section, Department of Medicine, University of Chicago , Chicago, Illinois
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Sharon Bledsoe
- Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Elaine M Worcester
- Nephrology Section, Department of Medicine, University of Chicago , Chicago, Illinois
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19
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Abstract
PURPOSE OF REVIEW The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. RECENT FINDINGS Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. SUMMARY Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future.
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20
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Chronic pain in medullary sponge kidney: a rare and never described clinical presentation. J Nephrol 2018; 31:537-542. [DOI: 10.1007/s40620-018-0480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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21
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The effects of HAP and macrophage cells to the expression of inflammatory factors and apoptosis in HK-2 cells of vitro co-cultured system. Urolithiasis 2017; 46:429-443. [PMID: 29236151 PMCID: PMC6153874 DOI: 10.1007/s00240-017-1032-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/11/2017] [Indexed: 01/26/2023]
Abstract
This study developed an in vitro system by co-culturing HK-2 cells with different concentration of hydroxyapatite (HAP) and/or macrophage cells to simulate the internal environment of urolithiasis as far as possible, investigating the regulatory effects of macrophage cells on HAP-induced expression of relative inflammatory factors of HK-2 cells. The control group (H group) was only comprised of HK-2 cells. Experimental groups included co-culturing HK-2 cells and macrophage cells (H + M group), co-culturing HK-2 cells and HAP (H + A group), co-culturing macrophage cells and HAP (M + A group), and co-culturing HK-2 cells and macrophage cells with HAP (H + M + A group). In the H + A, M + A, and H + M + A group, we set the concentration of HAP as 5 μg/cm2 (A1) and 10 μg/cm2 (A2). After co-culturing for 2, 4, and 6 h, we detected the expression of CCL-2 in the liquid by ELISA. We tested the expression of LDH and ROS to evaluate the damage of HK-2 cells. We assessed the apoptosis of HK-2 cells using DAPI staining assay, flow cytometry, and the rate of BAX/BCL-2. Western Blotting detected OPN, Fetuin-A, BAX, and BCL-2 of HK-2 cells. The expression of CCL-2 in the medium of H + A1 and H + A2 group increased significantly compared with the control (P < 0.05); CCL-2 of M + A1 and M + A2 group was higher than the H + A1 and H + A2 group (P < 0.05). The expression of CCL-2 in H + M + A1 and H + M + A2 group was also higher than M + A1 and M + A2 group (P < 0.05). Compared with control, the expression of OPN, LDH release, the ratio of BAX/BCL-2, and the generation of ROS in HK-2 cells increased in a dose- and time-dependent manner. Compared with the control, the expression of Fetuin-A decreased in various degrees at different incubation periods. Especially when co-culturing for 6 h, Fetuin-A decreased most seriously in the H + M + A1 group. (1) The HAP can induce the HK-2 cells oxidative stress and inflammatory damage and apoptosis, when adding the macrophages to co-culture, macrophage cells can aggravate the damage and apoptosis of the HK-2 cells. (2) After the stimulation of HAP, the expression of OPN in HK-2 cells increased in a time- and dose-dependent manner; macrophage cells can aggravate the increase of OPN in HK-2 cells. (3) In the HAP and HK-2 cells co-cultured system, the low-level Fetuin-A of HK-2 cells may be related to the excessive consumption of Fetuin-A in the process of HAP-induced renal tubular epithelial cell excessive oxidative stress, inflammatory injury, and cell apoptosis. When adding macrophage cells to co-culture, Fetuin-A decreased even more seriously, it reminds us that macrophage cells can slightly regulate the expression of Fetuin-A in the HK-2 cells.
