The role of the papilla in idiopathic calcium oxalate nephrolithiasis.

The complex and multifactorial phenomenon of urinary stone disease remains unclear. Anatomical and physiochemical theories do not adequately deal with certain aspects of idiopathic calcium oxalate nephrolithiasis in particular or of nephrolithiasis. One of the reasons for this could be that nephrolithiasis is not only a primary disorder but may also be a symptom of other disorders or various pathologic changes in the metabolism of lithogenic substances. Both affirmative and contradictory reports have been published since Randall's first description of papillary calcifications and their possible active role in the genesis of calcium oxalate nephrolithiasis. Our intention is to discuss focal calcified lesions as an etiologic factor of renal stone disease as well as the change from historical to modern concepts regarding the development of medullary calcifications and their relationship to idiopathic calcium oxalate nephrolithiasis.