PD03-06 PLAQUE, PITTING, CONTOUR LOSS - A PATHOGENETIC SEQUENCE IN RENAL PAPILLAE OF IDIOPATHIC CALCIUM STONE FORMERS

Abstract

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology I1 Apr 2018PD03-06 PLAQUE, PITTING, CONTOUR LOSS - A PATHOGENETIC SEQUENCE IN RENAL PAPILLAE OF IDIOPATHIC CALCIUM STONE FORMERS Melanie Adamsky, Andrew Cohen, Christopher Riedinger, Glenn Gerber, Elaine Worcester, and Frederic Coe Melanie AdamskyMelanie Adamsky More articles by this author , Andrew CohenAndrew Cohen More articles by this author , Christopher RiedingerChristopher Riedinger More articles by this author , Glenn GerberGlenn Gerber More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , and Frederic CoeFrederic Coe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.272AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal papillary abnormalities are thought to have deeper roots in renal physiology and stone pathogenesis. A unifying hypothesis is that Randall′s plaque (RP) production is continuous, plaque loss gives rise to pitting, and this loss of tissue gives rise to changes in papillary contour (Figure 1). We have tested these predictions in a cohort of idiopathic calcium stone formers (ICSF). METHODS A previously described renal papillary grading system, which quantifies the degree of RP, pitting, plugging, and contour on each papillum, was applied to ICSF during ureteroscopy. We performed 2x2 table analysis of relationships between the scores for each papillary feature at the level of the papillum and the level of the kidney. Finally, we calculated mean scores for each feature by kidney and used Pearson correlation coefficients to measure relationships between features at the kidney level. RESULTS 85 patients were included with a total of 361 papillae graded. In table analysis of pitting scores by plaque scores, values deviated powerfully from chance (X2=63.997, p<0.00001). Increasing plaque scores were associated with decreasing percentage of pitting score zero. The presence of plaque without pitting is more often seen than pitting without plaque. A similar but less pronounced relationship was seen in the analysis of contour loss by pitting scores (X2= 35.9461, p=0.0029). Furthermore, contour loss and plaque scores showed a very strong relationship (X2 = 57.2033, p<0.00001). Results of the papillum-level analysis are summarized in Figure 2. At the level of the kidney, the strongest relationship exists between mean RP and mean contour scores (rp=0.4630, p=0.0003). CONCLUSIONS These data support our critical hypothesis that RP and attached calcium stone complex are shed from the papillum leaving behind a pitting defect on the papillary surface, which can then either heal over or, with repeated insult, progress to loss of papillary contour. We believe that understanding this sequence helps link renal physiology to a urologic endpoint. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e72-e73 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Melanie Adamsky More articles by this author Andrew Cohen More articles by this author Christopher Riedinger More articles by this author Glenn Gerber More articles by this author Elaine Worcester More articles by this author Frederic Coe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...