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Review
. 2017 Feb;45(1):19-25.
doi: 10.1007/s00240-016-0944-z. Epub 2016 Dec 2.

What can the microstructure of stones tell us?

James C Williams Jr  1 , Elaine Worcester  2 , James E Lingeman  3
Affiliations
Review

What can the microstructure of stones tell us?

James C Williams Jr et al. Urolithiasis. 2017 Feb.

Abstract

How stones are retained within the kidney while small in size is still not fully understood. In this paper, we show two examples of how stones are retained during early growth: one is growth on Randall's (interstitial) plaque, and the other is growth on mineral that has formed as a luminal plug in a terminal collecting duct. These two mechanisms of stone retention during early growth have distinctive morphologic features that can be seen by methods that show the microscopic structure of the stones. Stones growing on Randall's plaque display an apatite region that is typically not large in size (<0.5 mm across) but which usually shows luminal spaces, which are signs of its origin in the connective tissue of the papilla. Stones growing on ductal plugs also show attachment to a piece of apatite, but the apatite regions are typically larger (often >1 mm long and >0.5 mm wide), and they are solid, without spaces running through them. We propose that knowing the mechanisms of stone retention during early stone formation could allow for better treatment of stone diseases.

Keywords: Imaging; Nephrolithiasis.

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Conflict of interest statement

none

Figures

Figure 1
Figure 1
Stone growing on Randall’s plaque, plucked from the papilla of a patient during ureteroscopic removal of renal stones. Photo, top, on mm paper. Left: Micro CT slice of stone. Right: Surface rendering of micro CT image stack. COM: calcium oxalate monohydrate. COD: calcium oxalate dihydrate.
Figure 2
Figure 2
Stone growing on apparent ductal plug, plucked from the papilla of a patient during ureteroscopic removal of renal stones. Photo, center, on mm paper. Left: Micro CT slice of stone. Right: Surface rendering of micro CT image stack. CaOx: calcium oxalate.
Figure 3
Figure 3
Stones from a percutaneous procedure that show no sign of any known mechanism of retention during early growth. Background shows micro CT slice through one of the stones; the lighter region in the center of the stone was COM by FT-IR, so the stones appear to be pure COM.
See this image and copyright information in PMC

References

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