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

Abstract

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology (MP07)1 Sep 2021MP07-15 CALCIUM OXALATE STONE FORMERS WHO MAKE EVEN ONE STONE ON RANDALL'S PLAQUE HAVE SMALLER STONE BURDENS AND DISTINCTIVE PAPILLARY MINERAL PATHOLOGY James Williams, Haider Al-Awadi, Manognya Muthenini, Sharon Bledsoe, Tarek El-Achkar, Andrew Evan, Fredric Coe, Elaine Worcester, and James Lingeman James WilliamsJames Williams More articles by this author , Haider Al-AwadiHaider Al-Awadi More articles by this author , Manognya MutheniniManognya Muthenini More articles by this author , Sharon BledsoeSharon Bledsoe More articles by this author , Tarek El-AchkarTarek El-Achkar More articles by this author , Andrew EvanAndrew Evan More articles by this author , Fredric CoeFredric Coe More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001980.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The purpose of this study was to compare idiopathic calcium oxalate stone formers with (RP) and without (Non-RP) positive evidence for formation of stones on Randall’s (interstitial) plaque. METHODS: Patients undergoing stone removal by percutaneous (PNL) or ureteroscopic (URS) endoscopy were consented for study. Included patients had stone analysis of >50% calcium oxalate, with no brushite, medullary sponge, bariatric surgery, primary hyperoxaluria or hyperparathyroidism. all stone material was imaged by micro CT and stones growing on Randall’s plaque were identified by adherent regions of apatite that showed characteristics of calcified tissue (including lumens of vessels/tubules in 76% of the cases). Endoscopic papillary appearance was graded and measured on endoscopic video by an investigator blinded to the patient classification. RESULTS: 32 RP patients had on average 5±6 stones on Randall’s plaque, with none in the 42 Non-RP patients. The RP group was younger (48±17 v 56±14, p=0.04), had more stones (8±8 v 5±4 stones/kidney, p=0.02), less total stone removed (80±120 v 480±1200 cubic mm/kidney), and smaller stones (160±230 v 560±1200 cubic mm per stone, p=0.01) than did Non-RP patients, and RP were more likely to have undergone URS. RP had on average 240% more Randall's plaque area (5.2±4.3 v 1.5±1.7 as percent of papilla area, p <0.0001) and 77% less ductal plugging area (0.17±0.38 v 0.73±0.77, p <0.0001). In semi-quantitative scores, RP had more plaque and pitting, less plugging/dilated ducts, and less loss of papillary contour (figure 1). 24-hour urine values did not differ between RP and Non-RP on any measure. CONCLUSIONS: Calcium oxalate stone formers who showed positive evidence of having even a single stone on plaque had small stone burdens and were more likely to have undergone URS. Their renal papillae showed much more plaque and much less ductal plugging than the Non-RP group. These data support RP as a distinct phenotype among calcium oxalate stone formers. Source of Funding: NIH P01 DK056788; NIH R01 DK124776 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e145-e145 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Williams More articles by this author Haider Al-Awadi More articles by this author Manognya Muthenini More articles by this author Sharon Bledsoe More articles by this author Tarek El-Achkar More articles by this author Andrew Evan More articles by this author Fredric Coe More articles by this author Elaine Worcester More articles by this author James Lingeman More articles by this author Expand All Advertisement Loading ...