title: Calcium oxalate calculi found attached to the renal papilla: Preliminary evidence for early mechanisms in stone formation.
abstract: BACKGROUND
  Calculi are commonly found attached to the renal papilla in calcium oxalate (CaOx) stone formers, but the mechanisms by which stones form in this manner are not well established.
  
  
  METHODS
  Data are presented from three attached stones collected from different patients. Stone morphology and composition were determined using micro computed tomography (CT) and infrared microspectrometry.
  
  
  RESULTS
  One of the stones was composed of CaOx with a peripheral region of apatite, such as might have come from a Randall's plaque. Another stone was covered with large CaOx crystals but contained at least two layers of apatite, with no apatite regions exposed at the surface. The third stone contained CaOx with inclusions of apatite and more apatite on its surface, along with a substantial volume of poorly mineralized material that could not be identified.
  
  
  CONCLUSIONS
  The complexity of these stones and their differing morphologies do not by themselves allow inference of the mechanism of stone formation. Future work will require the careful documentation of attached stones on the papilla, as well as study of the papilla after the stone has been removed, before it can be determined whether such diverse CaOx stones originate from the same or different underlying etiologies.
authors.affiliation: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana 46202-5120, USA. williams@anatomy.iupui.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Williams
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Kim
authors.forename: Molly E
authors.initials: ME
authors.lastname: Jackson
authors.forename: André J
authors.initials: AJ
authors.lastname: Sommer
authors.forename: James A
authors.initials: JA
authors.lastname: McAteer
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Evan
mesh_terms: D001031:Apatites / Q000737:chemistry*; D002129:Calcium Oxalate / Q000737:chemistry*; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000473:pathology; D007679:Kidney Medulla / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D013055:Spectrophotometry, Infrared; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D001031:Apatites; D002129:Calcium Oxalate