Introduction

Urinary tract stones have been tormenting humans since the ancient times with the true aetiology remaining a mystery until the past century. We review the life and pioneering work of Alexander Randall who paved the way to the understanding of stone formation.

Methodology

A comprehensive search was performed on the life of Alexander Randall and his work on the pathogenesis of urolithiasis.

Results

Alexander Randall (1885–1951) started his career in urology at John Hopkins in 1907. His research focused on the origin of stones by studying the renal papilla and investigated by inducing stones in animal models, however inconsistent results changed his methodology to using human cadavers.  In 1937, Randall described a hypothesis that renal calculus formation is due to renal papillary damage resulting in deposition of crystalline urinary salts. He reported vascular abnormalities and atherosclerosis associated with these plaques as degeneration of tissue overlying the calcium plaques would enhance subsequent stone formation. He published his most well-known series of over one thousand pairs of kidneys where he found that 20% showed evidence of early calcified plaques in at least one renal papilla, to which he gave his name.

With improvements in chemistry and imaging modalities, subsequent research on the pathophysiology of stone formation covered the gaps in Randall’s theory related to his plaques.

Conclusions

Randall gave his name to subepithelial calcified plaques of renal papillae which act as anchors for stone formation. Great tribute is due to his work which has formed the basis of contemporary stone research.