Skip to main content
SpringerLink
Log in

High frequency and wide range of human kidney papillary crystalline plugs

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

Most of kidney stones are supposed to originate from Randall’s plaque at the tip of the papilla or from papillary tubular plugs. Nevertheless, the frequency and the composition of crystalline plugs remain only partly described. The objective was to assess the frequency, the composition and the topography of papillary plugs in human kidneys. A total of 76 papillae from 25 kidneys removed for cancer and without stones were analysed by immunohistochemistry combined with Yasue staining, field emission-scanning electron microscopy and Fourier transformed infrared micro-spectroscopy. Papillary tubular plugs have been observed by Yasue staining in 23/25 patients (92%) and 52/76 papillae (68%). Most of these plugs were made of calcium phosphate, mainly carbonated apatite and amorphous calcium phosphate, and rarely octacalcium phosphate pentahydrate. Calcium and magnesium phosphate (whitlockite) have also been observed. Based upon immunostaining coupled to Yasue coloration, most of calcium phosphate plugs were located in the deepest part of the loop of Henle. Calcium oxalate monohydrate and dihydrate tubular plugs were less frequent and stood in collecting ducts. At last, we observed calcium phosphate plugs deforming and sometimes breaking adjacent collecting ducts. Papillary tubular plugging, which may be considered as a potential first step toward kidney stone formation, is a very frequent setting, even in kidneys of non-stone formers. The variety in their composition and the distal precipitation of calcium oxalate suggest that plugs may occur in various conditions of urine supersaturation. Plugs were sometimes associated with collecting duct deformation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Trinchieri A (2006) Epidemiological trends in urolithiasis: impact on our health care systems. Urol Res 34:151–156

    Article  PubMed  Google Scholar 

  2. Denstedt JD, Fuller A (2012) Epidemiology of stone disease in North America. In: Talati JJ, Tiselius H-G, Albala DM, YE Z (eds) Urolithiasis. Springer, London, pp 13–20

    Chapter  Google Scholar 

  3. Hesse A, Brändle E, Wilbert D et al (2003) Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 44:709–713

    Article  PubMed  CAS  Google Scholar 

  4. Ogawa Y (2012) Epidemiology of stone disease over a 40-year period in Japan. In: Talati JJ, Tiselius H-G, Albala DM, YE Z (eds) Urolithiasis. Springer, London, pp 89–96

    Chapter  Google Scholar 

  5. Coe FL, Evan AP, Worcester EM et al (2010) Three pathways for human kidney stone formation. Urol Res 38:147–160

    Article  PubMed  PubMed Central  Google Scholar 

  6. Randall A (1937) The origin and growth of renal calculi. Ann Surg 105:1009–1027

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Evan AP, Lingeman JE, Coe FL et al (2003) Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loop of Henle. J Clin Invest 111:607–616

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Low RK, Stoller ML (1997) Endoscopic mapping of renal papillae for Randall’s plaques in patients with urinary stone disease. J Urol 158:2062–2064

    Article  PubMed  CAS  Google Scholar 

  9. Linnes MP, Krambeck AE, Cornell L et al (2013) Phenotypic characterization of kidney stone formers by endoscopic and histological quantification of intrarenal calcification. Kidney Int 84:818–825

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Coe FL, Evan AP, Lingeman JE, Worcester EM (2010) Plaque and deposits in nine human stone diseases. Urol Res 38:239–247

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kuo RL, Lingeman JE, Evan AP et al (2003) Urine calcium and volume predict coverage of renal papilla by Randall’s plaque. Kidney Int 64:2150–2154

    Article  PubMed  Google Scholar 

  12. Evan AP, Lingeman J, Coe F et al (2007) Renal histopathology of stone-forming patients with distal renal tubular acidosis. Kidney Int 71:795–801

    Article  PubMed  CAS  Google Scholar 

  13. Verrier C, Bazin D, Huguet L et al (2016) Topography, composition and structure of incipient Randall plaque at the nanoscale level. J Urol 196:1566–1574

    Article  PubMed  Google Scholar 

  14. Khan SR (2004) Role of renal epithelial cells in the initiation of calcium oxalate stones. Nephron Exp Nephrol 98:e55–e60

