RANDALL'S PLAQUES--RELATIONSHIP TO NEPHROLITHIASIS

兰德尔斑块——与肾结石的关系

• 批准号: 6600906
• 负责人: JAMES E LINGEMAN
• 金额: $ 10.78万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-07-01 至 2003-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6600906
• 关键词: calcium; calcium phosphate; clinical research; gastrointestinal disorder; histology; human subject; jejunectomy /duodenectomy /ileectomy; kidney; nephrolithiasis; oxalates; pathologic process; renal tubule acidosis; urinary calculi

In the clinical setting, it is a common observation that all fixed renal pelvic stones are adherent to the papilla (either the distal end of the ducts of Bellini, the renal papilla surface, or, less often, to the forniceal region). Stones are new found attached directly to the transitional epithelium of the papilla without ulceration and/or plaque. Once the stone dislodged from its' point of attachment, a site of eruption is noted in the transitional epithelium associated with the stone and that this site of eruption has, as its foundation or base, a plaque, termed a Randall's plaque after discovered. A clinical spectrum of papillary plaques is seen, from small subepithelial plaques to large, eroded plaques with a common association of attached calcium oxalate stones. The majority of the plaque area appears to be local beneath the transitional epithelium (subepithelial). Histologic examination of the affected papilla shows a region plaque extending into the interstitium of the papilla with additional regions of crystal deposition involving all tissues the papillary tip. The process by which a plaque forms is presently not known; however, it has been hypothesized (Anderson-Carr-Randall progression of renal calculus formation) that calcium deposits begin within the tissues of the papilla, which may migrate to a subepithelial position, forming Randall's plaques. The uniqueness of the experimental design of this project is that we will undertake this study in kidneys of well-characterized human stone formers using the technical advances that have occurred in endoscopic equipment and percutaneous surgical techniques. Such approach has not been previously used to study the pathogenesis of uroliathiasis. Tissue samples will be collected from all regions of the kidney and analyzed using crystallography, Fourier transform infrared microscopy and spectroscopy quantitatively energy and wavelength dispersive analysis, light; transmission and scanning electron microscopy. The morphological/analytical data will then be correlated with physiologic data (serum and urine studies) collected from patients. Within the construct of a cooperative program project, we plan to determine what are the important a substantive steps that lead to pathologic formation of uroliathiasis. The other projects will address urinary metabolic factors and crystal inhibitors (Project 1), hypercalciuria in an animal model (Project 3), vitamin D physiology (Project 4) and crystal-cell interactions, growth and inhibitions (Project 5).

在临床环境中，常见的观察结果是所有固定的肾盂结石都附着在乳头上（要么是贝利尼管的远端，肾乳头表面，或者更少见的是，附着在肾孔穴区域）。新发现的结石直接附着于乳头移行上皮，无溃疡和/或斑块。一旦结石脱离附着点，在与结石相关的移行上皮中会发现一个出疹点，并且这个出疹点有一个斑块作为其基础或基础，发现后称为兰德尔斑块。临床可见乳头状斑块，从小的上皮下斑块到大的侵蚀斑块，通常伴有草酸钙结石。大多数斑块区域似乎在移行上皮下（上皮下）的局部。病变乳头的组织学检查显示一个区域斑块延伸到乳头间质，并有额外的晶体沉积区域，包括乳头尖端的所有组织。空斑形成的过程目前尚不清楚；然而，据推测（肾结石形成的安德森-卡尔-兰德尔进展），钙沉积开始于乳头组织内，可能迁移到上皮下位置，形成兰德尔斑块。本项目实验设计的独特之处在于，我们将利用内窥镜设备和经皮手术技术的技术进步，在具有良好特征的人类结石患者的肾脏中进行这项研究。这种方法尚未被用于研究尿路结石的发病机制。组织样本将从肾脏的所有区域收集，并使用晶体学，傅里叶变换红外显微镜和光谱定量分析能量和波长色散分析，光；透射和扫描电子显微镜。形态学/分析数据将与从患者收集的生理数据（血清和尿液研究）相关联。在合作计划项目的框架内，我们计划确定导致尿路结石病理形成的重要实质性步骤。其他项目将涉及尿代谢因子和晶体抑制剂（项目1）、动物模型中的高钙尿症（项目3）、维生素D生理学（项目4）和晶体-细胞相互作用、生长和抑制（项目5）。