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22
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Anatomically-specific intratubular and interstitial biominerals in the human renal medullo-papillary complex. PLoS One 2017; 12:e0187103. [PMID: 29145401 PMCID: PMC5690653 DOI: 10.1371/journal.pone.0187103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 10/15/2017] [Indexed: 01/03/2023] Open
Abstract
Limited information exists on the anatomically-specific early stage events leading to clinically detectable mineral aggregates in the renal papilla. In this study, quantitative multiscale correlative maps of structural, elemental and biochemical properties of whole medullo-papillary complexes from human kidneys were developed. Correlative maps of properties specific to the uriniferous and vascular tubules using high-resolution X-ray computed tomography, scanning and transmission electron microscopy, energy dispersive X-ray spectroscopy, and immunolocalization of noncollagenous proteins (NCPs) along with their association with anatomy specific biominerals were obtained. Results illustrated that intratubular spherical aggregates primarily form at the proximal regions distant from the papillary tip while interstitial spherical and fibrillar aggregates are distally located near the papillary tip. Biominerals at the papillary tip were closely localized with 10 to 50 μm diameter vasa recta immunolocalized for CD31 inside the medullo-papillary complex. Abundant NCPs known to regulate bone mineralization were localized within nanoparticles, forming early pathologic mineralized regions of the complex. Based on the physical association between vascular and urothelial tubules, results from light and electron microscopy techniques suggested that these NCPs could be delivered from vasculature to prompt calcification of the interstitial regions or they might be synthesized from local vascular smooth muscle cells after transdifferentiation into osteoblast-like phenotypes. In addition, results provided insights into the plausible temporal events that link the anatomically specific intratubular mineral aggregates with the interstitial biomineralization processes within the functional unit of the kidney.
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23
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WEI XL, XUE MF, QIN ZX, BAI XY, DONG FF, ZHANG JJ, LV N, CHEN H, ZHANG J. The Effect of Comprehensive Care on the Patients Received Minimally Invasive Percutaneous Nephrolithotomy. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:923-929. [PMID: 28845403 PMCID: PMC5563874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND We analyzed the effect of comprehensive care on the patients who received minimally invasive percutaneous nephrolithotomy (MPCNL). METHODS Patients hospitalized from 2013-2014 in Zhumadian Central Hospital (n=124) were enrolled and divided into two groups on random basis. The control group was treated with routine nursing model while the observation group was given comprehensive care additionally. The surgery time, degree of comfort, complications and successful cases, hospitalization time, sleep quality, nursing satisfaction and changes of systolic pressure, pulse and respiratory at different time were observed and analyzed. RESULTS The surgery time of the control group was significantly longer than that of observation group (P<0.05). The observation group felt more comfortable and showed more significant successful cases than the control group. Moreover, the hospitalization time were significantly reduced in observation group when compared with control group (P<0.05). The sleep quality of the observation group was significantly better than that of the control group (P<0.05). Before anesthesia, diastolic blood pressure, systolic blood pressure, pulse and respiration were not significantly different between the two groups. The diastolic blood pressure, systolic blood pressure, pulse and respiration after anesthesia, intraoperative 30 min, postoperative 30 min and other moments were significantly different. The incidence of complications in the control group was significantly higher than that in the observation group. The nursing satisfaction of the observation group was significantly higher than that of the control group. CONCLUSION The comprehensive care on the patients undergoing MPCNL was effective, and it can dramatically shorten surgery time, improve the success rate, improve the sleep quality of patients, keep life sign stable and minimize the complications.
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Affiliation(s)
- Xue-Li WEI
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China,Corresponding Author:
| | - Mei-Fang XUE
- Physical Examination Center, Zhumadian Central Hospital, Zhumadian, China
| | - Zhao-Xia QIN
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Xing-Yun BAI
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Fang-Fang DONG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Jin-Jin ZHANG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Ning LV
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Hui CHEN
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Jia ZHANG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
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24
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Abstract
How stones are retained within the kidney while small in size is still not fully understood. In this paper, we show two examples of how stones are retained during early growth: one is growth on Randall's (interstitial) plaque, and the other is growth on mineral that has formed as a luminal plug in a terminal collecting duct. These two mechanisms of stone retention during early growth have distinctive morphologic features that can be seen by methods that show the microscopic structure of the stones. Stones growing on Randall's plaque display an apatite region that is typically not large in size (<0.5 mm across) but which usually shows luminal spaces, which are signs of its origin in the connective tissue of the papilla. Stones growing on ductal plugs also show attachment to a piece of apatite, but the apatite regions are typically larger (often >1 mm long and >0.5 mm wide), and they are solid, without spaces running through them. We propose that knowing the mechanisms of stone retention during early stone formation could allow for better treatment of stone diseases.
