Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers

Boyd R. Viers, John C. Lieske, Terri J. Vrtiska, Loren P. Herrera Hernandez, Lisa E. Vaughan, Ramilia A. Mehta, Eric J. Bergstralh, Andrew D. Rule, David R. Holmes, Amy Krambeck

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Abstract

Objective To characterize the endoscopic and histologic renal papillary lesions in a cohort of uric acid (UA) stone formers (SF). Methods Data were prospectively obtained during percutaneous nephrolithotomy between 2009 and 2013. Renal papillae were endoscopically analyzed to quantitate surface area occupied by plaque or plug, and biopsies were obtained. UA SF were compared with non-SF controls and patients with >50% calcium oxalate (CaOx) in the absence of UA. Results There were 23 UA SF; of which 19 stones (83%) were admixed with CaOx and 4 (17%) were pure. Compared with CaOx SF and controls, UA SF had a higher prevalence of diabetes and obesity, greater serum creatinine and UA levels, lower estimated glomerular filtration rate and urine pH, and elevated UA supersaturation. Characteristics of UA SF were compared with 95 CaOx SF and 19 controls. Overall, 23 (100%) UA SF had endoscopic plaque and 13 (57%) plugs. Endoscopically, UA SF displayed a greater incidence of plugging (57% vs 45% vs 11%; P =.006) relative to CaOx SF and controls. Likewise, UA SF had a greater percentage surface area of plugging (0.1 vs 0.0; P =.002) and plaque (2.0 vs 0.9; P =.006) than controls but similar amounts to CaOx SF. Histologic plugs were similar in UA and CaOx SF, although CaOx SF demonstrated greater interstitial inflammation on endoscopic biopsy. Conclusion UA and CaOx SF have similar amounts of plaque, whereas UA SF have more endoscopic but not histologic collecting duct plugs. These data suggest an overlap between the pathogenesis of UA and CaOx stones. The anchoring site for UA stones remains uncertain.

Original languageEnglish (US)
Pages (from-to)771-776
Number of pages6
JournalUrology
Volume85
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Calcium Oxalate
Uric Acid
Kidney
Biopsy
Percutaneous Nephrostomy
Glomerular Filtration Rate

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Viers, B. R., Lieske, J. C., Vrtiska, T. J., Herrera Hernandez, L. P., Vaughan, L. E., Mehta, R. A., ... Krambeck, A. (2015). Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers. Urology, 85(4), 771-776. https://doi.org/10.1016/j.urology.2014.12.036

Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers. / Viers, Boyd R.; Lieske, John C.; Vrtiska, Terri J.; Herrera Hernandez, Loren P.; Vaughan, Lisa E.; Mehta, Ramilia A.; Bergstralh, Eric J.; Rule, Andrew D.; Holmes, David R.; Krambeck, Amy.

In: Urology, Vol. 85, No. 4, 01.04.2015, p. 771-776.

Research output: Contribution to journalArticle

Viers, BR, Lieske, JC, Vrtiska, TJ, Herrera Hernandez, LP, Vaughan, LE, Mehta, RA, Bergstralh, EJ, Rule, AD, Holmes, DR & Krambeck, A 2015, 'Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers', Urology, vol. 85, no. 4, pp. 771-776. https://doi.org/10.1016/j.urology.2014.12.036
Viers BR, Lieske JC, Vrtiska TJ, Herrera Hernandez LP, Vaughan LE, Mehta RA et al. Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers. Urology. 2015 Apr 1;85(4):771-776. https://doi.org/10.1016/j.urology.2014.12.036
Viers, Boyd R. ; Lieske, John C. ; Vrtiska, Terri J. ; Herrera Hernandez, Loren P. ; Vaughan, Lisa E. ; Mehta, Ramilia A. ; Bergstralh, Eric J. ; Rule, Andrew D. ; Holmes, David R. ; Krambeck, Amy. / Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers. In: Urology. 2015 ; Vol. 85, No. 4. pp. 771-776.
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abstract = "Objective To characterize the endoscopic and histologic renal papillary lesions in a cohort of uric acid (UA) stone formers (SF). Methods Data were prospectively obtained during percutaneous nephrolithotomy between 2009 and 2013. Renal papillae were endoscopically analyzed to quantitate surface area occupied by plaque or plug, and biopsies were obtained. UA SF were compared with non-SF controls and patients with >50{\%} calcium oxalate (CaOx) in the absence of UA. Results There were 23 UA SF; of which 19 stones (83{\%}) were admixed with CaOx and 4 (17{\%}) were pure. Compared with CaOx SF and controls, UA SF had a higher prevalence of diabetes and obesity, greater serum creatinine and UA levels, lower estimated glomerular filtration rate and urine pH, and elevated UA supersaturation. Characteristics of UA SF were compared with 95 CaOx SF and 19 controls. Overall, 23 (100{\%}) UA SF had endoscopic plaque and 13 (57{\%}) plugs. Endoscopically, UA SF displayed a greater incidence of plugging (57{\%} vs 45{\%} vs 11{\%}; P =.006) relative to CaOx SF and controls. Likewise, UA SF had a greater percentage surface area of plugging (0.1 vs 0.0; P =.002) and plaque (2.0 vs 0.9; P =.006) than controls but similar amounts to CaOx SF. Histologic plugs were similar in UA and CaOx SF, although CaOx SF demonstrated greater interstitial inflammation on endoscopic biopsy. Conclusion UA and CaOx SF have similar amounts of plaque, whereas UA SF have more endoscopic but not histologic collecting duct plugs. These data suggest an overlap between the pathogenesis of UA and CaOx stones. The anchoring site for UA stones remains uncertain.",
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T1 - Endoscopic and Histologic Findings in a Cohort of Uric Acid and Calcium Oxalate Stone Formers

