Randall’s plaque in stone formers originates in ascending thin limbs

Andrew Evan, Fredric L. Coe, James Lingeman, Sharon Bledsoe, Elaine M. Worcester

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Randall’s plaque, an attachment site over which calcium oxalate stones form, begins in the basement membranes of thin limbs of the loop of Henle. The mechanism of its formation is unknown. Possibly, enhanced delivery of calcium out of the proximal tubule, found in many stone formers, increases reabsorption of calcium from the thick ascending limb into the interstitium around descending vasa recta, which convey that calcium into the deep medulla, and raises supersaturations near thin limbs (“vas washdown”). According to this hypothesis, plaque should form preferentially on ascending thin limbs, which do not reabsorb water. We stained serial sections of papillary biopsies from stone-forming patients for aquaporin 1 (which is found in the descending thin limb) and the kidney-specific chloride channel ClC-Ka (which is found in the ascending thin limb). Plaque (which is detected using Yasue stain) colocalized with ClC-Ka, but not with aquaporin 1 (χ2 + 464, P < 0.001). We conclude that plaque forms preferentially in the basement membranes of ascending thin limbs, fulfilling a critical prediction of the vas washdown theory of plaque pathogenesis. The clinical implication is that treatments such as a low-sodium diet or thiazide diuretics that raise proximal tubule calcium reabsorption may reduce formation of plaque as well as calcium kidney stones.

Original languageEnglish (US)
Pages (from-to)F1236-F1242
JournalAmerican Journal of Physiology - Renal Physiology
Volume315
Issue number5
DOIs
StatePublished - Nov 1 2018

Fingerprint

Extremities
Calcium
Aquaporin 1
Basement Membrane
Aquaporin 2
Loop of Henle
Sodium Chloride Symporter Inhibitors
Sodium-Restricted Diet
Calcium Oxalate
Chloride Channels
Kidney Calculi
Rectum
Coloring Agents
Kidney
Biopsy
Water

Keywords

  • Ascending thin limb
  • Calcium oxalate
  • Nephrolithiasis
  • Randall’s plaque

ASJC Scopus subject areas

  • Physiology
  • Urology

Cite this

Randall’s plaque in stone formers originates in ascending thin limbs. / Evan, Andrew; Coe, Fredric L.; Lingeman, James; Bledsoe, Sharon; Worcester, Elaine M.

In: American Journal of Physiology - Renal Physiology, Vol. 315, No. 5, 01.11.2018, p. F1236-F1242.

Research output: Contribution to journalArticle

Evan, Andrew ; Coe, Fredric L. ; Lingeman, James ; Bledsoe, Sharon ; Worcester, Elaine M. / Randall’s plaque in stone formers originates in ascending thin limbs. In: American Journal of Physiology - Renal Physiology. 2018 ; Vol. 315, No. 5. pp. F1236-F1242.
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