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25
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Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29:715-734. [PMID: 27456839 PMCID: PMC5080344 DOI: 10.1007/s40620-016-0329-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
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Affiliation(s)
- Giovanni Gambaro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Fredric Coe
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - Orson Moe
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, USA
| | - Elen Worcester
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - Noor Buchholz
- Department of Urological Surgery, Sobeh's Vascular and Medical Center, Dubai, UAE
| | - David Bushinsky
- Department of Nephrology, Medical Center, University of Rochester, Rochester, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, USA
| | - Pietro Manuel Ferraro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniel Fuster
- Department of Nephrology, University of Bern, Bern, Switzerland
| | - David S Goldfarb
- Department of Nephrology, New York Harbor VA Health Care System, New York, USA
| | | | - Bernard Hess
- Department of Internal Medicine and Nephrology, Klinik Im Park Hospital, Zurich, Switzerland
| | - John Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Martino Marangella
- Department of Nephrology, A.S.O Ordine Mauriziano Hospital, Turin, Italy
| | - Dawn Milliner
- Department of Nephrology, Mayo Clinic, Rochester, USA
| | - Glen M Preminger
- Department of Urology, Duke University Medical Center, Durham, USA
| | | | - Khashayar Sakhaee
- Southwestern Medical Center, Mineral Metabolism Research, University of Texas, Dallas, USA
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indiana, USA
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26
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Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
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Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
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27
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Abstract
Nephrolithiasis, or stones, is one of the oldest urological diseases, with descriptions and treatment strategies dating back to ancient times. Despite the enormous number of patients affected by stones, a surprising lack of conceptual understanding of many aspects of this disease still exists. This lack of understanding includes mechanisms of stone formation and retention, the clinical relevance of different stone compositions and that of formation patterns and associated pathological features to the overall course of the condition. Fortunately, a number of new tools are available to assist in answering such questions. New renal endoscopes enable kidney visualization in much higher definition than was previously possible, while micro-CT imaging is the optimal technique for assessment of stone microstructure and mineral composition in a nondestructive fashion. Together, these tools have the potential to provide novel insights into the aetiology of stone formation that might unlock new prevention and treatment strategies, and enable more effective management of patients with nephrolithiasis.
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Khan SR, Gambaro G. Role of Osteogenesis in the Formation of Randall's Plaques. Anat Rec (Hoboken) 2015; 299:5-7. [PMID: 26414710 DOI: 10.1002/ar.23275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/01/2015] [Accepted: 08/19/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Saeed R Khan
- Departments of Pathology and Urology College of Medicine, University of Florida, Gainesville, Florida
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Columbus-Gemelli University Hospital Catholic University, School of Medicine, Rome, Italy
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Borofsky MS, Paonessa JE, Evan AP, Williams JC, Coe FL, Worcester EM, Lingeman JE. A Proposed Grading System to Standardize the Description of Renal Papillary Appearance at the Time of Endoscopy in Patients with Nephrolithiasis. J Endourol 2015; 30:122-7. [PMID: 26414908 DOI: 10.1089/end.2015.0298] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The appearance of the renal papillae in patients with nephrolithiasis can be quite variable and can range from entirely healthy to markedly diseased. The implications of such findings remain unknown. One potential reason is the lack of a standardized system to describe such features. We propose a novel grading scale to describe papillary appearance at the time of renal endoscopy. METHODS Comprehensive endoscopic renal assessment and mapping were performed on more than 300 patients with nephrolithiasis. Recurring abnormal papillary characteristics were identified and quantified based on degree of severity. RESULTS Four unique papillary features were chosen for inclusion in the PPLA scoring system- ductal Plugging, Pitting, Loss of contour, and Amount of Randall's plaque. Unique scores are calculated for individual papillae based on reference examples. CONCLUSIONS The description and study of renal papillary appearance in stone formers have considerable potential as both a clinical and research tool; however, a standardized grading system is necessary before using it for these purposes.
