Origin of monosodium urate Randall's plaques.

IF 2 2区 医学 Q2 UROLOGY & NEPHROLOGY
Els Van de Perre, Elise Maréchal, Karl Martin Wissing, Jean-Philippe Haymann, Michel Daudon, Emmanuel Letavernier
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Abstract

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 pos RP) and those with stone formation related to "classical" Randall's plaques (NaUr neg RP). There was a significantly higher urinary calcium and magnesium excretion in the NaUr neg 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 pos 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 pos RP group. Different formation mechanisms seem implicated in the formation of NaUr pos RP and NaUr neg 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 pos RP formation. Treatment with xanthine oxidase inhibitors may reduce the risk of recurrent stone formation on this specific Randall's plaque.

尿酸钠兰德尔斑块的起源。
在3.4%的兰德尔氏斑块中可检出尿酸钠。这些兰德尔斑块的形成机制尚不清楚,受影响患者的临床和生化特征尚不清楚。在这项单中心研究中,我们回顾性分析了与含尿酸钠兰德尔斑块(NaUr - RP)相关的肾结石形成患者的临床和生化特征,以及与“经典”兰德尔斑块(NaUr - RP)相关的肾结石形成患者的临床和生化特征。NaUr阴性RP组尿钙、镁排泄量显著高于对照组(6.09 vs 4.61 mmol/24 h, p = 0.03; 4.78 vs 3.55 mmol/24 h, p = 0.02)。两组患者尿尿酸排泄量及尿pH值无显著差异。NaUr后RP组高尿酸血症发生率更高(71.4比44.8%,p = 0.08),男性发生率更高(92.9比70.1%,p = 0.10),中位年龄更高(53.5比27.5,p = RP组)。不同的形成机制似乎与NaUr - RP和NaUr - RP相关肾结石的形成有关。我们假设肾乳头间质尿酸钠沉淀的机制是由高全身尿酸血清浓度驱动的,参与了NaUr后RP的形成。黄嘌呤氧化酶抑制剂治疗可以降低这种特殊兰德尔斑块结石复发的风险。
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来源期刊
Urolithiasis
Urolithiasis UROLOGY & NEPHROLOGY-
CiteScore
4.50
自引率
6.50%
发文量
74
期刊介绍: Official Journal of the International Urolithiasis Society The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field. Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.
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