Distinguishing characteristics of idiopathic calcium oxalate kidney stone formers with low amounts of randall’s plaque

Xiangling Wang, Amy E. Krambeck, James C. Williams, Xiaojing Tang, Andrew D. Rule, Fang Zhao, Eric Bergstralh, Zejfa Haskic, Samuel Edeh, David R. Holmes, Loren P. Herrera Hernandez, John C. Lieske

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background Overgrowth of calcium oxalate on Randall’s plaque is a mechanism of stone formation among idiopathic calciumoxalate stone-formers (ICSFs). It is less clear howstones formwhen there is little or no plaque. Design, setting, participants, & measurements Participants were a consecutive cohort of ICSFs who underwent percutaneous nephroscopic papillary mapping in the kidney or kidneys containing symptomatic stones and a papillary tip biopsy from a representative calyx during a stone removal procedure between 2009 and 2013. The distribution of Randall’s plaque coverage was analyzed and used to divide ICSFs into those with a high (³5%; mean, 10.5%; n=10) versus low (<5%; mean, 1.5%; n=32) amount of plaque coverage per papilla. Demographic and laboratory features were compared between these two groups. Results Low-plaque stone formers tended to be obese (50%versus 10%; P=0.03) and have a history of urinary tract infection (34% versus 0%; P=0.04). They were less likely to have multiple prior stone events (22% versus 80%; P=0.002) and had a lower mean 24-hour urine calcium excretion (187±86 mg versus 291±99 mg; P<0.01). Morphologically, stones from patients with low amounts of plaque lacked a calcium phosphate core by microcomputed tomography. Papillary biopsies fromlowplaque stone-formers revealed less interstitial and basement membrane punctate crystallization. Conclusions These findings suggest that other pathways independent of Randall’s plaquemay contribute to stone pathogenesis among a subgroup of ICSFs who harbor low amounts of plaque.

Original languageEnglish (US)
Pages (from-to)1757-1763
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number10
StatePublished - 2014

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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