Microstructures of Randall's plaques and their interfaces with calcium oxalate monohydrate kidney stones reflect underlying mineral precipitation mechanisms.
Randall's plaques (RP) are preferred sites for the formation of calcium oxalate monohydrate (COM) kidney stones. However, although processes of interstitial calcium phosphate (CaP) plaque formation are not well understood, the potential of plaque microstructures as indicators of CaP precipitation conditions received only limited attention. We investigated RP-associated COM stones for structural details of the calcified tissues and microstructural features of plaque-stone interfaces as indicators of the initial processes of stone formation. Significantly increased CaP supersaturation can be expected for interstitial fluid, if reabsorbed ions from the tubular system continuously diffuse into the collagenous connective tissue. Densely packed, fine-grained CaP particles were found in dense textures of basement membranes while larger, laminated particles were scattered in coarse-meshed interstitial tissue, which we propose to be due to differential spatial confinements and restrictions of ion diffusion. Particle morphologies suggest an initial precipitation as metastable amorphous calcium phosphate (ACP). Morphologies and arrangements of first COM crystals at the RP-stone interface ranged from stacked euhedral platelets to skeletal morphologies and even porous, dendritic structures, indicating, in this order, increasing levels of COM supersaturation. Furthermore, these first COM crystals were often coated with CaP. On this basis, we propose that ions from CaP-supersaturated interstitial fluid may diffuse through porous RP into the urine, where a resulting local increase in COM supersaturation could trigger crystal nucleation and, hence, initiate stone formation. Ion-depleted fluid in persistent pores of initial COM layers may get replenished from interstitial fluid, leading to CaP precipitation in porous COM.
Institut für Angewandte Geowissenschaften, Technische Universität Darmstadt, Schnittspahnstr. 9, 64287, Darmstadt, Germany. sethmann@geo.tu-darmstadt.de.
Ingo
http://orcid.org/0000-0003-1852-4198
I
Sethmann
Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany.
Gunnar
G
Wendt-Nordahl
Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany.
Thomas
T
Knoll
Institut für Geowissenschaften, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 21, 55128, Mainz, Germany.
Frieder
F
Enzmann
Institut für Geowissenschaften, Johannes Gutenberg-Universität Mainz, Johann-Joachim-Becher-Weg 21, 55128, Mainz, Germany.
Ludwig
L
Simon
Institut für Angewandte Geowissenschaften, Technische Universität Darmstadt, Schnittspahnstr. 9, 64287, Darmstadt, Germany.
Hans-Joachim
HJ
Kleebe
D001485:Basement Membrane / Q000737:chemistry; D002129:Calcium Oxalate / Q000737:chemistry*; D002130:Calcium Phosphates / Q000737:chemistry*; D045604:Extracellular Fluid / Q000737:chemistry; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000473:pathology / Q000601:surgery / Q000648:ultrastructure*; D007679:Kidney Medulla / Q000473:pathology*; D008855:Microscopy, Electron, Scanning; D000074642:Nephrolithotomy, Percutaneous; D014057:Tomography, X-Ray Computed
D002130:Calcium Phosphates; C519480:amorphous calcium phosphate; D002129:Calcium Oxalate; C018392:tricalcium phosphate
Calcium oxalate monohydrate; Calcium phosphate; Interstitial plaque; Microstructure; Nephrolithiasis; Precipitation mechanism
Urol Res. 2010 Aug;38(4):281-92
20625894
J Urol. 1997 Jan;157(1):376-83
8976301
Kidney Int. 1994 Sep;46(3):847-54
7996806
Anat Rec (Hoboken). 2007 Oct;290(10):1315-23
17724713
Invest Urol. 1981 Mar;18(5):358-63
7203960
Coll Relat Res. 1986 Jul;6(3):229-38
3021383
Kidney Int. 2002 Nov;62(5):1724-31
12371973
Urolithiasis. 2015 Jan;43 Suppl 1:109-23
25119506
J Biomed Mater Res A. 2004 Apr 1;69(1):11-6
14999746
J Urol. 2005 Jan;173(1):117-9; discussion 119
15592050
Urol Res. 1995;23(5):319-26
8839389
Kidney Int. 1978 May;13(5):344-60
351263
J Urol. 2011 Apr;185(4):1304-11
21334658
Miner Electrolyte Metab. 1994;20(6):385-92
7783701
Eur Urol. 2002 Sep;42(3):289-96
12234515
Clin Sci Mol Med. 1975 Nov;49(5):369-74
1192695
Urol Res. 2010 Jun;38(3):147-60
20411383
Calcif Tissue Int. 2013 Oct;93(4):348-54
23334303
J Synchrotron Radiat. 2010 May;17(3):374-9
20400836
Science. 1988 Dec 23;242(4885):1585
17788426
Kidney Int. 2006 Apr;69(8):1313-8
16614720
J Clin Invest. 2003 Mar;111(5):602-5
12618514
Urol Res. 2009 Aug;37(4):181-92
19444436
J Urol. 2016 Nov;196 (5):1566-1574
27157373
J Urol. 1984 Jan;131(1):77-81
6537822
Urol Res. 2009 Feb;37(1):11-7
19066874
Ann Surg. 1937 Jun;105(6):1009-27
17856988
Proc Natl Acad Sci U S A. 2000 Jul 18;97(15):8352-7
10890885
Urol Res. 2011 Aug;39(4):231-43
21246193
J Clin Invest. 2003 Mar;111(5):607-16
12618515
Chem Rev. 2008 Nov;108(11):4628-69
18816145
J Urol. 2012 Mar;187(3):1094-100
22266007
Urologe A. 2008 May;47(5):538, 540-44
18392604
Kidney Int. 2004 Nov;66(5):2032-7
15496176
Kidney Int. 2005 Jul;68(1):145-54
15954903
J Biol Chem. 1993 Jul 15;268(20):15180-4
8325891
Urolithiasis. 2015 Jan;43 Suppl 1:41-5
25475492
Biophys J. 2007 Sep 1;93(5):1768-77
17496021
Urolithiasis. 2015 Jan;43 Suppl 1:77-92
25119505