Introduction: Randall's Plaques are ubiquitously recognized by urologists; however, the history and modern ramifications of their discovery are not fully understood. The objective of this study is to highlight the historical investigation on Randall's plaques.
Methods: Sources from the William P. Didusch Center, medical journals available on PubMed and Scopus, online historical and newspaper archives were analyzed regarding the contributions of Alexander Randall as well as historical and modern perspectives on recurrent stone disease.
Results: Nephrolithiasis has been investigated since 600 B.C., with historic recommendations for prevention first introduced by the surgeon Sushruta. Although nephrolithotomy techniques and outcomes greatly improved, the underlying pathology and origin of nephrolithiasis was still unknown in the 1900s. It was not until Alexander Randall MD (1883 - 1951) published his work titled “The Origin and Growth of Renal Calculi” in 1937, that the knowledge on the origin of stone formation began to crystallize. Dr. Randall, born in 1883, completed his medical training at Johns Hopkins University. He then completed residency and served as a Major in the U.S. Army Medical Corps during World War I. He became a distinguished Professor at the University of Pennsylvania and served as AUA President in 1932. His prolific research included work on a plethora of urologic diseases and his later work focused on renal calculi. In his 1937 report he proposed that the renal stone was a symptom and not a disease entity and that all renal calculi must have, as a point of origin, some preexisting lesion on the renal pelvis. In this investigation, Dr. Randall examined 429 pairs of kidneys and identified by microscopy the preexisting lesion as a plaque of calcium deposited in the interstitial tissue of the renal papilla. He presented evidence from his microscopic studies of a plaque rupturing through its epithelial covering and then proposed that it served as a nidus for further stone formation from a constant bath of calyceal urine. He included micrographic evidence of these plaques and suggested that their composition may vary depending on the abundant mineral source. The work of Dr. Randall on the pathogenesis of nephrolithiasis has continued on and recently a unified theory tracing plaque origin to stone formation has been proposed. Dr. Randall passed away in 1951 but was survived by his four children and his wife Edith.
Conclusions: What Dr. Randall once described as a “morbid product” has had large ramifications in recent years, with increased nephrolithiasis incidence and treatment costs. Further research should build upon Randall’s work to aid in the prevention stone formation. Source of
