Randall's plaque, the origin of nephrolithiasis: Where do we stand now?

The prevalence of renal stones, or nephrolithiasis, has been increasing consistently over the past few decades. Changes in lifestyles and dietary habits of the population may be responsible for the rise. Moreover, chronic diseases such as diabetes, hypertension, obesity, and metabolic syndrome are significant risk factors for renal stone formation. The 5-year recurrence rate of renal stones is around 50%. Those affected have a higher risk of comorbidities such as recurrent urinary tract infections, chronic kidney disease, and even end-stage renal disease. There is exciting ongoing research into newer treatments for renal stones. Currently, the prevailing hypothesis is that renal stones originate from Randall's plaques, which are patches of creamy-yellow calcium deposits found attached to the renal pelvis. However, the early steps involved in stone formation are still unclear. With the help of advanced technology and newer modalities, we can now observe the formative events upstream to actual stone formation. There are two recently updated theories that detail the biochemical events and structural changes that occur during this initial period. These well-designed works have expanded our awareness of Randall's plaques and provided direction for further research.