Alexander Randall may have had it right after all
Commentary

Alexander Randall may have had it right after all

Thomas Chi, Eric Taylor, Marshall L. Stoller

Department of Urology, University of California, San Francisco, California, USA

Correspondence to: Thomas Chi. Assistant Professor, Department of Urology, University of California, 400 Parnassus Ave, 6th Floor Urology Clinics, Box 0638, San Francisco, CA 94143, USA. Email: tchi@urology.ucsf.edu; Marshall L. Stoller, M.D. Professor and Vice Chair, Department of Urology, University of California, 400 Parnassus Ave, 6th Floor Urology Clinics, Box 0638, San Francisco, CA 94143, USA. Email: MStoller@urology.ucsf.edu.

Submitted Jul 09, 2014. Accepted for publication Aug 09, 2014.

doi: 10.3978/j.issn.2223-4683.2014.08.08


Several theories exist regarding the pathogenesis of urinary calculi, and the early incipient events leading to calculus formation remain the most controversial. The authors detail a theory by which microscopic Randall plaques (RP) lead to calcium oxalate calculi in idiopathic calcium oxalate stone formers (1). Outlined is a process by which RP form in the basement membrane of the loops of Henle and spread through the interstitium through mineral deposition in an organic matrix, eventually eroding through the urothelium. Once exposed to the urinary milieu, precipitation of minerals and organic substances occurs based on urinary constituents. The process leading to RP formation is not yet fully defined, but one must consider an alternative theory based on a more vascular process. In short, formation may be RP due to a process similar to how atherosclerotic lesions form in arteries as the vasa recta that surround the tubules have turbulent flow, relative hypoxia, and hyperosmolarity which is an ideal environment for vascular injury and a calcifying process. The early events leading to RP and calcium oxalate stone formation has yet to be determined, but is likely multifactorial and represents an area of research fit for collaboration beyond our fellow urologic colleagues.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Chung HJ. The role of Randall plaques on kidney stone formation. Transl Androl Urol 2014;3:251-4.
Cite this article as: Chi T, Taylor E, Stoller ML. Alexander Randall may have had it right after all. Transl Androl Urol 2014;3(3):255. doi: 10.3978/j.issn.2223-4683.2014.08.08