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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2016 Jul 21

Advanced ureteroscopy for stone disease: characteristics of renal papillae in kidney stone formers

Tracy P. MARIEN, Nicole L. MILLER

Vanderbilt Medical Center, Department of Urologic Surgery, Nashville, USA

INTRODUCTION: The mechanism of kidney stone formation is not well understood. To better understand the pathophysiology for specific kidney stone compositions and systemic diseases associated with kidney stones, endoscopic papillary mapping studies with concurrent biopsies have been conducted. This review will summarize the findings of these studies and proposed mechanisms for thirteen disease processes associated with kidney stones.
EVIDENCE ACQUISITION: A review of the literature was performed identifying thirteen studies that endoscopically mapped and biopsied renal papillae of different stone formers. These studies characterized renal papillae based on amount of Randall’s plaque, Bellini duct pathology, papillary contour changes, presence of attached stones, pitting, and frequently papillary and cortical biopsies. The groups studied and reviewed here are kidney stone formers who have a history of idiopathic calcium oxalate stone formation, cystinuria, brushite stones, gastric bypass, ileostomy, small bowel resection, primary hyperparathyroidism, distal renal tubular acidosis (dRTA), primary hyperoxaluria, idiopathic calcium phosphate stone formation, medullary sponge kidney (MSK), uric acid stones, and struvite stones. A proposed standardized scoring system for papillary pathology was also reviewed.
EVIDENCE SYNTHESIS: The series showed various degrees and types of changes to the renal papillae and corresponding histopathologic changes for each type of stone former reviewed. Those with predominantly alone Randall’s plaque pathology had less tissue damage versus those with extensive Bellini duct lesions who had more interstitial fibrosis and cortical pathology. Randall’s plaques are associated with stone formers who have low urinary volume, high urinary calcium, and acidic urine and thus are frequently seen in those with brushite stones, primary hyperparathyroidism, small bowel resection, and idiopathic calcium phosphate stone formers. Bellini duct plugging and pathology is theorized to occur via free solution crystallization, ductal obstruction, inflammation, cellular injury, fibrosis, and acidification defects.
CONCLUSIONS: Ureteroscopic manifestations of stone disease can vary from normal appearing papillae to significantly diseased appearing papillae. Some diseases have very characteristic papillary changes.Further studies are necessary to fully elucidate the mechanisms of stone formation in patients with nephrolithiasis.

language: English


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