Renal Intratubular Crystals and Hyaluronan Staining Occur in Stone Formers with Bypass Surgery but not with Idiopathic Calcium Oxalate Stones

Abstract

Whether idiopathic calcium oxalate (CaOx) stone formers form inner medullary collecting duct (IMCD) crystal deposits bears on pathogenetic mechanisms of stone formation. In prior work, using light and transmission electron microscopy, we have found no IMCD crystal deposits. Here, we searched serial sections of papillary biopsies from a prior study of 15 idiopathic calcium oxalate stone formers, 4 intestinal bypass patients with CaOx stones, and 4 non-stone-forming subjects, and biopsies from an additional hitherto unreported 15 idiopathic calcium oxalate stone formers and 1 bypass patient using polarized light oil immersion optics, for deposits overlooked in our original study. We found no IMCD deposits in any of 1,500 serial sections from the 30 idiopathic calcium oxalate stone formers, nor in 87 additional sections from a frozen idiopathic calcium oxalate stone former biopsy sample processed without exposure to aqueous solutions. Among 4 of the 5 bypass patients but in none of the 30 idiopathic calcium oxalate stone formers or 4 normal stone formers, we found tiny birefringent thin crystalline overlays on scattered IMCD cell membranes. We also found IMCD lumen deposits in two bypass patients that contained mixed birefringent and nonbirefringent crystals, presumably CaOx and apatite. In the bypass patients, we observed focal apical IMCD cell hyaluronan staining, which was absent in idiopathic calcium oxalate stone formers. The absence of any IMCD deposits in 1,500 serial sections of biopsies from 30 idiopathic calcium oxalate stone formers allows us to place the upper limit on the probability of their occurrence at approximately 0.002 and place the lower limit of their size at the resolution of the optics (<0.2 m). The tiny deposits in bypass patients may be the initial crystal lesion.

Pathogenic Variants of Urolithiasis

“…Говоря о непосредственном механизме форми-рования камня согласно «бляшечному» механизму, необходимо отметить, что ранняя стадия формиро-вания бляшек берет начало на базальной мембране тонкого нисходящего сегмента петли Генле с фор-мирования микросферулитов (с или без включения кристаллов ГА) [10], где они сливаются и формиру-ют единый матрикс, в котором кристаллы гидрок-сиапатита располагаются в виде изолированных «островков». На следующем этапе формирования бляшки последняя, увеличиваясь в размерах между канальцами и сосудами, примыкает к сосочковому эпителию.…”

“…У пациентов с ГА-и БР-конкрементами почти всегда видны за-глушки, так же как они могут быть и у пациентов с илеостомией или первичным гиперпаратиреозом. У пациентов с дистальным канальцевым почечным ацидозом после резекции тонкой кишки, с ожире-нием, шунтированием, цистинурией и первичной гипероксалурией 1-го типа [27,10] также можно на-блюдать заглушки, но реже.…”

“…• рост конкрементов над «белыми» интерстици-альными гидроксиапатитными бляшками, или бляшками Рэндалла [7,10,11,22];…”

Renal Stone Disease: A Commentary on the Nature and Significance of Randall’s Plaque

“…It is the ICSF group, and only this group, that closely matches the observations of Randall [7] . To date, biopsies from 30 ICSF individuals have been reported using a variety of fixation techniques [7,8] . Digital endoscopic examination of the renal papillae of ICSF patients clearly show irregular whitish regions, usually near the papillary tip, on most, if not all, papillae; these are the deposits Randall observed with a hand lens and called papillary type 1 lesions.…”

Üriner Sistem Taş Hastalığında Randal Plaklarının Önemi

“…Evan ve ark. 'larının gözlemlerine göre de; plak subepitelyal yerleşimliydi ve dokuya yapışık taşın alınmasından dolayı oluşan çukur bölge hariç pürüzsüz bir dış yüzeye sahipti (7). Yasue yöntemi ile boyalı papiller biyopsi materyalinin, ışık mikroskopi incelemesi minerallerin ilk toplandığı yerin Henle ince kolunun bazal membranı altındaki özel bir böl-gede olduğu ortaya konulmuştur.…”