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 7

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Pattern of intraluminal crystal deposition in medullary tissue of bypass...
Pattern of intraluminal crystal deposition in medullary tissue of bypass patients. In (a), early crystal attachment to the apical surface of several collecting duct cells is shown in a 1-μm plastic section. At this stage, these collecting ducts have a mixture of normal and injured (*) cells. In (b), several cells are shown by transmission electron microscopy (see rectangle in a) that possess attached crystals (arrow). In (c), another 1-μm plastic section of a collecting duct shows complete crystallization of the tubular lumen and lining cells. In (d), an electron micrograph of a region of the collecting ducts seen in (c) is shown (see rectangle). No cellular detail remains; only crystalline material is found. Magnification, ×450 (a); ×6,400 (b); ×550 (c); ×4,000 (d).