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2014 ; 297
(4
): 731-48
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Contrasting histopathology and crystal deposits in kidneys of idiopathic stone
formers who produce hydroxy apatite, brushite, or calcium oxalate stones
#MMPMID24478243
Evan AP
; Lingeman JE
; Worcester EM
; Sommer AJ
; Phillips CL
; Williams JC
; Coe FL
Anat Rec (Hoboken)
2014[Apr]; 297
(4
): 731-48
PMID24478243
show ga
Our previous work has shown that stone formers who form calcium phosphate (CaP)
stones that contain any brushite (BRSF) have a distinctive renal histopathology
and surgical anatomy when compared with idiopathic calcium oxalate stone formers
(ICSF). Here we report on another group of idiopathic CaP stone formers, those
forming stone containing primarily hydroxyapatite, in order to clarify in what
ways their pathology differs from BRSF and ICSF. Eleven hydroxyapatite stone
formers (HASF) (2 males, 9 females) were studied using intra-operative digital
photography and biopsy of papillary and cortical regions to measure tissue
changes associated with stone formation. Our main finding is that HASF and BRSF
differ significantly from each other and that both differ greatly from ICSF. Both
BRSF and ICSF patients have significant levels of Randall's plaque compared with
HASF. Intra-tubular deposit number is greater in HASF than BRSF and nonexistent
in ICSF while deposit size is smaller in HASF than BRSF. Cortical pathology is
distinctly greater in BRSF than HASF. Four attached stones were observed in HASF,
three in 25 BRSF and 5-10 per ICSF patient. HASF and BRSF differ clinically in
that both have higher average urine pH, supersaturation of CaP, and calcium
excretion than ICSF. Our work suggests that HASF and BRSF are two distinct and
separate diseases and both differ greatly from ICSF.