Pathogenic Variants of Urolithiasis

Cover Page


The essence of Urolithiasis - one of the oldest diseases known by the mankind - is still not understood completely. For a long time the comprehension of Urolithiasis was based on matrix, colloid, ionic, inhibitory and precipitation theories. In these cases it was impossible to single out separate pathogenetic patterns. Besides, in spite of the absence of in vivo proofs the fact that new concrement nucleus forming (de novo nucleation) is only possible outside of the stone-forming metastability range should be taken into consideration for metaphilactic purposes. Fortunately, certain progress in understanding Urolithiasis started with the onset of studies devoted to detailed scrutiny of stone-forming patients’ metabolic peculiarities as well as with the introduction into clinical practice of the up-to-date digital endoscopes. Based on existing publications one may classify pathogenesis of stone-forming into 4 major groups: growth of calcium-oxalic stones on Randall’s plaques in patients with hypercalciumuria; excrescences on the of Belliny’s ducts’ “gags”; microlites forming within the internal medullar layer discharging tubules’ lumen in patients with cystineuria; stones forming in free solution. There is no doubt this classification is not the final one, neither does it exclude mixed variants, however better understanding of the aforementioned pathogenic variants would facilitate a novel view at Urolithiasis and in patients with kidney stones would increase anti-relapse measures’ effectiveness.

Petr S Baketin

Author for correspondence.
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine
Russian Federation

urologist, Department of Urology

Rashid A Mollaev
Askerkhanov Central municipal hospital
Russian Federation


Denis A Mazurenko
Urologic Clinic. EMC
Russian Federation

urologist, MD, PhD. Vice Director

Vladislav E Grigoryev
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine
Russian Federation

urologist, Department of Urology

Nariman K Gadzhiev
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine
Russian Federation

urologist, Department of Urology

Vladimir M Obidnyak
St Petersburg St Luka Clinical Hospital
Russian Federation

MD, urologist. Department of Urology

Alexey V Pisarev
St Petersburg Multiprofile Center
Russian Federation

MD, urologist. Department of Urology

Nair S Tagirov
St Petersburg St Elisabeth City Hospital
Russian Federation

MD, PhD, urologist

Vigen A Malkhasyan
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Russian Federation

Assistant, Department of Urology

Sergey B Petrov
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine
Russian Federation

urologist, MD, Professor. Head of department of Urology

Sergei V Popov
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine
Russian Federation

MD, PhD, Dr Med Sci, Head Doctor

  • Васильев А.Г., Комяков Б.К., Тагиров Н.С., Мусаев С.А. Чрескожная нефролитотрипсия в лечении коралловидного нефролитиаза // Профилактическая и клиническая медицина. – 2009. – № 4. – С. 183–186. [Vasil’ev AG, Komjakov BK, Tagirov NS, Musaev SA. Percutaneous nephrolithotripsy in treatment of staghorn urolithiasis. Profilakticheskaja i klinicheskaja medicina. 2009;(4):183-186. (In Russ.)]
  • Тагиров Н.С., Назаров Т.Х., Васильев А.Г., и др. Опыт применения чрескожной нефролитотрипсии и контактной уретеролитотрипсии в комплексном лечении мочекаменной болезни // Профилактическая и клиническая медицина. – 2012. – № 4. – С. 30–33. [Tagirov NS, Nazarov TH, Vasil’ev AG, et al. Combined PCNL and URS in urinary stone disease treatment. Profilakticheskaja i klinicheskaja medicina. 2012;(4):30-33. (In Russ.)]
  • Трашков А.П., Васильев А.Г., Коваленко А.Л., Тагиров Н.С. Метаболическая терапия мочекаменной болезни на различных моделях поражения почек у крыс // Экспериментальная и клиническая фармакология. – 2015. – Т. 78. – № 3. – С. 17–21. [Trashkov AP, Vasil’ev AG, Kovalenko AL, Tagirov NS. Metabolic treatment of urolithiasis in different rat models. Eksperimental’naja i klinicheskaja farmakologija. 2015;78(3):17-21. (In Russ.)]
  • Asplin JR, Parks JH, Coe FL. Dependence of upper limit of metastability on supersaturation in nephrolithiasis. Kidney Int. 1997;52:1602-8. doi: 10.1038/ki. 1997.491.
  • Bergsland KJ, Worcester EM, Coe FL. Role of proximal tubule in the hypocalciuric response to thiazide of patients with idiopathic hypercalciuria. Am J Physiol Renal Physiol. 2013;305:F592-9. doi: 10.1152/ajprenal.00116.2013.
  • Evan AP, Lingeman J, Coe F, et al. Renal histopathology of stone-forming patients with distal renal tubular acidosis. Kidney Int. 2007;71:795-801. doi: 10.1038/
  • Evan AP, Lingeman JE, Coe FL, et al. Randall’s plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle. J Clin Invest. 2003;111:607-16. doi: 10.1172/JCI17038.
  • Evan AP, Lingeman JE, Coe FL, et al. Crystal-associated nephropathy in patients with brushite nephrolithiasis. Kidney Int. 2005;67:576-91. doi: 10.1111/j.1523-1755.2005.67114.x.
  • Evan A, Lingeman J, Coe FL, Worcester E. Randall’s plaque: pathogenesis and role in calcium oxalate nephrolithiasis. Kidney Int. 2006;69:1313-8. doi: 10.1038/
  • Evan AP, Coe FL, Gillen D, et al. Renal intratubular crystals and hyaluronan staining occur in stone formers with bypass surgery but not with idiopathic calcium oxalate stones. Anat Rec (Hoboken). 2008;291:325-34. doi: 10.1002/ar.20656.
  • Evan AP, Coe FL, Lingeman JE, et al. Renal crystal deposits and histopathology in patients with cystine stones. Kidney Int. 2006;69:2227-35. doi: 10.1038/
  • Evan AP, Coe FL, Lingeman JE, et al. Mechanism of formation of human calcium oxalate renal stones on Randall’s plaque. Anat Rec (Hoboken). 2007;290:1315-23. doi: 10.1002/ar.20580.
  • Evan AP, Lingeman JE, Worcester EM, et al. Renal histopathology and cry*stal deposits in patients with small bowel resection and calcium oxalate stone disease. Kidney Int. 2010;78:310-7. doi: 10.1038/ki.2010.131.
  • Evan AP. Histopathology predicts the mechanism of stone formation. AIP Conf Proc. 2007;900:15-25. doi: 10.1063/1.2723555.
  • Evan AP, Lingeman JE, Coe FL, et al. Intra-tubular deposits, urine and stone composition are divergent in patients with ileostomy. Kidney Int. 2009;76:1081-8. doi: 10.1038/ki.2009.321.
  • Evan AP, Lingeman JE, Worcester EM, et al. Contrasting histopathology and crystal deposits in kidneys of idiopathic stone formers who produce hydroxy apatite, brushite, or calcium oxalate stones. Anat Rec (Hoboken). 2014;297:731-48. doi: 10.1002/ar.22881.
  • Gokhale JA, McKee MD, Khan SR. Immunocytochemical localization of Tamm-Horsfall protein in the kidneys of normal and nephrolithic rats. Urol Res. 1996;24:201-9. doi: 10.1007/BF00295893.
  • Jamison R, Frey N, Lacy F. Calcium reabsorption in the thin loop of Henle. Am J Physiol (Leg Content). 1974;227.
  • Kok DJ, Khan SR. Calcium oxalate nephrolithiasis, a free or fixed particle disease. Kidney Int. 1994;46:847-54. doi: 10.1038/ki.1994.341.
  • Miller NL, Gillen DL, Williams JC, et al. A formal test of the hypothesis that idiopathic calcium oxalate stones grow on Randall’s plaque. BJU Int. 2009;103:966-71. doi: 10.1111/j.1464-410X.2008.08193.x.
  • Miller NL, Williams JC, Evan AP, et al. In idiopathic calcium oxalate stone-formers, unattached stones show evidence of having originated as attached stones on Randall’s plaque. BJU Int. 2010;105:242-5. doi: 10.1111/j.1464-410X.2009.08637.x.
  • Parks JH, Coward M, Coe FL. Correspondence between stone composition and urine supersaturation in nephrolithiasis. Kidney Int. 1997;51:894-900.
  • Parks JH, Coe FL. Evidence for durable kidney stone prevention over several decades. BJU Int. 2009;103:1238-46. doi: 10.1111/j.1464-410X.2008.08170.x.
  • Randall A. The origin and growth of renal calculi. Ann Surg. 1937;105:1009-27. doi: 10.1097/00000658-193706000-00014.
  • Verkoelen C, Verhulst A. Proposed mechanisms in renal tubular crystal retention. Kidney Int. 2007;72:13-8. doi: 10.1038/
  • Vermeulen CW, Lyon ES, Fried FA, et al. Mechanisms of genesis and growth of calculi. Am J Med. 1968;45:684-92. doi: 10.1016/0002-9343(68)90204-0.
  • Worcester EM, Evan AP, Coe FL, et al. A test of the hypothesis that oxalate secretion produces proximal tubule crystallization in primary hyperoxaluria type I. Am J Physiol Renal Physiol. 2013;305:F1574-84. doi: 10.1152/ajprenal.00382.2013.
  • Worcester EM, Coe FL, Evan AP, et al. Evidence for increased postprandial distal nephron calcium delivery in hypercalciuric stone-forming patients. Am J Physiol Renal Physiol. 2008;295: F1286-94. doi: 10.1152/ajprenal.90404.2008.


Abstract - 111

PDF (Russian) - 223

Copyright (c) 2017 Baketin P.S., Mollaev R.A., Mazurenko D.A., Grigoryev V.E., Gadzhiev N.K., Obidnyak V.M., Pisarev A.V., Tagirov N.S., Malkhasyan V.A., Petrov S.B., Popov S.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.