Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Christopher D. Jaeger; Andrew D. Rule; Ramila A. Mehta; Lisa E. Vaughan; Terri J. Vrtiska; David R. Holmes; Cynthia M. McCollough; Matthew J. Ziegelmann; Loren P. Herrera Hernandez; John C. Lieske; Amy E. Krambeck

doi:10.1016/j.urology.2015.12.037

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Christopher D. Jaeger, Andrew D. Rule, Ramila A. Mehta, Lisa E. Vaughan, Terri J. Vrtiska, David R. Holmes, Cynthia M. McCollough, Matthew J. Ziegelmann, Loren P. Herrera Hernandez, John C. Lieske, Amy E. Krambeck^*

^*Corresponding author for this work

Urology

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Objective To describe the endoscopic characteristics of renal papillae in struvite stone formers (SFs). Materials and Methods From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae were performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. Results We identified 29 struvite SFs to compare with 90 idiopathic CaOx SFs and 17 controls. On endoscopic mapping, 28 struvite SFs (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5 ± 1.4%) was less than CaOx SFs (3.7 ± 4.3%, P = .0018) and similar to controls (1.7 ± 2.7%, P = .76). Average mean plug SA was similar between struvite SFs, CaOx SFs, and controls. On metabolic assessment, 83% of struvite SFs had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (P = .002). Despite lack of active urinary tract infection, interstitial inflammation was more prevalent in struvite SFs compared to CaOx SFs (43.5% vs 7.3%, P = .0001). Conclusions Our findings suggest a limited role for Randall's plaque in struvite stone formation. Struvite SFs have less plaque formation than CaOx SFs, but demonstrate evidence of severe parenchymal inflammation compared to other SFs. The role of this prominent interstitial inflammation requires further study.

Original language	English (US)
Pages (from-to)	39-44
Number of pages	6
Journal	Urology
Volume	90
DOIs	https://doi.org/10.1016/j.urology.2015.12.037
State	Published - Apr 1 2016

Funding

Funding Support: This study was supported by the Mayo Clinic O'Brien Urology Research Center , from the National Institute of Diabetes and Digestive and Kidney Diseases ( U54 DK100227 ), and from the National Center for Advancing Translational Sciences and the Mayo Foundation ( UL1-TR000135 ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

ASJC Scopus subject areas

Urology

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10.1016/j.urology.2015.12.037

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@article{c02b568d70f240b2abad2e8d6a121f7a,

title = "Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers",

abstract = "Objective To describe the endoscopic characteristics of renal papillae in struvite stone formers (SFs). Materials and Methods From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae were performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. Results We identified 29 struvite SFs to compare with 90 idiopathic CaOx SFs and 17 controls. On endoscopic mapping, 28 struvite SFs (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5 ± 1.4%) was less than CaOx SFs (3.7 ± 4.3%, P = .0018) and similar to controls (1.7 ± 2.7%, P = .76). Average mean plug SA was similar between struvite SFs, CaOx SFs, and controls. On metabolic assessment, 83% of struvite SFs had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (P = .002). Despite lack of active urinary tract infection, interstitial inflammation was more prevalent in struvite SFs compared to CaOx SFs (43.5% vs 7.3%, P = .0001). Conclusions Our findings suggest a limited role for Randall's plaque in struvite stone formation. Struvite SFs have less plaque formation than CaOx SFs, but demonstrate evidence of severe parenchymal inflammation compared to other SFs. The role of this prominent interstitial inflammation requires further study.",

author = "Jaeger, {Christopher D.} and Rule, {Andrew D.} and Mehta, {Ramila A.} and Vaughan, {Lisa E.} and Vrtiska, {Terri J.} and Holmes, {David R.} and McCollough, {Cynthia M.} and Ziegelmann, {Matthew J.} and {Herrera Hernandez}, {Loren P.} and Lieske, {John C.} and Krambeck, {Amy E.}",

note = "Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.",

year = "2016",

month = apr,

day = "1",

doi = "10.1016/j.urology.2015.12.037",

language = "English (US)",

volume = "90",

pages = "39--44",

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TY - JOUR

T1 - Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

AU - Jaeger, Christopher D.

AU - Rule, Andrew D.

AU - Mehta, Ramila A.

AU - Vaughan, Lisa E.

AU - Vrtiska, Terri J.

AU - Holmes, David R.

AU - McCollough, Cynthia M.

AU - Ziegelmann, Matthew J.

AU - Herrera Hernandez, Loren P.

AU - Lieske, John C.

AU - Krambeck, Amy E.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective To describe the endoscopic characteristics of renal papillae in struvite stone formers (SFs). Materials and Methods From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae were performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. Results We identified 29 struvite SFs to compare with 90 idiopathic CaOx SFs and 17 controls. On endoscopic mapping, 28 struvite SFs (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5 ± 1.4%) was less than CaOx SFs (3.7 ± 4.3%, P = .0018) and similar to controls (1.7 ± 2.7%, P = .76). Average mean plug SA was similar between struvite SFs, CaOx SFs, and controls. On metabolic assessment, 83% of struvite SFs had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (P = .002). Despite lack of active urinary tract infection, interstitial inflammation was more prevalent in struvite SFs compared to CaOx SFs (43.5% vs 7.3%, P = .0001). Conclusions Our findings suggest a limited role for Randall's plaque in struvite stone formation. Struvite SFs have less plaque formation than CaOx SFs, but demonstrate evidence of severe parenchymal inflammation compared to other SFs. The role of this prominent interstitial inflammation requires further study.

AB - Objective To describe the endoscopic characteristics of renal papillae in struvite stone formers (SFs). Materials and Methods From 2009 to 2014, patients undergoing percutaneous nephrolithotomy were prospectively enrolled in our study. Endoscopic analysis and biopsy of papillae were performed to demonstrate the presence and percentage surface area (SA) of Randall's plaque or ductal plug. Comparison with idiopathic calcium oxalate (CaOx) SF and non-SF controls was performed. Results We identified 29 struvite SFs to compare with 90 idiopathic CaOx SFs and 17 controls. On endoscopic mapping, 28 struvite SFs (97%) demonstrated Randall's plaque and 9 (31%) had plugging. The average mean SA of Randall's plaque in struvite SF (1.5 ± 1.4%) was less than CaOx SFs (3.7 ± 4.3%, P = .0018) and similar to controls (1.7 ± 2.7%, P = .76). Average mean plug SA was similar between struvite SFs, CaOx SFs, and controls. On metabolic assessment, 83% of struvite SFs had at least one urine abnormality, with urinary uric acid and oxalate levels significantly higher among struvite SFs compared to controls (P = .002). Despite lack of active urinary tract infection, interstitial inflammation was more prevalent in struvite SFs compared to CaOx SFs (43.5% vs 7.3%, P = .0001). Conclusions Our findings suggest a limited role for Randall's plaque in struvite stone formation. Struvite SFs have less plaque formation than CaOx SFs, but demonstrate evidence of severe parenchymal inflammation compared to other SFs. The role of this prominent interstitial inflammation requires further study.

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DO - 10.1016/j.urology.2015.12.037

M3 - Article

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AN - SCOPUS:84957085432

SN - 0090-4295

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SP - 39

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JO - Urology

JF - Urology

ER -

Endoscopic and Pathologic Characterization of Papillary Architecture in Struvite Stone Formers

Abstract

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