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Renal histopathology of stone-forming patients with distal renal tubular acidosis
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Renal histopathology of stone-forming patients with distal renal tubular acidosis
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Renal histopathology of stone-forming patients with distal renal tubular acidosis
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Journal Article
Renal histopathology of stone-forming patients with distal renal tubular acidosis
2007
Overview
To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.
Publisher
Elsevier Inc,Nature Publishing,Elsevier Limited
Subject
Acidosis, Renal Tubular - diagnostic imaging
/ Acidosis, Renal Tubular - pathology
/ Acidosis, Renal Tubular - surgery
/ Adult
/ Aged
/ Biological and medical sciences
/ Biopsy
/ Female
/ Humans
/ Kidney Calculi - diagnostic imaging
/ Kidney Cortex - diagnostic imaging
/ Kidney Medulla - diagnostic imaging
/ Male
/ Nephrology. Urinary tract diseases
