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Beginnings of nephrolithiasis: insights into the past, present and future of Randall's plaque formation research

Wiener, Scott, V.a; Ho, Sunita, P.a,b; Stoller, Marshall, L.a

Current Opinion in Nephrology and Hypertension: July 2018 - Volume 27 - Issue 4 - p 236–242
doi: 10.1097/MNH.0000000000000414
MINERAL METABOLISM: Edited by Tamara Isakova and David A. Bushinsky

Purpose of review Kidney stones form as a result of heterogeneous nucleation on a calcium phosphate lesion in the renal papilla known as Randall's plaque. Stone disease has plagued humans for millennia with relatively little progress made in the realm of prevention. An understanding of the historical aspects of research into Randall's plaque is necessary to interpret novel correlative imaging discoveries. Focus for the past several decades has been on the distal papillary tip, and the overlooked Anderson–Carr–Randall progression is revitalized with novel supporting evidence.

Recent findings Novel correlative techniques of three-dimensional micro-XCT imaging combined with electron and light microscopy techniques have revealed that the earliest mineralization event in the papilla is a distinct event that occurs proximal to the region where Randall's plaque has traditionally been identified.

Summary The history of Randall's plaque research and the Anderson–Carr–Randall progression is reviewed. Proximal intratubular mineral deposits in normal and Randall's plaque affected papillae may be a target for future therapeutic interventions for nephrolithiasis. Further collaboration between nephrologists and urologists is necessary to cure this debilitating disease.

aDepartment of Urology, School of Medicine

bDepartment of Preventive and Restorative Dental Sciences School of Dentistry, University of California San Francisco, San Francisco, California, USA

Correspondence to Sunita P. Ho, PhD, UCSF, San Francisco, CA 94143, USA. Tel: +1 415 514 2818; e-mail:

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