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      Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update

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          Abstract

          Introduction

          To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description.

          Patients and methods

          We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions.

          Results

          Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones.

          Conclusions

          The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.

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          Most cited references17

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          THE ORIGIN AND GROWTH OF RENAL CALCULI.

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            Urinary calculi: review of classification methods and correlations with etiology.

            Current physical and chemical methods available for urinary stones analysis are critically reviewed. No one method is sufficient to provide all the clinically useful information on the structure and composition of the stones. We show that a combination of refined morphological and structural examination of stone with optical microscopy, complemented by compositional analysis using infrared spectroscopy of the core, cross-section and surface of calculi, provides a precise and reliable method for identifying the structure and crystalline composition, and permits quantification of stone components while being highly cost effective. Using such morphoconstitutional studies leads to a classification of urinary stones in seven distinctive types and twenty-one subtypes among monohydrate (whewellite) and dihydrate (weddellite) calcium oxalates, phosphates, uric acid, urates, protein, and cystine calculi. Furthermore, all of the recognized sub-types exhibit correlations with specific pathophysiologic conditions. We conclude that such morphoconstitutional refined analysis and classification of urinary calculi is of interest to properly identify the type of stone disease and provides clues to etiopathogeny.
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              Randall's plaque as the origin of calcium oxalate kidney stones.

              Eight decades ago, Alexander Randall identified calcium phosphate deposits at the tip of renal papillae as the origin of renal calculi. The awareness that these "Randall's plaque" promote renal stone formation has been amplified during the past years by the development of endoscopic procedures allowing the in situ visualization of these plaques. Recent studies based upon kidney biopsies evidenced that apatite deposits at the origin of these plaque originate from the basement membranes of thin loops of Henle and then spread in the surrounding interstitium. In addition, scanning electron microscopy examination of calcium oxalate stones developed on Randall's plaque evidenced that plaque may also be made of tubules obstructed by calcium phosphate plugs. Hypercalciuria has been associated to Randall's plaque formation. However, several additional mechanisms may be involved resulting in increased tissular calcium phosphate supersaturation and the role of macromolecules in plaque formation remains elusive. At last, apatite crystals are the main mineral phase identified in plaques, but other calcium phosphates and various chemical species such as purines have been evidenced, revealing thereby that several mechanisms may be responsible for plaque formation.
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                Author and article information

                Contributors
                c_almeras@yahoo.fr
                michel.daudon@aphp.fr
                vincent.estrade@gmail.com
                gautierjr@hotmail.fr
                olivier.traxer@aphp.fr
                paul.meria@aphp.fr
                Journal
                World J Urol
                World J Urol
                World Journal of Urology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0724-4983
                1433-8726
                19 March 2020
                19 March 2020
                2021
                : 39
                : 1
                : 177-185
                Affiliations
                [1 ]Department of Urology, La Croix du Sud Clinic, 52 chemin de Ribaute, 31130 Quint Fonsegrives, France
                [2 ]Unit of Functional Explorations, Tenon Hospital, Pierre and Marie Curie University, Paris, France
                [3 ]Department of Urology, Hospital, Angoulême, France
                [4 ]Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France
                [5 ]Department of Urology, Saint-Louis Hospital, Denis Diderot University, Paris, France
                Article
                3149
                10.1007/s00345-020-03149-4
                7858204
                32193654
                bce94a0a-0a78-4d1c-bd42-f497a8c9a699
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 25 August 2019
                : 26 February 2020
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Urology
                kidney,stone,renal,papillary abnormalities,classification
                Urology
                kidney, stone, renal, papillary abnormalities, classification

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