Urological Research Center (URC), Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
World J Urol. 2019 Oct;37(10):2207-2215. doi: 10.1007/s00345-018-02616-3. Epub 2019 Jan 4.
Advancements in endoscopy offer the possibility of inspection of intrarenal anatomy and pathology. The aim of the study was to evaluate renal papillary appearance in kidney stone formers and to correlate papillary findings with stone type and patient metabolic data.
A consecutive cohort of 46 kidney stone formers undergoing retrograde intrarenal surgery was enrolled. During surgery, renal papillae were characterized in the domains of ductal Plugging (DP), surface Pitting, Loss of papillary contour, and Amount of Randall's plaque (RP, PPLA scoring). Stone material was analyzed using micro-CT and infrared spectroscopy, and blood and urine were collected for metabolic evaluation.
In all patients, renal papillae had changes in at least one of the domains of the PPLA score. Examining the total population, it was evident that patients with predominantly plugging (DP > 0) all had very low RP scores. There were no significant trends between mean PPLA scores and urinary analytes for the total group.
Efforts to prevent renal stone formation have so far been insufficient in majority of patients. Digital endoscopy reveals that kidney stone formers have different and distinct papillary morphologies that seem to be linked to specific stone-forming pathways. Since renal papillary abnormalities may be easily identified during endoscopy, this may in the future prove to be an important method for tailoring prevention strategies in kidney stone patients.
内镜技术的进步为检查肾内解剖结构和病理提供了可能。本研究旨在评估肾结石患者的肾乳头外观，并将乳头发现与结石类型和患者代谢数据相关联。
连续纳入 46 例接受逆行肾盂内手术的肾结石患者。在手术过程中，对肾乳头在管腔阻塞（DP）、表面凹陷、乳头轮廓丧失和 Randall 斑块量（PPLA 评分）等领域进行了特征描述。使用 micro-CT 和红外光谱分析结石材料，并采集血液和尿液进行代谢评估。
在所有患者中，至少有一个 PPLA 评分领域的肾乳头发生了变化。在整个研究人群中，明显的是，主要存在阻塞（DP>0）的患者的 RP 评分均非常低。对于整个组，平均 PPLA 评分与尿分析物之间没有显著趋势。
到目前为止，大多数患者的肾结石预防措施都不够充分。数字内镜显示，肾结石患者的肾乳头形态不同且独特，似乎与特定的结石形成途径有关。由于在进行内镜检查时很容易识别肾乳头异常，因此这可能是未来为肾结石患者量身定制预防策略的重要方法。
