Van de Perre Els, Maréchal Elise, Wissing Karl Martin, Haymann Jean-Philippe, Daudon Michel, Letavernier Emmanuel
Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Kidney Diseases, Dialysis & Transplantation Research Unit (NIER), Vitality Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Urolithiasis. 2025 May 27;53(1):99. doi: 10.1007/s00240-025-01743-y.
In 3.4% of Randall's plaques, monosodium urate can be detected. The formation mechanism of these Randall's plaques is unrevealed and the clinical and biochemical characteristics of affected patients are unknown. In this single centre study, we retrospectively analysed the clinical and biochemical characteristics of patients with kidney stone formation related to monosodium urate-containing Randall's plaques (NaUr RP) and those with stone formation related to "classical" Randall's plaques (NaUr RP). There was a significantly higher urinary calcium and magnesium excretion in the NaUr RP group (6.09 vs. 4.61 mmol/24 h, p = 0.03 and 4.78 vs. 3.55 mmol/24 h, p = 0.02). There was no significant difference in urinary uric acid excretion or urinary pH between both groups. The NaUr RP group tended to have more frequent hyperuricemia (71.4 vs. 44.8%, p = 0.08) and to be more frequently male (92.9 vs. 70.1%, p = 0.10) and had higher median age (53.5 vs. 27.5, p < 0.001) and serum creatinine (96.4 vs. 77.0 µmol/L, p < 0.001). Additionally, there was a signal of higher prevalences of hypertension, dyslipidemia, cardiovascular disease and gout in the NaUr RP group. Different formation mechanisms seem implicated in the formation of NaUr RP and NaUr RP - associated kidney stones. We hypothesize a mechanism of interstitial monosodium urate precipitation at the renal papilla driven by high systemic uric acid serum concentration to be involved in NaUr RP formation. Treatment with xanthine oxidase inhibitors may reduce the risk of recurrent stone formation on this specific Randall's plaque.
在3.4%的兰德尔斑中可检测到尿酸钠。这些兰德尔斑的形成机制尚未明确，受影响患者的临床和生化特征也不清楚。在这项单中心研究中，我们回顾性分析了与含尿酸钠的兰德尔斑（NaUr RP）相关的肾结石形成患者以及与“经典”兰德尔斑（NaUr RP）相关的结石形成患者的临床和生化特征。NaUr RP组的尿钙和镁排泄量显著更高（分别为6.09 vs. 4.61 mmol/24小时，p = 0.03；4.78 vs. 3.55 mmol/24小时，p = 0.02）。两组之间的尿酸排泄量或尿pH值无显著差异。NaUr RP组往往有更频繁的高尿酸血症（71.4% vs. 44.8%，p = 0.08），男性比例更高（92.9% vs. 70.1%，p = 0.10），中位年龄更高（53.5 vs. 27.5，p < 0.001），血清肌酐水平更高（96.4 vs. 77.0 µmol/L，p < 0.001）。此外，NaUr RP组中高血压、血脂异常、心血管疾病和痛风的患病率有升高的迹象。NaUr RP和与NaUr RP相关的肾结石的形成似乎涉及不同的形成机制。我们推测，高血清尿酸浓度驱动的肾乳头间质尿酸钠沉淀机制参与了NaUr RP的形成。使用黄嘌呤氧化酶抑制剂进行治疗可能会降低这种特定兰德尔斑上复发性结石形成的风险。