AU - Viers, Boyd R.

AU - Lieske, John C.

AU - Vrtiska, Terri J.

AU - Herrera Hernandez, Loren P.

AU - Vaughan, Lisa E.

AU - Mehta, Ramilia A.

AU - Bergstralh, Eric J.

AU - Rule, Andrew D.

AU - Holmes, David R.

AU - Krambeck, Amy

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Objective To characterize the endoscopic and histologic renal papillary lesions in a cohort of uric acid (UA) stone formers (SF). Methods Data were prospectively obtained during percutaneous nephrolithotomy between 2009 and 2013. Renal papillae were endoscopically analyzed to quantitate surface area occupied by plaque or plug, and biopsies were obtained. UA SF were compared with non-SF controls and patients with >50% calcium oxalate (CaOx) in the absence of UA. Results There were 23 UA SF; of which 19 stones (83%) were admixed with CaOx and 4 (17%) were pure. Compared with CaOx SF and controls, UA SF had a higher prevalence of diabetes and obesity, greater serum creatinine and UA levels, lower estimated glomerular filtration rate and urine pH, and elevated UA supersaturation. Characteristics of UA SF were compared with 95 CaOx SF and 19 controls. Overall, 23 (100%) UA SF had endoscopic plaque and 13 (57%) plugs. Endoscopically, UA SF displayed a greater incidence of plugging (57% vs 45% vs 11%; P =.006) relative to CaOx SF and controls. Likewise, UA SF had a greater percentage surface area of plugging (0.1 vs 0.0; P =.002) and plaque (2.0 vs 0.9; P =.006) than controls but similar amounts to CaOx SF. Histologic plugs were similar in UA and CaOx SF, although CaOx SF demonstrated greater interstitial inflammation on endoscopic biopsy. Conclusion UA and CaOx SF have similar amounts of plaque, whereas UA SF have more endoscopic but not histologic collecting duct plugs. These data suggest an overlap between the pathogenesis of UA and CaOx stones. The anchoring site for UA stones remains uncertain.

AB - Objective To characterize the endoscopic and histologic renal papillary lesions in a cohort of uric acid (UA) stone formers (SF). Methods Data were prospectively obtained during percutaneous nephrolithotomy between 2009 and 2013. Renal papillae were endoscopically analyzed to quantitate surface area occupied by plaque or plug, and biopsies were obtained. UA SF were compared with non-SF controls and patients with >50% calcium oxalate (CaOx) in the absence of UA. Results There were 23 UA SF; of which 19 stones (83%) were admixed with CaOx and 4 (17%) were pure. Compared with CaOx SF and controls, UA SF had a higher prevalence of diabetes and obesity, greater serum creatinine and UA levels, lower estimated glomerular filtration rate and urine pH, and elevated UA supersaturation. Characteristics of UA SF were compared with 95 CaOx SF and 19 controls. Overall, 23 (100%) UA SF had endoscopic plaque and 13 (57%) plugs. Endoscopically, UA SF displayed a greater incidence of plugging (57% vs 45% vs 11%; P =.006) relative to CaOx SF and controls. Likewise, UA SF had a greater percentage surface area of plugging (0.1 vs 0.0; P =.002) and plaque (2.0 vs 0.9; P =.006) than controls but similar amounts to CaOx SF. Histologic plugs were similar in UA and CaOx SF, although CaOx SF demonstrated greater interstitial inflammation on endoscopic biopsy. Conclusion UA and CaOx SF have similar amounts of plaque, whereas UA SF have more endoscopic but not histologic collecting duct plugs. These data suggest an overlap between the pathogenesis of UA and CaOx stones. The anchoring site for UA stones remains uncertain.

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