Endoscopic observations as a tool to define underlying pathology in kidney stone formers

Purpose Advancements in endoscopy offer the possibility of inspection of intrarenal anatomy and pathology. The aim of the study was to evaluate renal papillary appearance in kidney stone formers and to correlate papillary findings with stone type and patient metabolic data. Materials and methods A c...

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Bibliographic Details
Published in:World journal of urology 2019-10, Vol.37 (10), p.2207-2215
Main Authors: Pless, Maria Sloth, Williams, James Caldwell, Andreassen, Kim Hovgaard, Jung, Helene Ulrich, Osther, Susanne Sloth, Christensen, Dorte Ravnsmed, Osther, Palle Jörn Sloth
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Calculi
Computed tomography
Endoscopy
Female
Humans
Infrared spectroscopy
Kidney Calculi - etiology
Kidney Calculi - pathology
Kidney stones
Kidneys
Male
Medicine
Medicine & Public Health
Metabolism
Middle Aged
Nephrolithiasis
Nephrology
Oncology
Original
Original Article
Papillae
Prospective Studies
Surgery
Ureteroscopy
Urine
Urology
Young Adult
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Summary:Purpose Advancements in endoscopy offer the possibility of inspection of intrarenal anatomy and pathology. The aim of the study was to evaluate renal papillary appearance in kidney stone formers and to correlate papillary findings with stone type and patient metabolic data. Materials and methods A consecutive cohort of 46 kidney stone formers undergoing retrograde intrarenal surgery was enrolled. During surgery, renal papillae were characterized in the domains of ductal Plugging (DP), surface Pitting, Loss of papillary contour, and Amount of Randall’s plaque (RP, PPLA scoring). Stone material was analyzed using micro-CT and infrared spectroscopy, and blood and urine were collected for metabolic evaluation. Results In all patients, renal papillae had changes in at least one of the domains of the PPLA score. Examining the total population, it was evident that patients with predominantly plugging (DP > 0) all had very low RP scores. There were no significant trends between mean PPLA scores and urinary analytes for the total group. Conclusion Efforts to prevent renal stone formation have so far been insufficient in majority of patients. Digital endoscopy reveals that kidney stone formers have different and distinct papillary morphologies that seem to be linked to specific stone-forming pathways. Since renal papillary abnormalities may be easily identified during endoscopy, this may in the future prove to be an important method for tailoring prevention strategies in kidney stone patients.
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-018-02616-3