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Case ID: 13006

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DiagnosisMedullary Nephrocalcinosis
History40 y.o. man with a history of "kidney stones"
Findings• Ultrasound images show hyperechoic foci in the region of the renal medullary pyramids. • CT images demonstrate high density particles in the region of the renal medullary pyramids.
Differential Dx• Medullary nephrocalcinosis • Papillary necrosis
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ContributorJames Odone MD :: David Grant USAF Medical Center - Author Info
ReviewerRobert A Jesinger M.D. :: David Grant USAF Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 11844

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DiagnosisMedullary nephrocalcinosis
History27 y/o female with history of "severe nephrolithiasis."
FindingsSonographic evaluation of the kidneys demonstrate increased echogenicity of the medullary pyramids.
Differential Dx-Hyperparathyroidism -Medullary sponge kidney -Renal Tubular Acidosis -Milk-Alkali Syndrome -Hyperthyroidism -Hypothyroidism -Sarcoidosis -Furosemide therapy -Vitamin D therapy -Rickets
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ContributorPaul M Michaud :: Eisenhower Army Medical Center - Author Info
ReviewerMichael S Gibson :: National Naval Medical Center Bethesda - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 11662

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DiagnosisMedullary Nephrocalcinosis secondary to Hypophosphatemic Rickets
HistoryThis nine year old boy presents with a history of Hypophosphatemic Rickets.
FindingsSonographic images through both kidneys demonstrate multiple areas of increased echogenicity involving the medullary pyramids. The remaining renal cortex is normal in echogenicity. There is no evidence of hydronephrosis or focal mass lesions.
Differential DxCauses of Medullary Nephrocalcinosis: Hyperparathyroidism Hypercalciuria Hypercalcemia Medullary sponge kidney Renal Tubular Acidosis Milk-Alkali Syndrome Cushing Syndrome Bony Metastases Hyperthyroidism Hypothyroidism Sarcoidosis Furosemide therapy Vitamin D and Phosphorus therapy in Hypophosphatemic Rickets
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ContributorRobert A Liotta :: National Capital Consortium - Author Info
ReviewerChristopher J Bennett :: National Capital Consortium - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 11328

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DiagnosisMedullary Nephrocalcinosis - Likely Medullary Sponge Kidney
History51 year-old woman with a 4-5 month history of colicky abdominal pain. RUQ ultrasound ordered to evaluate for gallstones. Postive Murphy's sign per the ordering clinician.
Findings1. Gallbladder is unremarkable - no sonographic Murphy's sign 2. The right kidney is normal in size and contour with normal corticomedullary differentiation. The renal collecting system is decompressed. There are multiple hyperechoic foci within the medullary pyramids, the largest measuring approximately 1 cm in greatest diameter with posterior acoustic shadowing, consistent with multiple medullary stones. 3. Comparison CT demonstrates medullary calcifications
Differential DxNephrolithiasis Medullary Nephrocalcinosis -medullary sponge kidney -hyperparathyroidism -renal tubular acidosis -other causes of hypercalcemia
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ContributorHugh M Dainer :: National Capital Consortium - Author Info
ReviewerCharles M Hollcraft :: Walter Reed Army Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 10483

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DiagnosisMedullary Nephrocalcinosis
HistoryNon-contributory.
FindingsHyperechoic bilateral renal pyramids with cortical thinning.
Differential DxHyperparathyroidism Medullary Sponge Kidney Distal Renal Tubular Acidosis Hypercalcemic States
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ContributorEric D Sturgill :: Naval Medical Center Portsmouth - Author Info
ReviewerStephanie A Bernard :: Penn State University - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 10060

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DiagnosisMedullary Nephrocalcinosis likely secondary to Wilson's syndrome
HistoryA patient with Wilson's syndrome presents with a urinary tract infection.
FindingsHyperechoic renal pyramids with faint shadowing.
Differential DxPathognomonic. causes include: Hyperparathyroidism Renal tubular acidosis Medullary sponge kidney Papillary necrosis Other: Drugs (furosemide,amphotericin,steroids,etc), chronic pyelonephritis Wilson's syndrome
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ContributorMichael J Walden :: National Capital Consortium - Author Info
ReviewerWilliam R Carter, M.D. :: National Naval Medical Center Bethesda - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 9860

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DiagnosisMedullary Nephrocalcinosis
HistoryA 8 year old child with autoimmune polyglandular syndrome to evaluate for calcium deposits in the kidneys.
FindingsHyperechoic rings around at the tips and margins of the renal pyramids. Otherwise, normal collecting systems and cortex without macroscopic stones.
Differential DxDDX for nephrocalcinosis: Hypercalcemia (primary hyperparathyroidism) Renal Tubular Acidosis (distal) Medullary sponge kidney Alkali excess Chronic glomerulonephritis Hyperoxaluria
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ContributorNicholas Lange :: National Capital Consortium - Author Info
ReviewerChristopher J Bennett :: National Capital Consortium - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 9228

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DiagnosisMedullary Nephrocalcinosis
HistoryEleven-year-old female with history of hypertension.
FindingsSagittal ultrasonographic images of the right kidney demonstrate diffusely echogenic pyramids with subtle posterior shadowing. The size of the right kidney is at the lower limits of normal. Normal renal contour is observed without evidence of cortical thinning or scarring.
Differential DxMedullary Nephrocalcinosis caused by: Renal Tubular Acidosis, Type I (distal form) Hyperparathyroidism (hypercalciuria, hypercalcemia) Medullary Sponge Kidney Hypercalcemic/Hypercalciuric States Papillary Necrosis Nephrotoxic Drugs (Amphotericin B) Furosemide Treatment of the Newborn Chronic Pyelonephritis Milk-Alkali Syndrome Hypervitaminosis D
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ContributorMark M Morton :: Naval Medical Center Portsmouth - Author Info
ReviewerStephanie A Bernard :: Penn State University - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 8398

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DiagnosisMedullary Nephrocalcinosis.
HistoryA 39 year old female patient presented with a history of cloudy urine and dysuria. She also reported 6/10 bilateral flank pain. A renal-stone protocol abdominal CT was ordered to assess for nephrolithiasis.
FindingsAn unenhanced renal-stone protocol CT scan demonstrates calcifications in the renal medullary pyramids bilaterally, consistent with medullary nephrocalcinosis.
Differential DxMedullary nephrocalcinosis.
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ContributorKevin M Nakamura :: Tripler Army Medical Center - Author Info
ReviewerRichard P. Moser, III :: Walter Reed Army Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 7849

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DiagnosisRenal Tubular Acidosis, Medullary Nephrocalcinosis
History35 year old white male with flank pain. Patient has history of frequent stone passage, sometimes as frequently as every other day
FindingsSevere bilateral medullary nephrocalcinosis
Differential DxThe primary differential covering the majority of cases: 1. Hyperparathyroidism 2. Renal tubular acidosis 3. Medullary sponge kidney An exhaustive differential includes…. Hypercalciuria: Hyperparathyroidism Paraneoplastic syndrome of lung and renal primaries Cushings syndrome Diabetes insipidis Hyper or hypothyroidism Alimentary: Mild-alkali syndrome Hypervitaminosis D Beryllium poisoning Osseous: Osseous mets, multiple myeloma Porlonged immobilization Progessive senile osteoporosis Renal: Medullary sponge kidney Renal tubular acidosis Barter syndrome Drugs: Furosemide in infants Prolonged ACTH therapy Excess vitamin E, D or calcium Nephrotoxic drugs such as amphotericin B Miscellaneous Sarcoidosis Idiopathic hypercalciuria or hypercalcemia
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ContributorJames W Graham :: Madigan Army Medical Center - Author Info
ReviewerJoseph A Ronsivalle :: Madigan Army Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 5648

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DiagnosisMedullary Nephrocalcinosis
History51yo woman POD 3 from EXLAP/TAH/BSO/PPLND for stage III endometrial Ca now with fevers and decreased urine output. please r/o hydro or other abnormality.
FindingsThere is a mild thinning of the renal cortex, which is iso- to hyper-echoic with respect to liver. There is prominence of the renal medulla with increased echogenicity within the medullary pyramids with prominent posterior shadowing. Findings are consistent with bilateral nephrocalcinosis.
Differential DxMedullary Sponge Kidney Renal Tubular Acidosis Hypercalcemia / Hyperparathyroidism.
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ContributorErik S Storm :: Uniformed Services University - Author Info
ReviewerPhilip A Dinauer :: Civilian Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
Case ID: 5494

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DiagnosisMedullary Nephrocalcinosis, diagnosis based on sonographic findings and clinical history including prolonged furosemide therapy.
HistoryFormer 24 week premature female, now day-of-life 126, with positive urine culture. Please evaluate.
FindingsLongitudinal image of the left kidney demonstrates at least three hyperechoic foci within the renal medullary pyramids, with weak posterior acoustic shadowing.
Differential DxMedullary nephrocalcinosis Renal stones Renal candidal bezoar
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User Group
ContributorKevin M Nakamura :: Tripler Army Medical Center - Author Info
ReviewerLynne Ruess :: Tripler Army Medical Center - Editor Info
Case Accepted: 2009-05-27 01:10:52-04 :: Revised: :: Submitted:
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