Abstract
This study provides the largest radiographic investigation of the Randall's plaque and the authors are to be commended for this contribution. However, at present, its clinical role as it relates to acute and long-term patient management, remains elusive. As has been demonstrated by previous investigators, the association of Randall's plaques with calcium stones is a solid one. 1 Matlaga B.R. Coe F.L. Evan A.P. Lingeman J.E. The role of Randall's plaques in the pathogenesis of calcium stones. J Urol. 2007; 177: 31-38 Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar , 2 Evan A.P. Coe F.L. Lingeman J.E. et al. Mechanism of formation of human calcium oxalate renal stones on Randall's plaque. Anat Rec (Hoboken). 2007; 290: 1315-1323 Crossref PubMed Scopus (155) Google Scholar Could we as clinicians make use of the radiographic correlates established in this study to guide our understanding of stone composition in patients presenting to the emergency room with renal colic or in those who have not yet passed a stone that can be analyzed? Could this CT appearance eliminate the need for, or at a bare minimum, compliment the chemical analysis of the urine in certain patients? This is certainly a possibility that can and should be explored in future studies. Although this study sets the foundation for the radiographic determination of stone composition, there is much opportunity for additional investigation. We are likely not far away from an in situ determination of stone composition by a radiography-based crystallographic analysis, and the “one stop shop” for all your stone needs may be nigh. 3 Williams Jr., J.C. McAteer J.A. Evan A.P. Lingeman J.E. Micro-computed tomography for analysis of urinary calculi. Urol Res. 2010; 38: 477-484 Crossref PubMed Scopus (60) Google Scholar , 4 Fung G.S. Kawamoto S. Matlaga B.R. et al. Differentiation of kidney stones using dual-energy CT with and without a tin filter. AJR Am J Roentgenol. 2012; 198: 1380-1386 Crossref PubMed Scopus (30) Google Scholar Validation of Randall's Plaque Theory Using Unenhanced Abdominal Computed TomographyUrologyVol. 81Issue 2PreviewTo determine whether nephrolithiasis is associated with radiographic changes in renal papillae. Full-Text PDF ReplyUrologyVol. 81Issue 2PreviewThe Randall plaques might have an important role in the non-invasive diagnosis of stone disease. It is already known that there is a strong correlation between the presence of Randall plaques and calcium stones.1,2 Our study further confirms that Randall plaques can be identified in unenhanced abdominal CT images. Nonetheless the simple presence of the Randall plaques in patients with active stone disease is not a clear indicator of calcium composition of stones. On the other hand, the same CT images that can identify the Randall plaques can bring valuable information about the stone composition. Full-Text PDF
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