What is your approach to differentiating Randall plaques from actual small non-obstructing stones when reviewing imaging testing for your patients with recurrent nephrolithiasis?

In truth, I almost never can tell with present CT imaging. Once we have a URS with images, it is easier in a given case. Even more misleading is plugging, which can be dense looking on CT and essentially in tissues and not amenable to removal, now requiring surgery. Specialized, very high-resolution...

Randall‘s plaque represents subepithelial deposits of calcium phosphate in the renal papillae. They typically serve as a nidus for calcium oxalate stones.

Differentiating the two radiographically is challenging. However, they have common risk factors: hypercalciuria and low urine volume.

My approach...

I don't worry about the distinction, since that would not impact my recommendations for lowering risk for stones. In a previously identified stone former, the goal is to prevent the accumulation of stones, so this finding would simply establish the state of their disease at a time point that can be ...