Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease

James C Williams, Michael S Borofsky, Sharon B Bledsoe, Andrew P Evan, Fredric L Coe, Elaine M Worcester, James E Lingeman

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique.

MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue.

RESULTS: A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall's plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite.

CONCLUSIONS: Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.

OriginalsprogEngelsk
TidsskriftJournal of Urology
Vol/bind199
Udgave nummer1
Sider (fra-til)186-192
ISSN0022-5347
DOI
StatusUdgivet - 1. jan. 2018
Udgivet eksterntJa

Fingeraftryk

Kidney
Growth
Minerals

Citer dette

Williams, J. C., Borofsky, M. S., Bledsoe, S. B., Evan, A. P., Coe, F. L., Worcester, E. M., & Lingeman, J. E. (2018). Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease. Journal of Urology, 199(1), 186-192. https://doi.org/10.1016/j.juro.2017.08.063
Williams, James C ; Borofsky, Michael S ; Bledsoe, Sharon B ; Evan, Andrew P ; Coe, Fredric L ; Worcester, Elaine M ; Lingeman, James E. / Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease. I: Journal of Urology. 2018 ; Bind 199, Nr. 1. s. 186-192.
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title = "Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease",
abstract = "PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique.MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue.RESULTS: A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall's plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite.CONCLUSIONS: Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.",
keywords = "calcium phosphate, collecting, dibasic, dihydrate, etiology, kidney calculi, kidney tubules, tomography, x-ray computed",
author = "Williams, {James C} and Borofsky, {Michael S} and Bledsoe, {Sharon B} and Evan, {Andrew P} and Coe, {Fredric L} and Worcester, {Elaine M} and Lingeman, {James E}",
note = "Copyright {\circledC} 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "1",
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Williams, JC, Borofsky, MS, Bledsoe, SB, Evan, AP, Coe, FL, Worcester, EM & Lingeman, JE 2018, 'Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease', Journal of Urology, bind 199, nr. 1, s. 186-192. https://doi.org/10.1016/j.juro.2017.08.063

Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease. / Williams, James C; Borofsky, Michael S; Bledsoe, Sharon B; Evan, Andrew P; Coe, Fredric L; Worcester, Elaine M; Lingeman, James E.

I: Journal of Urology, Bind 199, Nr. 1, 01.01.2018, s. 186-192.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease

AU - Williams, James C

AU - Borofsky, Michael S

AU - Bledsoe, Sharon B

AU - Evan, Andrew P

AU - Coe, Fredric L

AU - Worcester, Elaine M

AU - Lingeman, James E

N1 - Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique.MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue.RESULTS: A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall's plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite.CONCLUSIONS: Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.

AB - PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique.MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth and attachment to renal tissue.RESULTS: A total of 25 intact brushite stones were removed from 8 patients and analyzed. Video confirmed attachment of 13 of the 25 stones with the remainder believed to have been accidently dislodged during the procedure. Microscopic examination by light and computerized tomography failed to show evidence of Randall's plaque associated with any stone containing brushite. Conversely each brushite stone demonstrated microstructural evidence of having grown attached to a ductal plug formed of apatite.CONCLUSIONS: Three-dimensional analysis of small brushite stones suggests overgrowth on ductal apatite plugs as a mechanism of early stone growth and retention. Such findings represent what is to our knowledge the initial supporting evidence for a novel mechanism of stone formation which has previously been hypothesized but never verified.

KW - calcium phosphate

KW - collecting

KW - dibasic

KW - dihydrate

KW - etiology

KW - kidney calculi

KW - kidney tubules

KW - tomography

KW - x-ray computed

U2 - 10.1016/j.juro.2017.08.063

DO - 10.1016/j.juro.2017.08.063

M3 - Journal article

C2 - 28822796

VL - 199

SP - 186

EP - 192

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -