Figure 6 Tissular changes in crystalline CKD

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Figure 6 Tissular changes in crystalline CKD Figure 6 | Endoscopic and histopathologic changes in papillary biopsy samples from stone formers. a | Idiopathic calcium oxalate stone formers (ICSFs) with hypercalciuria have calcium oxalate stones (arrowheads) attached to a white Randall's plaque (arrows). b | The white, suburothelial sites of the interstitial plaque (arrows) are easily visible after the attached stones have been removed using percutaneous nephrolithotomy or ureteroscopic lithotripsy. c | The initial formation sites of Randall's or interstitial plaques are in the basement membranes of thin loops of Henle (arrows). d | The plaque forms as spherical deposits of alternating layers of crystals (electron lucent) and matrix (electron dense) materials (arrows). The interstitial plaque appears as islands of crystals and matrix (double arrows) in the interstitial space. e,f | Another histopathologic change that occurs in most stone formers except ICSFs with hypercalciuria is the presence of intraluminal plugs usually in the ducts of Bellini (panel e, arrow) and inner medullary collecting ducts (panel f, arrows, von Kossa staining), as seen in this stone former with primary hyperparathyroidism. The insert in panel e shows several inner medullary collecting duct plugs seen by micro-computed tomography. The insert in panel f shows an inner medullary collecting duct plug seen by transmission electron microscopy. Panels a and b reproduced with permission from Elsevier © Evan A. et al., Kidney Int. 69, 1313–1318, (2006). Panels c and d reproduced with permission from Springer Link © Evan A. P. et al., Urolithiasis 43, 19–32, (2015). Panels e and f reproduced with permission from Elsevier © Evan, A.E. et al., Kidney Int. 74, 223–229, (2008). Panels a and b reproduced with permission from Elsevier © Evan A. et al., Kidney Int. 69, 1313–1318, (2006). Panels c and d reproduced with permission from Springer Link © Evan A. P. et al., Urolithiasis 43, 19–32, (2015). Panels e and f reproduced with permission from Elsevier © Evan, A.E. et al., Kidney Int. 74, 223–229, (2008). Mulay, S. R. & Anders, H.-J. (2017) Crystal nephropathies: mechanisms of crystal-induced kidney injury Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.10