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Can biologic nanoparticles initiate nephrolithiasis?

Nature Clinical Practice Nephrology volume 4, pages 308–309 (2008)Cite this article

The formation of kidney stones is clearly a multifactorial process. Normal human urine is often supersaturated with respect to one or more crystalline compounds; for example calcium oxalate, calcium phosphate and uric acid, which (not surprisingly) comprise the three most common forms of kidney stones. Work over the past few decades has defined many factors that can contribute to such types of supersaturation, including hypercalciuria, hyperoxaluria and hypocitraturia, which are all often compounded by a relatively low urine volume. Each of these factors seems to be the result of environmental influences (the most important of which is usually considered to be diet1), combined with genetic factors.

Much work remains to be done in order to define the contributions of genetics to urinary supersaturation. In addition, the mechanisms whereby urinary supersaturation translates into a kidney stone are not well understood. Recent studies highlight the importance of medullary interstitial calcium phosphate deposits (Randall's plaques) in the formation of the most common variety of kidney stones, 'idiopathic' calcium oxalate stones (which account for up to 75% of patients presenting with kidney stones).2 These deposits seem to begin as nanometer-sized calcifications within the basement membranes of the medullary interstitium. Importantly, the pattern of intrarenal crystallization events during the formation of the other common types of stone seems to differ from this pattern. In patients with either calcium oxalate stones caused by intestinal disease (i.e. enteric hyperoxaluria), pure calcium phosphate stones (which are often associated with renal acidification defects), or uric acid stones, the first crystals probably deposit within the distal tubules as opposed to the interstitium. One key and current goal in nephrolithiasis research is to define the processes that drive the formation of Randall's plaques.

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Acknowledgements

The author would like to acknowledge Dr Virginia Miller for invaluable contributions to the work described, and for helpful comments regarding this manuscript. This work was supported by research grants from the NIH, Fetzer Foundation, Ralph C Wilson Sr Foundation, Mayo Foundation, and Nanobac Pharmaceuticals.

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  1. Mayo Clinic, Division of Nephrology and Hypertension, 200 1st Street SW, Stabile 7-03, Rochester, MN 55905, USA lieske.john@mayo.edu

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  1. JC Lieske is Professor of Medicine in the Division of Nephrology and Hypertension at the Mayo Clinic, Rochester, MN, USA.,

    John C Lieske

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The author has received grant/research support from Nanobac Pharmaceuticals.

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Lieske, J. Can biologic nanoparticles initiate nephrolithiasis?. Nat Rev Nephrol 4, 308–309 (2008). https://doi.org/10.1038/ncpneph0794

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