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Affiliation(s)
- Michael S Borofsky
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jessica E Paonessa
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Andrew P Evan
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James C Williams
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Fredric L Coe
- 3 Section of Nephrology, The University of Chicago , Chicago, Illinois
| | | | - James E Lingeman
- 1 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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Do kidney stone formers have a kidney disease? Kidney Int 2015; 88:1240-1249. [PMID: 26376133 PMCID: PMC4675687 DOI: 10.1038/ki.2015.254] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 12/13/2022]
Abstract
Nephrolithiasis is a highly prevalent disorder affecting approximately one in eleven people and is associated with multiple complications including hypertension, cardiovascular disease, and chronic kidney disease. Significant epidemiologic associations with chronic kidney disease and ESRD have been noted and are reviewed herein, but debate persists in the literature as to whether kidney stone formation is a pathogenic process contributing to kidney disease. Corroborating evidence supporting the presence of kidney disease in stone formers includes the variability of renal function by stone type, the positive association of stone size with renal dysfunction, the presence of markers of renal injury in the urine of even asymptomatic stone formers, and direct evidence of renal tissue injury on histopathology. Proposed pathogenic mechanisms include recurrent obstruction and comorbid conditions such as recurrent urinary tract infections and structural abnormalities. Recent work evaluating the renal histopathology of different groups of stone formers adds further granularity, suggesting variability in mechanisms of renal injury by stone type and confirming the pathogenic effects of crystal formation. Genetic abnormalities leading to stone formation including cystinuria and primary hyperoxaluria, among others, contribute to the burden of disease in the stone-forming population.
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Bhojani N, Paonessa JE, Hameed TA, Worcester EM, Evan AP, Coe FL, Borofsky MS, Lingeman JE. Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease. J Urol 2015; 194:1308-12. [PMID: 25988516 DOI: 10.1016/j.juro.2015.05.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Nephrocalcinosis is commonly present in primary hyperparathyroidism, distal renal tubular acidosis and medullary sponge kidney disease. To our knowledge it has not been studied in patients with calcium phosphate stones who do not have systemic disease. MATERIALS AND METHODS We studied patients undergoing percutaneous nephrolithotomy who had calcium phosphate or calcium oxalate stones and did not have hyperparathyroidism, distal renal tubular acidosis or medullary sponge kidney disease. On postoperative day 1 all patients underwent noncontrast computerized tomography. If there were no residual calcifications, the patient was categorized as not having nephrocalcinosis. If there were residual calcifications, the patient underwent secondary percutaneous nephrolithotomy. If the calcifications were found to be stones, the patient was categorized as not having nephrocalcinosis. If the calcifications were not stones, the patient was categorized as having nephrocalcinosis. Patients were grouped based on the type of stones that formed, including hydroxyapatite, brushite and idiopathic calcium oxalate. The extent of nephrocalcinosis was quantified as 0--absent nephrocalcinosis to 3--extensive nephrocalcinosis. Patients with residual calcifications on postoperative day 1 noncontrast computerized tomography who did not undergo secondary percutaneous nephrolithotomy were excluded from analysis. The presence or absence of nephrocalcinosis was correlated with metabolic studies. RESULTS A total of 67 patients were studied, including 14 with hydroxyapatite, 19 with brushite and 34 with idiopathic calcium oxalate calculi. Nephrocalcinosis was present in 10 of 14 (71.4%), 11 of 19 (57.9%) and 6 of 34 patients (17.6%) in the hydroxyapatite, brushite and idiopathic calcium oxalate groups, respectively (chi-square p = 0.01). The mean extent of nephrocalcinosis per group was 1.98, 1.32 and 0.18 for hydroxyapatite, brushite and idiopathic calcium oxalate, respectively (p ≤0.001). The presence of nephrocalcinosis positively correlated with urine calcium excretion (mean ± SD 287.39 ± 112.49 vs 223.68 ± 100.67 mg per day, p = 0.03). CONCLUSIONS Patients without systemic disease who form hydroxyapatite and brushite stones commonly have coexistent nephrocalcinosis. Nephrocalcinosis can occur in calcium oxalate stone formers but the quantity and frequency of nephrocalcinosis in this group are dramatically less.
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Affiliation(s)
- Naeem Bhojani
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jessica E Paonessa
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tariq A Hameed
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Fredric L Coe
- Department of Nephrology, University of Chicago, Chicago, Illinois
| | - Michael S Borofsky
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
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