Randall’s斑与尿路结石

Randall’s斑是肾乳头尖部或其周围的间质组织中出现结晶沉淀的现象，随着结晶沉淀残留，最终发展为尿路结石。这一观点被越来越多的学者关注。因此Randall’s斑的研究对揭开结石形成之迷具有重要意义。本文就Randall’s斑发现、Randall’s斑尿石学说、Randall’s斑发生机制、Randall’s斑形成起始部位和成分、Randall’s斑与尿路结石和尿液关系等作一综述。     

肾移植病人尿路结石的诊断与治疗

肾移植病人尿路结石可以分为供肾原有结石和移植后新发结石两类，其诊断虽具有一定的难度，但是其治疗方法与非移植病人大致相仿，且预后较好，本文就其发病原因，诊断，治疗进行综述。     

上尿路结石药物治疗研究进展

近年来,药物治疗上尿路结石研究的不断深入,目前许多药物既可用于上尿路结石的保守治疗,还可作为结石碎石术后的辅助排石用药,为提高上尿路结石的疗效开拓了一个新的途径.     

尿路结石的细菌感染

报告50例尿路结石细菌培养和尿液检查结果,发现结石核心和表层的细菌感染率分别为32%和38%,尿路结石的数目增多和出现肾积水可使感染率升高,尤其在肾功能受损时,结石感染率显著增加(55%)。提示,尿液检查往往不能确切反映出结石内的感染情况;尿路结石的核心和表层可存在不同的感染细菌,肾功能的变化对此有较大影响。     

肾移植病人尿路结石的诊断与治疗

肾移植病人尿路结石可以分为供肾原有结石和移植后新发结石两类。其诊断虽具有一定的难度 ,但是其治疗方法与非移植病人大致相仿 ,且预后较好。本文就其发病原因、诊断、治疗进行综述。     

尿路结石药物排石疗法研究新进展

尿路结石微创外科治疗过去10年突飞猛进，而药物排石疗法（MET）在尿路结石治疗中仍占重要地位。排石药物主要包括：α-受体阻滞剂、钙离子通道拈抗剂、前列腺素生成酶抑制剂、性激素、糖皮质激素。现对药物排石疗法研究新进展作一综述。     

肠道对草酸的处理与尿路结石防治的新进展

近年来，草酸的肠道吸收对泌尿系结石的防治正渐渐的被人所重视。本文就草酸的肠道吸收重要性、草酸的肠道转运方式、影响草酸吸收的因素等方面，将近年来的新进展加以阐述。     

化学定性与红外光谱分析尿路结石成分

尿石症是泌尿外科的常见病，治疗后复发率很高。结石成分的确定，对于深入探讨泌尿系结石的成因、治疗和预防结石复发有着重要的临床意义。我院对2001年4月至2006年5月的656例结石标本进行了化学定性和定量分析，现报告如下。     

The riddle of Randall's plaques.

Randall described a pre-calculus lesion of the renal papilla in the 1930s and this was substantiated by others during the next decade and then largely ignored. This insignificant subepithelial calcification of the renal papilla. Randall's plaque type I, becomes the nucleus of at least 15% of calcium oxalate calculi, as demonstrated by apatite nuclei existing in papillary depression on the external stone surface. Cross section study of the stone demonstrates the peripheral nucleus with eccentric lamination postulating a mural origin. Contrariwise, study of the stone developing upon a nucleus originating in the papillary ducts (without producing obstruction) or out in the calix demonstrates a central nucleus surrounded by concentric laminations or lack of a mural origin, the more common type of calcium oxalate stone structure. Obstruction of the papillary ducts by hyperexcretion of stone salt may result in anemic infarction and sloughing of the apex of the papilla. Data concerning the prevalence of Randall's plaques in the population have been reviewed. Evidence of the incidence of calcium oxalate calculi that have developed upon Randall's plaques has been presented. A plea for further study of the pathology of the renal papilla has been voiced.     

