2075 characteristics and metabolic correlations of a novel interstitial deposit in patients who form hydroxy-apatite stones

You have accessJournal of UrologyStone Disease: Basic Research I1 Apr 20122075 CHARACTERISTICS AND METABOLIC CORRELATIONS OF A NOVEL INTERSTITIAL DEPOSIT IN PATIENTS WHO FORM HYDROXY-APATITE STONES Andrew Evan, James Lingeman, Fredric Coe, Andre Sommer, James Williams, and Elaine Worcester Andrew EvanAndrew Evan Indianapolis, IN More articles by this author , James LingemanJames Lingeman Indianapolis, IN More articles by this author , Fredric CoeFredric Coe Chicago, IL More articles by this author , Andre SommerAndre Sommer Oxford, OH More articles by this author , James WilliamsJames Williams Indianapolis, IN More articles by this author , and Elaine WorcesterElaine Worcester Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2241AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our group has previously characterized the histopathology, surgical anatomy and physiology in brushite patients, a type of calcium phosphate stone former (SF). The purpose here is to describe a new kind of crystal deposit as well as the histopathology and metabolic correlates in SF patients with predominately hydroxy-apatite (without brushite) renal stones. METHODS Ten SF patients (8 females and 2 males) with kidney stones containing greater than 50% hydroxy-apatite were studied using digital video imaging of renal papillae, and obtained cortical and papillary biopsies at the time of stone removal by PCNL. Biopsies were analyzed by light and electron microscopy and micro-infrared spectroscopy. RESULTS All ten patients showed intra-luminal apatite plugs which varied in number from minimal to marked. Two patients possessed dilated ducts of Bellini with an attached apatite stone noted on a protruding plug. Five of ten patients possessed a new type of interstitial deposit termed, novel interstitial plaque structure (NIPS). NIPS appear as irregular randomly distributed laminar deposits of interstitial crystals and plaque, as compared to Randall's plaque which is characterized by micro-spherules embedded in the basement membrane of thin loops of Henle or a sea of interstitial matrix. NIPS was not observed extending to the basal surface of papillary epithelium as is common for Randall's plaque. Five of ten patients showed sites of Randall's plaque but no NIPS. NIPS and Randall's plaque never occurred in the same papillary biopsy. CONCLUSIONS Clinically, idiopathic calcium phosphate SF do not seem to differ from those with brushite stones. Both share in common tubule apatite plugging; however; brushite SF have Randall's plaque while calcium phosphate SF without brushite have either sites of Randall's plaque or NIPS. NIPS may not reflect the pathophysiology of stone formation but the consequence of stones and their treatment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAssimos D (2020) Re: Evidence for Disordered Acid-Base Handling in Calcium Stone-Forming PatientsJournal of Urology, VOL. 203, NO. 5, (875-875), Online publication date: 1-May-2020. Volume 187Issue 4SApril 2012Page: e836-e837 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Evan Indianapolis, IN More articles by this author James Lingeman Indianapolis, IN More articles by this author Fredric Coe Chicago, IL More articles by this author Andre Sommer Oxford, OH More articles by this author James Williams Indianapolis, IN More articles by this author Elaine Worcester Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...