title: Crystals, Randall's plaques and renal stones: do bone and atherosclerosis teach us something?
abstract: The pathogenesis of calcium-oxalate (CaOx) renal stones is still debated and a number of issues needs to be clarified. In particular, it is difficult to combine the intraluminal physical-chemical imbalance and fixed particle theory with the evidence that CaOx stones actually form and grow on Randall's plaque in the renal pelvis. On the basis of recent findings in renal stone research, and data from the biology of ectopic calcification, the hypothesis is advanced that abnormal pre-urine CaOx supersaturation triggers inflammation in the long Henle's loop cells at tip forceps level. This in turn induces differentiation of these cells toward the osteogenic lineage, determining the synthesis of typical bone osteoid proteins (osteopontin, osteocalcin, BMP-2, etc) and hydroxyapatite mineralization of the Henle's basement membrane (beneath the differentiating cells) which precedes Randal's plaque formation. This may constitute a further, still unexplored example of epithelial-mesenchymal-differentiation in the kidney.
authors.affiliation: Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Italy. giovanni.gambaro@univr.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambaro
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Antionia
authors.initials: A
authors.lastname: Fabris
authors.forename: Enrica
authors.initials: E
authors.lastname: Tosetto
authors.forename: Franca
authors.initials: F
authors.lastname: Anglani
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
mesh_terms: D000818:Animals; D001161:Arteriosclerosis / Q000503:physiopathology; D001842:Bone and Bones / Q000378:metabolism; D002129:Calcium Oxalate / Q000378:metabolism*; D003460:Crystallization; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology*
chemical_list: D002129:Calcium Oxalate