Kidney stone growth 'rings' visualized using micro ct and fluorescence microscopy: similarities in growth of randall's plaque calcium oxalate stones from the same kidneys

You have accessJournal of UrologyCME1 Apr 2023MP05-20 KIDNEY STONE GROWTH ‘RINGS’ VISUALIZED USING MICRO CT AND FLUORESCENCE MICROSCOPY: SIMILARITIES IN GROWTH OF RANDALL’S PLAQUE CALCIUM OXALATE STONES FROM THE SAME KIDNEYS Emily Wachter, Angela Sabo, Tarek El-Achkar, Elaine Worcester, James Lingeman, and James Williams Emily WachterEmily Wachter More articles by this author , Angela SaboAngela Sabo More articles by this author , Tarek El-AchkarTarek El-Achkar More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , James LingemanJames Lingeman More articles by this author , and James WilliamsJames Williams More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent work has shown that mechanisms of stone growth can be demonstrated at the microscopic level using fluorescence microscopy. The objective here was to study multiple stones to observe patterns of mineral and organic deposition within and between patients. METHODS: Stones were removed by basket during endoscopic procedure, and a total of 12 stones were studied from 3 patients. All stones were verified by micro CT as having grown on Randall’s plaque by residue visible on the stone. Each stone was mounted on polystyrene and ground down to reveal a planar surface inside the stone. The stone was then imaged using confocal microscopy (Leica SP8) with a water immersion lens (20x, 0.75 NA). Each stone was ground repeatedly to collect as many interior planes as possible, with micro CT verification of each plane of section and mineral regions exposed. RESULTS: Within a patient, similarities of layering (both thickness and color) were apparent in stones from the same kidney, but stones from different patients had different fluorescent features. Several stones showed evidence of episodic growth by deposition of aggregates of calcium oxalate dihydrate crystals, and these stones with evidence of dihydrate aggregates tended to be larger stones within a given patient. Regions of apatite adjacent to Randall’s plaque showed yellow fluorescence distinctly different from apatite in later stone overgrowth. CONCLUSIONS: The unique fluorescence of apatite laid down as the first overgrowth on Randall’s plaque is suggestive of special urine molecules deposited at the initiation of stone growth. Outside of this consistent finding, fluorescent molecules laid down with mineral in calcium oxalate stones are not universal among patients, but stones from the same kidney showed similar fluorescence patterns. Source of Funding: NIH R01 DK124776, NIH P01 DK056788 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e52 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Wachter More articles by this author Angela Sabo More articles by this author Tarek El-Achkar More articles by this author Elaine Worcester More articles by this author James Lingeman More articles by this author James Williams More articles by this author Expand All Advertisement PDF downloadLoading ...