Primary renal calculi: Anderson-Carr-Randall progression?

Although numerous reports deal with the histology of renal medullary calcification, there has been only limited application of radiographic methods for its description. From routine autopsy material, findings on 61 kidneys studied by high resolution radiography are presented and related to those of Randall (1937), Anderson (1945), Carr (1954), and others. Histologically Anderson found microscopic plaques formed from coalesced calcific "droplets" in the pyramids of practically all of 168 kidneys, including some very young infants. Carr, using microradiographic techniques, also found calcific deposits in nearly all of 209 kidneys from patients over 9 years of age. Anderson and Car separately concluded that the calcific deposits they demonstrated could, by migration, form the subepithelial plaques that Randall observed earlier. The present work illustrates some radiologic aspects of renal calcification which seem to support a hypothesis that primary renal calculi result, under certain circumstances, from the migration of calcific deposits from the substance to the surface of renal papillae. In order to emphasize the pathogenetic sequence of the work of the previously mentioned authors, it is proposed that the sequence of events be referred to as the Anderson-Carr-Randall morphologic progression of primary renal calculus formation. Proposals are made for additional experimental work.