Determinants of renal papillary appearance in kidney stone formers: An in-depth examination
https://doi.org/10.4081/aiua.2023.10748
Accepted: August 20, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objectives: The aim of this study is to investi-gate the association between the urinary metabolic milieu and kidney stone recurrence with a validated papillary evaluation score (PPLA).
Materials and methods: We prospectively enrolled 30 stone for-mers who underwent retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed to calculate PPLA score, based on the characterization of ductal plugging, surface pitting, loss of papillary contour and Randall’s plaque extension. Stone compositions, 24h urine collections and kidney stone events during follow-up were collected. Relative supersaturation ratios (RSS) for calcium oxalate (CaOx), brushite and uric acid were calculated using EQUIL-2. PPLA score > 3 was defined as high.
Results: Median follow-up period was 11 months (5, 34). PPLA score was inversely correlated with BMI (OR 0.59, 95% CI 0.38, 0.91, p = 0.018), type 2 diabetes (OR 0.04, 95% CI 0.003, 0.58, p = 0.018) and history of recurrent kidney stones (OR 0.17, 95%CI 0.04, 0.75, p = 0.019). The associations between PPLA score, diabetes and BMI were not confirmed after excluding patients with uric acid stones. Higher PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.15, 95% CI 0.02, 1.00, p = 0.05). No other significant correla-tions were found.
Conclusions: Our results confirm the lack of efficacy of PPLA score in phenotyping patients affected by kidney stone disease or in predicting the risk of stone recurrence. Larger, long-term studies need to be performed to clarify the role of PPLA on the risk of stone recurrence.
Croppi E, Ferraro PM, Taddei L, Gambaro G, GEA Firenze Study Group. Prevalence of renal stones in an Italian urban population: a general practice-based study. Urol Res. 2012; 40:517-522. DOI: https://doi.org/10.1007/s00240-012-0477-z
Lotan Y. Economics and cost of care of stone disease. Adv Chronic Kidney Dis. 2009; 16:5-10. DOI: https://doi.org/10.1053/j.ackd.2008.10.002
Bargagli M, Tio MC, Waikar SS, Ferraro PM. Dietary Oxalate Intake and Kidney Outcomes. Nutrients. 2020; 12:2673. DOI: https://doi.org/10.3390/nu12092673
Ferraro PM, Bargagli M, Trinchieri A, Gambaro G. Risk of Kidney Stones: Influence of Dietary Factors, Dietary Patterns, and Vegetarian-Vegan Diets. Nutrients. 2020; 12:779. DOI: https://doi.org/10.3390/nu12030779
Shavit L, Ferraro PM, Johri N, et al. Effect of being overweight on urinary metabolic risk factors for kidney stone formation. Nephrol Dial Transplant. 2015; 30:607-613. DOI: https://doi.org/10.1093/ndt/gfu350
Madore F, Stampfer MJ, Rimm EB, Curhan GC. Nephrolithiasis and risk of hypertension. Am J Hypertens. 1998; 11:46-53. DOI: https://doi.org/10.1016/S0895-7061(97)00371-3
Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int. 2005; 68:1230-1235. DOI: https://doi.org/10.1111/j.1523-1755.2005.00516.x
Spatola L, Ferraro PM, Gambaro G, et al. Metabolic syndrome and uric acid nephrolithiasis: insulin resistance in focus. Metabolism 2018; 83:225-233. DOI: https://doi.org/10.1016/j.metabol.2018.02.008
Gambaro G, Croppi E, Bushinsky D, et al. The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review. J Uro. 2017; 198:268-273. DOI: https://doi.org/10.1016/j.juro.2016.12.135
Ferraro PM, Taylor EN, Eisner BH, et al. History of kidney stones and risk of coronary heart disease. JAMA. 2013; 310:408-415. DOI: https://doi.org/10.1001/jama.2013.8780
Ferraro PM, Marano R, Primiano A, et al. Stone composition and vascular calcifications in patients with nephrolithiasis. J Nephrol. 2019; 32:589-594. DOI: https://doi.org/10.1007/s40620-019-00619-w
