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Urolithiasis

, Volume 46, Issue 4, pp 333–341 | Cite as

High frequency and wide range of human kidney papillary crystalline plugs

  • Léa Huguet
  • Marine Le Dudal
  • Marine Livrozet
  • Dominique Bazin
  • Vincent Frochot
  • Joëlle Perez
  • Jean-Philippe Haymann
  • Isabelle Brocheriou
  • Michel Daudon
  • Emmanuel Letavernier
Original Paper

Abstract

Most of kidney stones are supposed to originate from Randall’s plaque at the tip of the papilla or from papillary tubular plugs. Nevertheless, the frequency and the composition of crystalline plugs remain only partly described. The objective was to assess the frequency, the composition and the topography of papillary plugs in human kidneys. A total of 76 papillae from 25 kidneys removed for cancer and without stones were analysed by immunohistochemistry combined with Yasue staining, field emission-scanning electron microscopy and Fourier transformed infrared micro-spectroscopy. Papillary tubular plugs have been observed by Yasue staining in 23/25 patients (92%) and 52/76 papillae (68%). Most of these plugs were made of calcium phosphate, mainly carbonated apatite and amorphous calcium phosphate, and rarely octacalcium phosphate pentahydrate. Calcium and magnesium phosphate (whitlockite) have also been observed. Based upon immunostaining coupled to Yasue coloration, most of calcium phosphate plugs were located in the deepest part of the loop of Henle. Calcium oxalate monohydrate and dihydrate tubular plugs were less frequent and stood in collecting ducts. At last, we observed calcium phosphate plugs deforming and sometimes breaking adjacent collecting ducts. Papillary tubular plugging, which may be considered as a potential first step toward kidney stone formation, is a very frequent setting, even in kidneys of non-stone formers. The variety in their composition and the distal precipitation of calcium oxalate suggest that plugs may occur in various conditions of urine supersaturation. Plugs were sometimes associated with collecting duct deformation.

Keywords

Kidney stone Calcium Phosphate Papilla Crystal Plug 

Notes

Compliance with ethical standards

Funding

This work has been supported by the Agence Nationale de la Recherche (ANR-13-JSV1-0010-01, ANR-12-BS08-0022), the Société de Néphrologie (Genzyme Grant), the Académie Nationale de Médecine (Nestlé-Waters award), Convergence-UPMC CVG1205 and CORDDIM-2013-COD130042.

Conflict of interest

All authors declare to have no conflict of interest.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Léa Huguet
    • 1
    • 2
  • Marine Le Dudal
    • 1
    • 2
  • Marine Livrozet
    • 1
    • 2
  • Dominique Bazin
    • 3
    • 4
  • Vincent Frochot
    • 5
  • Joëlle Perez
    • 1
    • 2
  • Jean-Philippe Haymann
    • 1
    • 2
    • 5
  • Isabelle Brocheriou
    • 6
  • Michel Daudon
    • 1
    • 2
    • 5
  • Emmanuel Letavernier
    • 1
    • 2
    • 5
    • 7
  1. 1.Sorbonne Universités, UPMC Univ Paris 06, UMR S 1155ParisFrance
  2. 2.INSERM, UMR S 1155ParisFrance
  3. 3.CNRS, Laboratoire de Chimie de la Matière Condensée de ParisUPMC, Collège de FranceParisFrance
  4. 4.Laboratoire de Physique des Solides, CNRS UMR 8502Université Paris Sud XIOrsayFrance
  5. 5.Physiology Unit, AP-HPHôpital TenonParisFrance
  6. 6.Pathology Unit, AP-HPHôpital TenonParisFrance
  7. 7.Service des Explorations Fonctionnelles MultidisciplinairesHôpital TENONParisFrance

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