Kidney stone pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Pathophysiology

Pathogenesis

• It is understood that nephrolithiasis is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
• [Pathogen name] is usually transmitted via the [transmission route] route to the human host.
• Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
• [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
• The progression to [disease name] usually involves the [molecular pathway].
• The pathophysiology of [disease/malignancy] depends on the histological subtype.

Genetics

• [Disease name] is transmitted in [mode of genetic transmission] pattern.
• Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
• The development of [disease name] is the result of multiple genetic mutations.

Associated Conditions

• Hyperparathyroidism
• Gout
• Hypocitaturia
• Sarcoidosis
• Chronic urinary tract infections
• Obesity

Gross Pathology

• On gross pathology,the characteristic findings of nephrolithiasis are:
  • Location = 80% unilateral, usually in calyces, pelvis or bladder
  • Size=variable, 2 - 3 mm usually
  • All stones contain an organic matrix of mucoprotein
  • Shape=
    • Struvite stone= staghorn calculus

• 
  Nephrolithiasis, Source: Wikimedia commons
• 
  Staghorn shape of struvite stones, Source: Wikimedia commons
• 
  Renal calculi, different shapes and sizes, Source: Wikimedia commons
• 
  Kidney stone with a maximum dimension of 5mm, Source: Wikimedia commons

Microscopic Pathology

• On microscopic histopathological analysis, the characteristic findings of nephrolithiasis are:

• 
  Calcium oxalate dihydrate crystals under Scanning Electron Micrograph (SEM) taken at 30 KV. Source: Wikimedia commons
• 
  Density-dependent color scanning electron micrograph of kidney stone, Source: Wikimedia commons