Matlaga BR, Coe FL, Evan AP, Lingeman JE. The Role of Randall’s Plaques in the Pathogenesis of Calcium Stones. J Urol. 2007; 177:31-38. DOI: https://doi.org/10.1016/j.juro.2006.08.088
Matlaga BR, Williams JC, Kim SC, et al. Endoscopic Evidence of Calculus Attachment to Randall’s Plaque. J Urol. 2006; 175:1720-1724. DOI: https://doi.org/10.1016/S0022-5347(05)01017-7
Borofsky MS, Paonessa JE, Evan AP, et al. A Proposed Grading System to Standardize the Description of Renal Papillary Appearance at the Time of Endoscopy in Patients with Nephrolithiasis. J Endourol. 2016; 30:122-127. DOI: https://doi.org/10.1089/end.2015.0298
Werness PG, Brown CM, Smith LH, Finlayson B. EQUIL2: a BASIC computer program for the calculation of urinary saturation. J Urol. 1985; 134:1242-1244. DOI: https://doi.org/10.1016/S0022-5347(17)47703-2
Cohen AJ, Borofsky MS, Anderson BB, et al. Endoscopic Evidence That Randall’s Plaque is Associated with Surface Erosion of the Renal Papilla. J Endourol 2017; 31:85-90. DOI: https://doi.org/10.1089/end.2016.0537
Bargagli M, Dhayat NA, Anderegg M, et al. Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan. Clin J Am Soc Nephrol. 2020; 15:1007-1014. DOI: https://doi.org/10.2215/CJN.13861119
Coe FL, Evan AP, Worcester EM, Lingeman JE. Three pathways for human kidney stone formation. Urol Res 2010; 38:147-160. DOI: https://doi.org/10.1007/s00240-010-0271-8
Almeras C, Daudon M, Estrade V, et al. Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update. World J Urol. 2021; 39:177-185. DOI: https://doi.org/10.1007/s00345-020-03149-4
Kuo RL, Lingeman JE, Evan AP, et al. Urine calcium and volume predict coverage of renal papilla by Randall’s plaque. Kidney Int 2003; 64:2150-2154. DOI: https://doi.org/10.1046/j.1523-1755.2003.00316.x
Linnes MP, Krambeck AE, Cornell L, et al. Phenotypic charac-terization of kidney stone formers by endoscopic and histological quantification of intrarenal calcification. Kidney Int. 2013; 84:818-825. DOI: https://doi.org/10.1038/ki.2013.189
Pless MS, Williams JC, Andreassen KH, et al. Endoscopic obser-vations as a tool to define underlying pathology in kidney stone for-mers. World J Urol. 2019; 37:2207-2215. DOI: https://doi.org/10.1007/s00345-018-02616-3
Sabaté Arroyo XA, Grases Freixedas F, Bauzà Quetglas JL, et al. Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis. BMC Urol. 2020; 20:46. DOI: https://doi.org/10.1186/s12894-020-00615-4
Metze D, Cury VF, Gomez RS, et al. Hypocitraturia. In: Lang F, ed. Encyclopedia of Molecular Mechanisms of Disease. Springer Berlin Heidelberg; 2009:969-970.
Pozdzik A, Maalouf N, Letavernier E, et al. Meeting report of the “Symposium on kidney stones and mineral metabolism: calcium kid-ney stones in 2017.” J Nephrol. 2019; 32:681-698. DOI: https://doi.org/10.1007/s40620-019-00587-1
Poore W, Boyd CJ, Singh NP, et al. Obesity and Its Impact on Kidney Stone Formation. Rev Urol. 2020; 22:17.
Daudon M, Traxer O, Conort P, et al. Type 2 Diabetes Increases the Risk for Uric Acid Stones. JASN. 2006; 17:2026-2033. DOI: https://doi.org/10.1681/ASN.2006030262
Maalouf NM, Cameron MA, Moe OW, et al. Low Urine pH: A Novel Feature of the Metabolic Syndrome. CJASN. 2007; 2:883-888. DOI: https://doi.org/10.2215/CJN.00670207
Moran ME, Abrahams HM, Burday DE, Greene TD. Utility of oral dissolution therapy in the management of referred patients with secondarily treated uric acid stones. Urology. 2002; 59:206-210. DOI: https://doi.org/10.1016/S0090-4295(01)01499-6
Ferraro PM, Vittori M, Macis G, et al. Changes in renal papil-lary density after hydration therapy in calcium stone formers. BMC Urol. 2018; 18:101. DOI: https://doi.org/10.1186/s12894-018-0415-7
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