    Article  PubMed  CAS  Google Scholar 

  15. Khan SR, Hackett RL (1991) Retention of calcium oxalate crystals in renal tubules. Scanning Microsc 5:707–711

    PubMed  CAS  Google Scholar 

  16. Meria P, Hadjadj H, Jungers P et al (2010) Stone formation and pregnancy: pathophysiological insights gained from morphoconstitutional stone analysis. J Urol 183:1412–1416

    Article  PubMed  Google Scholar 

  17. Maurice-Estepa L, Levillain P et al (1999) Crystalline phase differentiation in urinary calcium phosphate and magnesium phosphate calculi. Scand J Urol Nephrol 33:99–305

    Article  Google Scholar 

  18. Carpentier X, Daudon M, Traxer O et al (2009) Relationships between carbonation rate of carbapatite and morphologic characteristics of calcium phosphate stones and etiology. Urology 73:968–975

    Article  PubMed  Google Scholar 

  19. Daudon M, Bazin D (2016) Vibrational spectroscopies to investigate concretions and ectopic calcifications for medical diagnosis. C R Chimie 19:1416–1423

    Article  CAS  Google Scholar 

  20. Evan AP, Lingeman JE, Worcester EM et al (2014) Contrasting histopathology and crystal deposits in kidneys of idiopathic stone formers who produce hydroxy apatite, brushite, or calcium oxalate stones. Anat Rec 297:731–748

    Article  CAS  Google Scholar 

  21. Tournus M, Seguin N, Perthame B et al (2013) A model of calcium transport along the rat nephron. Am J Physiol Renal Nephrol 305:F979–F994

    Article  CAS  Google Scholar 

  22. Khan SR, Glenton PA (2008) Calcium oxalate crystal deposition in kidneys of hypercalciuric mice with disrupted type IIa sodium–phosphate cotransporter. Am J Physiol Renal Physiol 294:F1109–F1115

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Khan SR (2017) Histological aspects of the “fixed-particle” model of stone formation in animal studies. Urolithiasis 45:75–87

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155, 75020, Paris, France

    Léa Huguet, Marine Le Dudal, Marine Livrozet, Joëlle Perez, Jean-Philippe Haymann, Michel Daudon & Emmanuel Letavernier

  2. INSERM, UMR S 1155, 75020, Paris, France

    Léa Huguet, Marine Le Dudal, Marine Livrozet, Joëlle Perez, Jean-Philippe Haymann, Michel Daudon & Emmanuel Letavernier

  3. CNRS, Laboratoire de Chimie de la Matière Condensée de Paris, UPMC, Collège de France, Paris, France

    Dominique Bazin

  4. Laboratoire de Physique des Solides, CNRS UMR 8502, Université Paris Sud XI, 91405, Orsay, France

    Dominique Bazin

  5. Physiology Unit, AP-HP, Hôpital Tenon, 75020, Paris, France

    Vincent Frochot, Jean-Philippe Haymann, Michel Daudon & Emmanuel Letavernier

  6. Pathology Unit, AP-HP, Hôpital Tenon, 75020, Paris, France

    Isabelle Brocheriou

  7. Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital TENON, 4 rue de la Chine, 75020, Paris, France

    Emmanuel Letavernier

Authors
  1. Léa Huguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marine Le Dudal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marine Livrozet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dominique Bazin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent Frochot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joëlle Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Philippe Haymann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Isabelle Brocheriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michel Daudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Emmanuel Letavernier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emmanuel Letavernier.

Ethics declarations

Funding

This work has been supported by the Agence Nationale de la Recherche (ANR-13-JSV1-0010-01, ANR-12-BS08-0022), the Société de Néphrologie (Genzyme Grant), the Académie Nationale de Médecine (Nestlé-Waters award), Convergence-UPMC CVG1205 and CORDDIM-2013-COD130042.

Conflict of interest

All authors declare to have no conflict of interest.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huguet, L., Le Dudal, M., Livrozet, M. et al. High frequency and wide range of human kidney papillary crystalline plugs. Urolithiasis 46, 333–341 (2018). https://doi.org/10.1007/s00240-017-1031-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-017-1031-9

Keywords

Search

Navigation