Presentation Authors: Xavier Arnau Sabate Arroyo*, Sant Iscle de Vallalta, Spain, Enrique Pieras Ayala, Felix Grases Freixedas, Jose Luis Bauza Quetglas, Jorge Guimerá Garcia, Pedro Piza Reus, Palma de Mallorca, Spain
Introduction: Our purpose was to study the relationship between the type of endoscopic calcification in the renal papilla (Randallâ€™s plaque, intratubular calcification, papillary crater) with stone chemistry and 24-h urine chemistry.
Methods: This was a prospective study of 41 patients (age range: 18 to 80 years) undergoing retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 mm Â± 7.2 mm). We classified injuries of the renal papilla as Randall's plaque, tubular calcification, or papillary crater. The renal calculi were classified as uric acid, calcium oxalate monohydrate, calcium oxalate dihydrate, or calcium phosphate. A 24 h urine analysis of calcium, oxalate, citrate, and pH was performed in all patients. _x000D_
Each papillary endoscopically injury was analyzed and correlated with the type of stone and urine chemistry. Fisher's exact test and Student's t-test were used to determine the significance of differences. A p-value below 0.05 was considered statistically significant.
Results: The most common injury was tubular calcification (78%), followed by Randall's plaque (58%) and papillary crater (39%). There was no significant relationship between Randall's plaque with the type of stone. However, there were significant relationships between the type of stone and intratubular calcification (p = 0.025) and papillary crater (p = 0.041), in that COD and calcium phosphate stones were the most common types in both groups. There was also a significant relationship between the papillary crater and hypercalciuria (p = 0,036), between Randallâ€™s plaque and hypocitraturia (p=0,005) and papillary crater and hypooxaluria (p=0,024). None of the other differences were statistically significant.
Conclusions: Tubular calcification is the most common injury in patients with advanced renal lithiasis. Tubular calcification and papillary crater most often have COD and calcium phosphate stones. Hypercalciuria has positive associations with tubular calcification. Hypocitraturia has positive associations with Randallâ€™s plaque.. Tubular calcification and papillary crater may represent the same type of papillary injury.