https://doi.org/10.4081/aiua.2023.10748

Determinants of renal papillary appearance in kidney stone formers: An in-depth examination

Vol. 95 No. 1 (2023)
Submitted: July 19, 2022
Accepted: August 20, 2022
Published: February 22, 2023
Kidney stones, Retrograde intrarenal surgery, Stone recurrence, Management, Stone phenotype
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Authors

Matteo Bargagli
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Francesco Pinto
U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Rossella De Leonardis
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy.
Mauro Ragonese
U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Angelo Totaro
U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Salvatore Recupero
U.O.C. Urologia, Ospedale Fatebenefratelli, Rome, Italy.
Matteo Vittori
Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
PierFrancesco Bassi
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Giovanni Gambaro
Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy.
Pietro Manuel Ferraro
pietromanuel.ferraro@unicatt.it
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.

Objectives: The aim of this study is to investi-gate the association between the urinary metabolic milieu and kidney stone recurrence with a validated papillary evaluation score (PPLA).
Materials and methods: We prospectively enrolled 30 stone for-mers who underwent retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed to calculate PPLA score, based on the characterization of ductal plugging, surface pitting, loss of papillary contour and Randall’s plaque extension. Stone compositions, 24h urine collections and kidney stone events during follow-up were collected. Relative supersaturation ratios (RSS) for calcium oxalate (CaOx), brushite and uric acid were calculated using EQUIL-2. PPLA score > 3 was defined as high.
Results: Median follow-up period was 11 months (5, 34). PPLA score was inversely correlated with BMI (OR 0.59, 95% CI 0.38, 0.91, p = 0.018), type 2 diabetes (OR 0.04, 95% CI 0.003, 0.58, p = 0.018) and history of recurrent kidney stones (OR 0.17, 95%CI 0.04, 0.75, p = 0.019). The associations between PPLA score, diabetes and BMI were not confirmed after excluding patients with uric acid stones. Higher PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.15, 95% CI 0.02, 1.00, p = 0.05). No other significant correla-tions were found.
Conclusions: Our results confirm the lack of efficacy of PPLA score in phenotyping patients affected by kidney stone disease or in predicting the risk of stone recurrence. Larger, long-term studies need to be performed to clarify the role of PPLA on the risk of stone recurrence.

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How to Cite

Bargagli, M., Pinto, F., De Leonardis, R., Ragonese, M., Totaro, A., Recupero, S., Vittori, M., Bassi, P., Gambaro, G., & Ferraro, P. M. (2023). Determinants of renal papillary appearance in kidney stone formers: An in-depth examination. Archivio Italiano Di Urologia E Andrologia, 95(1). https://doi.org/10.4081/aiua.2023.10748
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