Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease

Andrew Evan, James E. Lingeman, Elaine M. Worcester, Sharon B. Bledsoe, Andre J. Sommer, James Williams, Amy Krambeck, Carrie Phillips, Fredric L. Coe

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic urine of reduced volume. As was found with ileostomy and obesity bypass, inner medullary collecting ducts (IMCDs) contained crystal deposits associated with cell injury, interstitial inflammation, and papillary deformity. Cortical changes included modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Randall's plaque (interstitial papillary apatite) was abundant, with calcium oxalate stone overgrowth similar to that seen in ileostomy, idiopathic calcium oxalate stone formers, and primary hyperparathyroidism. Abundant plaque was compatible with the low urine volume and pH. The IMCD deposits all contained apatite, with calcium oxalate present in three cases, similar to findings in patients with obesity bypass but not an ileostomy. The mechanisms for calcium oxalate stone formation in IMCDs include elevated urine and presumably tubule fluid calcium oxalate supersaturation, but a low calcium to oxalate ratio. However, the mechanisms for the presence of IMCD apatite remain unknown.

Original languageEnglish
Pages (from-to)310-317
Number of pages8
JournalKidney International
Volume78
Issue number3
DOIs
StatePublished - Aug 2010

Fingerprint

Calcium Oxalate
Kidney
Apatites
Ileostomy
Urine
Obesity
Hyperoxaluria
Oxalates
Primary Hyperparathyroidism
Sclerosis
Crohn Disease
Atrophy
Anatomy
Fibrosis
Inflammation
Wounds and Injuries

Keywords

  • clinical nephrology
  • kidney stones
  • renal biopsy
  • renal pathology
  • renal physiology

ASJC Scopus subject areas

  • Nephrology

Cite this

Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease. / Evan, Andrew; Lingeman, James E.; Worcester, Elaine M.; Bledsoe, Sharon B.; Sommer, Andre J.; Williams, James; Krambeck, Amy; Phillips, Carrie; Coe, Fredric L.

In: Kidney International, Vol. 78, No. 3, 08.2010, p. 310-317.

Research output: Contribution to journalArticle

Evan, Andrew ; Lingeman, James E. ; Worcester, Elaine M. ; Bledsoe, Sharon B. ; Sommer, Andre J. ; Williams, James ; Krambeck, Amy ; Phillips, Carrie ; Coe, Fredric L. / Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease. In: Kidney International. 2010 ; Vol. 78, No. 3. pp. 310-317.
@article{45ba4146f9ef4999a3681c0401d02297,
title = "Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease",
abstract = "We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic urine of reduced volume. As was found with ileostomy and obesity bypass, inner medullary collecting ducts (IMCDs) contained crystal deposits associated with cell injury, interstitial inflammation, and papillary deformity. Cortical changes included modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Randall's plaque (interstitial papillary apatite) was abundant, with calcium oxalate stone overgrowth similar to that seen in ileostomy, idiopathic calcium oxalate stone formers, and primary hyperparathyroidism. Abundant plaque was compatible with the low urine volume and pH. The IMCD deposits all contained apatite, with calcium oxalate present in three cases, similar to findings in patients with obesity bypass but not an ileostomy. The mechanisms for calcium oxalate stone formation in IMCDs include elevated urine and presumably tubule fluid calcium oxalate supersaturation, but a low calcium to oxalate ratio. However, the mechanisms for the presence of IMCD apatite remain unknown.",
keywords = "clinical nephrology, kidney stones, renal biopsy, renal pathology, renal physiology",
author = "Andrew Evan and Lingeman, {James E.} and Worcester, {Elaine M.} and Bledsoe, {Sharon B.} and Sommer, {Andre J.} and James Williams and Amy Krambeck and Carrie Phillips and Coe, {Fredric L.}",
year = "2010",
month = "8",
doi = "10.1038/ki.2010.131",
language = "English",
volume = "78",
pages = "310--317",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease

AU - Evan, Andrew

AU - Lingeman, James E.

AU - Worcester, Elaine M.

AU - Bledsoe, Sharon B.

AU - Sommer, Andre J.

AU - Williams, James

AU - Krambeck, Amy

AU - Phillips, Carrie

AU - Coe, Fredric L.

PY - 2010/8

Y1 - 2010/8

N2 - We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic urine of reduced volume. As was found with ileostomy and obesity bypass, inner medullary collecting ducts (IMCDs) contained crystal deposits associated with cell injury, interstitial inflammation, and papillary deformity. Cortical changes included modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Randall's plaque (interstitial papillary apatite) was abundant, with calcium oxalate stone overgrowth similar to that seen in ileostomy, idiopathic calcium oxalate stone formers, and primary hyperparathyroidism. Abundant plaque was compatible with the low urine volume and pH. The IMCD deposits all contained apatite, with calcium oxalate present in three cases, similar to findings in patients with obesity bypass but not an ileostomy. The mechanisms for calcium oxalate stone formation in IMCDs include elevated urine and presumably tubule fluid calcium oxalate supersaturation, but a low calcium to oxalate ratio. However, the mechanisms for the presence of IMCD apatite remain unknown.

AB - We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic urine of reduced volume. As was found with ileostomy and obesity bypass, inner medullary collecting ducts (IMCDs) contained crystal deposits associated with cell injury, interstitial inflammation, and papillary deformity. Cortical changes included modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Randall's plaque (interstitial papillary apatite) was abundant, with calcium oxalate stone overgrowth similar to that seen in ileostomy, idiopathic calcium oxalate stone formers, and primary hyperparathyroidism. Abundant plaque was compatible with the low urine volume and pH. The IMCD deposits all contained apatite, with calcium oxalate present in three cases, similar to findings in patients with obesity bypass but not an ileostomy. The mechanisms for calcium oxalate stone formation in IMCDs include elevated urine and presumably tubule fluid calcium oxalate supersaturation, but a low calcium to oxalate ratio. However, the mechanisms for the presence of IMCD apatite remain unknown.

KW - clinical nephrology

KW - kidney stones

KW - renal biopsy

KW - renal pathology

KW - renal physiology

UR - http://www.scopus.com/inward/record.url?scp=77954759083&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954759083&partnerID=8YFLogxK

U2 - 10.1038/ki.2010.131

DO - 10.1038/ki.2010.131

M3 - Article

C2 - 20428098

AN - SCOPUS:77954759083

VL - 78

SP - 310

EP - 317

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 3

ER -