Abstract
Several previous studies have reported an increase in Hounsfield unit density of the renal papillae in patients with nephrolithiasis compared with controls. Kidney stone formers (KSF) were found to have higher papillary and cortical density in both kidneys, irrespective of which side had calculi, and it was proposed that this might be related to the presence of underlying hypercalciuria. The current study was designed: (1) to determine whether recurrent KSF do have higher papillary density compared with healthy controls; (2) to test an association between higher renal papillary density and the presence of hypercalciuria in KSF. This retrospective case-matched controlled study was carried out at the Royal Free Hospital, London, UK. We investigated 111 patients, 57 of whom were KSF and 54 healthy controls. The CT attenuation values were measured within a 0.2 cm2 area of the renal papilla in the upper, middle, and lower segments of each kidney, and were compared between KSF and non-stone formers, and between KSF with and without hypercalciuria. There were no significant differences in age and sex between groups. Papillary density was significantly higher in KSF by both crude and adjusted analyses (p < 0.001). However, there was no association between higher papillary density and hypercalciuria in KSF. The papillary density measured by CT is a useful, non-invasive tool to differentiate between KSF and healthy controls. The absence of any correlation between papillary density and hypercalciuria suggests that the presence of clinically significant underlying renal stone disease, rather than urinary metabolic abnormalities, correlates with radiologically detectable increased papillary density.
Similar content being viewed by others
References
Evan AP, Unwin RJ, Williams JC (2011) Renal stone disease: a commentary on the nature and significance of Randall’s plaque. Nephron Physiol 119(4):49–53
Evan A, Lingeman J, Coe FL, Worcester E (2006) Randall’s plaque: pathogenesis and role in calcium oxalate nephrolithiasis. Kidney Int 69:1313
Bhuskute NM, Yap WW, Wah TM (2009) A retrospective evaluation of Randall’s plaque theory of nephrolithiasis with CT attenuation values. Eur J Radiol 72(3):470–472
Eisner BH, Iqbal A, Namasivayam S, Catalano O, Kambadakone A, Dretler SP et al (2008) Differences in computed tomography density of the renal papillae of stone formers and non-stone-formers: a pilot study. J Endourol 22(10):2207–2210
Baran I, Voyvoda N, Tokgöz Ö, Tokgöz H (2012) Can Hounsfield unit values of the cortex and papillae determined by computed tomography demonstrate the possibility of kidney stone formation? Eur J Radiol 81(7):1446–1449
Ciudin A, Luque MP, Salvador R, Diaconu MG, Franco A, Collado-Belvis A et al (2014) The evolution of CT diagnosed papillae tip microcalcifications: can we predict the development of stones? J Endourol 28(8):1016–1021
Ciudin A, Luque MP, Salvador R, Diaconu MG, Franco A, Constantin V et al (2013) Abdominal computed tomography–a new tool for predicting recurrent stone disease. J Endourol 27(8):965–969
Ciudin A, Luque Galvez MP, Salvador Izquierdo R, Diaconu MG, de Castro AF, Constantin V et al (2013) Validation of Randall’s plaque theory using unenhanced abdominal computed tomography. Urology 81(2):246–249
Linnes MP, Krambeck AE, Cornell L, Williams JC Jr, Korinek M, Bergstralh EJ et al (2013) Phenotypic characterization of kidney stone formers by endoscopic and histological quantification of intrarenal calcification. Kidney Int 84(4):818–825
MacIsaac R, Panagiotopoulos S, McNeil K, Smith T, Tsalamandris C, Hao H et al (2006) Is nonalbuminuric renal insufficiency in type 2 diabetes related to an increase in intrarenal vascular disease? Diabet Care 29:1560–1566
MacIsaac RJ, Thomas MC, Panagiotopoulos S, Smith TJ, Hao H, Matthews DG et al (2008) Association between intrarenal arterial resistance and diastolic dysfunction in type 2 diabetes. Cardiovasc Diabetol 23(7):15
McCarty MF, DiNicolantonio JJ (2014) The molecular biology and pathophysiology of vascular calcification. Postgrad Med 126(2):54–64
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest.
Disclosure
We declare that the manuscript is original research, has not been previously published and has not been submitted for publication elsewhere while under consideration. It has been seen and approved by all authors.
Rights and permissions
About this article
Cite this article
Shavit, L., Girfoglio, D., Kirkham, A. et al. Increased renal papillary density in kidney stone formers detectable by CT scan is a potential marker of stone risk, but is unrelated to underlying hypercalciuria. Urolithiasis 44, 471–475 (2016). https://doi.org/10.1007/s00240-016-0873-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-016-0873-x