Kidney stone disease
Fredric L. Coe, … , Andrew Evan, Elaine Worcester
Fredric L. Coe, … , Andrew Evan, Elaine Worcester
Published October 3, 2005
Citation Information: J Clin Invest. 2005;115(10):2598-2608. https://doi.org/10.1172/JCI26662.
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Science in Medicine

Kidney stone disease

Abstract

About 5% of American women and 12% of men will develop a kidney stone at some time in their life, and prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP); 10% of struvite (magnesium ammonium phosphate produced during infection with bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stones. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. Here we focus on the mechanisms of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including recent developments in our understanding of related changes in human kidney tissue and of underlying genetic causes, in addition to current therapeutics.

Authors

Fredric L. Coe, Andrew Evan, Elaine Worcester

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Figure 2

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Accumulation of interstitial crystal deposits as seen in light and TEM i...
Accumulation of interstitial crystal deposits as seen in light and TEM images in a papillary biopsy from an idiopathic CaOx SF. (A) Light microscopy reveals extensive accumulation of crystalline deposits (green arrow) shown around the Henle loops and nearby vascular bundles and inner medullary CDs. This progressive accumulation of crystalline material in the interstitium results in the formation of incomplete to complete cuffs of plaque. (B) TEM reveals a normal thin Henle loop surrounded by a complete cuff of interstitial plaque. (C) TEM shows a site of plaque located in the interstitial space, away from a tubular wall. Note that single crystal deposits appear embedded in a sea of matrix. Magnification: ×1,500 (A); ×13,000 (B); ×13,000 (C). A reprinted from ref. 19. B reprinted with permission from Urological Research (123). C reprinted with permission from Kidney International (21).