Abstract
BackgroundOur purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis.MethodsThis prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall’s plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher’s exact test and Student’s t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant.ResultsThe most common injury was tubular calcification (78%), followed by Randall’s plaque (58%), and papillary crater (39%). There was no significant relationship of Randall’s plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall’s plaque with hypocitraturia (p = 0.005).ConclusionsThere are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall’s plaque.
Highlights
Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis
Because the urine is always supersaturated with calcium oxalate, a calcium oxalate monohydrate (COM) calculus will form when there is a deficiency of crystallization inhibitors and/or an alteration of the immune system
There were significant relationships of endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) with type of stone, in that calcium oxalate dihydrate (COD) and calcium phosphate stones were more common in both groups (Tables 2 and 3)
Summary
Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis. Because the interstitial fluid has a pH of 7.4, and is always supersaturated with calcium phosphate, cellular detritus or oxidized cellular collagen can act as a heterogeneous nucleant, leading to the deposit of hydroxyapatite (HAP) If this deposit grows enough to break through the epithelium that covers the papilla, it can contact the urine. Stones can form when there is intratubular injury of the Bellini ducts and urine supersaturation, in which there are large amounts of calcium oxalate dihydrate (COD) and/or HAP crystals In this case, obstruction of the collecting tubules and deposits that form in the most distal part of the tubule, upon contacting the urine, generate the renal calculi [3,4,5]
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