. Renal epithelial cells constitutively produce a protein that blocks adhesion of crystals to their surface. Am J Physiol Renal Physiol 287: F373-F383, 2004. First published April 20, 2004 10.1152/ajprenal.00418.2003.-Attachment of newly formed crystals to renal tubular epithelial cells appears to be a critical step in the development of kidney stones. The present study was undertaken to identify autocrine factors released from renal epithelial cells into the culture medium that inhibit adhesion of calcium oxalate crystals to the cell surface. A 39-kDa glycoprotein that is constitutively secreted by renal cells was purified by gel filtration chromatography. Amino acid microsequencing revealed that it is novel and not structurally related to known inhibitors of calcium oxalate crystallization. Hence, it was named crystal adhesion inhibitor, or CAI. Immunoreactive CAI was detected in diverse rat tissues, including kidney, heart, pancreas, liver, and testis. Immunohistochemistry revealed that CAI is present in the renal cell cytosol and is also on the plasma membrane. Importantly, CAI is present in normal human urine, from which it can be purified using calcium oxalate monohydrate crystal affinity chromatography. CAI could be an important defense against crystal attachment to tubular cells and the subsequent development of renal stones in vivo.calcium oxalate monohydrate; cell-crystal interaction; DING protein; inhibitor; nephrolithiasis NEPHROLITHIASIS IS AN EXTREMELY common condition in the United States, affecting up to 10% of the population at some point during their lives (26,32). Although many affected individuals have identifiable urinary metabolic risk factors, such as excessively concentrated urine that may contain too much calcium, uric acid, or oxalate, or perhaps too little citrate, many do not (12). Therefore, the concentration of these urinary constituents does not appear to fully explain the formation of renal stones. In addition, nucleation and growth of individual crystals appear unlikely to produce particles large enough to occlude the nephron lumen in vivo (15). Recent evidence suggests, that in many calcium oxalate stone formers, the earliest changes may be depositions of calcium phosphate in the medullary interstitium, which then serve as a nidus for a calcium oxalate stone (14). The processes that mediate calcium phosphate deposition and its evolution into calcium oxalate stones remain to be determined. In more marked hyperoxaluric states (e.g., enteric or primary hyperoxaluria), direct adhesion of calcium oxalate crystals to renal epithelial cells may predominate (14). Therefore, our laboratory (19 -24) and others (29,30,37,38,43) have sought to identify regulatory mechanism(s) by which urinary calcium oxalate and calcium phosphate crystals in tubular fluid bind to renal epithelial cells, are retained in the kidney, and become a nidus for stone formation.Previous studies have demonstrated that anionic molecules in tubular fluid can coat calcium oxalate monohydrate (COM) and hydroxyapatite (H...