Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle
Andrew P. Evan, … , Ramsay L. Kuo, Marc Grynpas
Andrew P. Evan, … , Ramsay L. Kuo, Marc Grynpas
Published March 1, 2003
Citation Information: J Clin Invest. 2003;111(5):607-616. https://doi.org/10.1172/JCI17038.
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Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle

Abstract

Our purpose here is to test the hypothesis that Randall’s plaques, calcium phosphate deposits in kidneys of patients with calcium renal stones, arise in unique anatomical regions of the kidney, their formation conditioned by specific stone-forming pathophysiologies. To test this hypothesis, we performed intraoperative biopsies of plaques in kidneys of idiopathic-calcium-stone formers and patients with stones due to obesity-related bypass procedures and obtained papillary specimens from non–stone formers after nephrectomy. Plaque originates in the basement membranes of the thin loops of Henle and spreads from there through the interstitium to beneath the urothelium. Patients who have undergone bypass surgery do not produce such plaque but instead form intratubular hydroxyapatite crystals in collecting ducts. Non–stone formers also do not form plaque. Plaque is specific to certain kinds of stone-forming patients and is initiated specifically in thin-limb basement membranes by mechanisms that remain to be elucidated.

Authors

Andrew P. Evan, James E. Lingeman, Fredric L. Coe, Joan H. Parks, Sharon B. Bledsoe, Youzhi Shao, Andre J. Sommer, Ryan F. Paterson, Ramsay L. Kuo, Marc Grynpas

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Figure 6

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Endoscopic and histologic images of Randall’s plaques in intestinal bypa...
Endoscopic and histologic images of Randall’s plaques in intestinal bypass patients. In (a), an example of a papilla from an intestinal-bypass stone former that was video recorded at the time of the mapping is shown. Distinct sites of Randall’s plaque material are not found on the papilla of the intestinal-bypass patient; instead, several nodular-appearing structures (arrowheads) were noted near the opening of the ducts of Bellini. In (b), a low magnification light microscopic image of a papillary biopsy specimen from an intestinal-bypass patient is shown. Crystal deposition was only found in the lumens of a few collecting ducts as far down as the ducts of Bellini (*). A large site of crystal material was seen in a duct of Bellini. No other sites of deposits were noted. Note dilated collecting ducts (arrows) with cast material and regions of fibrosis around crystal-deposit–filled collecting ducts. Magnification, ×100 (b).