Metabolic and urinary risk factors associated with Randall's papillary plaques

BACKGROUND AND PURPOSE: Increasing evidence suggests that Randall's plaques contribute to the pathogenesis of urinary stone formation. The purpose of our study was to evaluate the urinary risk factors of stone patients who underwent endoscopic mapping of their calices for Randall's plaques. PATIENTS AND MATERIALS: Patients (N = 143) having endoscopic procedures to remove upper tract calculi or for other purposes underwent mapping of their calices for Randall's plaques. Plaque incidence and pattern were correlated with the stone composition and urinary risk factors found on subsequent metabolic evaluation. RESULTS: Papillary plaques were found more commonly in patients having calcium oxalate stones than in patients with other stone types and patients without a history of stones. Papillary plaque incidence and pattern did not correlate with any specific urinary risk factor; however, patients with plaques tended to exhibit a higher incidence of all risk factors. Plaque severity tended to be greater in patients exhibiting hypercalciuria. CONCLUSIONS: Randall's plaques are found most frequently in patients with calcium oxalate stones and are most important in the pathogenesis of calcium oxalate nephrolithiasis. Stone patients with papillary plaques are more likely to exhibit abnormalities in their urinary milieu than are patients without papillary plaques.     

Papillary stones: calcified renal tubules in Randall's plaques

Papillary stones are small, rounded concretions with one smooth convex face and one concave face which corresponds to its implantation on the papilla and in which a whitish Randall's plaque is often present. Eighty-seven papillary stones were studied with stereoscopic, scanning electron microscopic and x-ray dispersive energy analysis. Sixty-three stones had a plaque and 13 of these showed calcified renal tubules that demonstrated their intrapapillary origin and a link between partial papillary nephrocalcinosis and renal stones.     

The role of Randall's plaques in the pathogenesis of calcium stones

PURPOSE: Knowledge of the inciting lesion in kidney stone formation has remained rudimentary until quite recently. Randall theorized that areas of apatite plaque on the renal papillae would be an ideal site for an overgrowth of calcium oxalate to develop into a calculus. We reviewed in vivo data that have further defined the role of Randall's plaques in stone disease. MATERIALS AND METHODS: We examined a set of literature that tested 2 hypotheses, that is 1) Randall's plaques are a specialized disease that begins as apatite in a unique region of the kidney due to local driving forces and anatomy, and 2) stones that arise from causes different from common calcium oxalate stones do not necessarily arise on plaque. RESULTS: Intraoperative papillary and cortical biopsy specimens obtained during percutaneous nephrolithotomy from the kidneys of 3 types of stone formers (idiopathic calcium stone formers, patients with stones due to bariatric procedures and brushite stone formers) showed unique histopathological findings. CONCLUSIONS: The metabolic and surgical pathological findings in 3 distinct groups of stone formers demonstrate that the histology of the renal papillae from a stone former is particular to the clinical setting.     

Revisiting Randall's plaque

Kidney stones have probably affected mankind for ages with early reports in an Egyptian mummy. While prevalence of stone disease is increasing, its pathogenesis remains elusive. Randall, after his study on more than 1100 cadaver kidneys, gave hypothesis of subepithelial plaque acting as a nucleation site for kidney stones. His plaque hypothesis met with criticism because he proposed a unified theory for all types of stones. However, recently Randall's plaque has been reinvestigated. This review discusses their role in stone formation and current understanding about their pathogenesis.Randall's plaques begin in the basement membrane of thin segment of loop of Henle. Low urine volume, hypercalciuria, low urine pH are now implicated as important urinary risk factors. Plaque–stone association is best described in the idiopathic calcium oxalate stone formers. Pathogenesis of plaque itself involves interaction of multiple factors including gene polymorphism, oxidative stress, inflammatory mediators, matrix proteins, and urinary solute supersaturation.     

Randall斑的研究现状

Randall斑可能是肾结石形成的初始环节,目前对其形成机制已有较多研究.分泌性蛋白、离子转运和细胞-晶体反应等可能在其中发挥作用.本文对此作一,为进一步研究Randall斑的形成提供新的思路.