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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 93-94

Rare case of nephrocalcinosis in an adult female


1 Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
2 Department of Medicine, INHS Kalyani, Visakhapatnam, Andhra Pradesh, India

Date of Submission10-Aug-2019
Date of Decision19-Sep-2019
Date of Acceptance10-Oct-2019
Date of Web Publication21-Jan-2020

Correspondence Address:
Dr. Reddy Ravikanth
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_39_19

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How to cite this article:
Ravikanth R, Majumdar P. Rare case of nephrocalcinosis in an adult female. BLDE Univ J Health Sci 2020;5:93-4

How to cite this URL:
Ravikanth R, Majumdar P. Rare case of nephrocalcinosis in an adult female. BLDE Univ J Health Sci [serial online] 2020 [cited 2020 Oct 23];5:93-4. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/1/93/276312



Sir,

Ultrasonography (USG) was performed to evaluate the urinary tract of a 32-year-old female who presented with complaints of recurrent urinary tract infection, which demonstrated no evidence of hydroureteronephrosis. Sagittal and transverse views of both kidneys demonstrated triangular-shaped echogenicities with no acoustic shadowing in the distribution of renal pyramids [Figure 1]a and [Figure 1]b. The laboratory evaluation revealed hypercalciuria with a urine calcium of 543 mg/24 h. Serum calcium, parathyroid hormone, and Vitamin D levels were within normal limits (9.2 mg/dL, 33 pg/mL, and 22 ng/mL, respectively). There was no evidence for renal tubular acidosis. A diagnosis of medullary nephrocalcinosis was made based on the USG findings. Clinically, she was diagnosed with nephrocalcinosis due to idiopathic hypercalciuria and started on hydrochlorothiazide and low-sodium diet.
Figure 1: Ultrasonography image demonstrating enlarged right kidney (a) and left kidney (b) with increased echogenicities without shadowing in the region of renal pyramids consistent with medullary nephrocalcinosis

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Medullary nephrocalcinosis varies from subtle to florid deposition of calcifications in the distribution of the renal pyramids and is the result of calcification in the medullary portions of the kidney.[1] With subtle calcifications, there is no acoustic shadowing. USG has more sensitivity than radiographs or computed tomography (CT) in the detection of faint calcifications of medullary nephrocalcinosis.[2] Features of medullary nephrocalcinosis on USG are classified as early-stage with hyperechogenicity in the periphery of the pyramids, middle stage demonstrates diffusely hyperechoic pyramids, and late-stage demonstrates clumps of calcium deposition. Although medullary nephrocalcinosis has a varied etiology, hypercalcemia remains the most common cause.[3]

Medullary nephrocalcinosis occurs as a nonspecific renal manifestation in various conditions such as hypophosphatemic rickets, Type 1 renal tubular acidosis, primary hyperparathyroidism, hypercalcemia of unclear origin, and chronic renal insufficiency requiring dialysis.[4] Medullary nephrocalcinosis is demonstrated by means of sonographically detectable changes in the renal medulla region. The USG appearance of medullary nephrocalcinosis is characterized by the detection of echo-enhanced structures in the region of the renal pyramids. Medullary nephrocalcinosis is generally confirmed with adequate reliability on the basis of USG findings and characteristic clinical pictures.

On USG, the diagnosis of nephrocalcinosis can be suggested only when increased echogenicity is localized to the area of the renal medulla. In 50% of normal individuals, based on relative echogenicity, there is a clear distinction between cortex and medulla. In about 25% of individuals, the arcuate vessels can be seen coursing along the base of pyramids at the corticomedullary junction. Furthermore, unequivocal localization of increased echogenicity to the medulla of the kidney is made if an arcuate vessel is seen capping the base of pyramids.[5]

In conclusion, medullary nephrocalcinosis can be a sign of renal parenchymal disease, presenting as increased echogenicities in the distribution of renal pyramids on USG and should be suggested even in the absence of confirmatory radiographic evidence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Evan AP. Physiopathology and etiology of stone formation in the kidney and the urinary tract. Pediatr Nephrol 2010;25:831-41.  Back to cited text no. 1
    
2.
Boyce AM, Shawker TH, Hill SC, Choyke PL, Hill MC, James R, et al. Ultrasound is superior to computed tomography for assessment of medullary nephrocalcinosis in hypoparathyroidism. J Clin Endocrinol Metab 2013;98:989-94.  Back to cited text no. 2
    
3.
Starinsky R, Vardi O, Batasch D, Goldberg M. Increased renal medullary echogenicity in neonates. Pediatr Radiol 1995;25 Suppl 1:S43-5.  Back to cited text no. 3
    
4.
Avni EF, Spehl-Robberecht M, Lebrun D, Gomes H, Garel L. Transient acute tubular disease in the newborn: Characteristic ultrasound pattern. Ann Radiol (Paris) 1983;26:175-82.  Back to cited text no. 4
    
5.
Riebel TW, Abraham K, Wartner R, Müller R. Transient renal medullary hyperechogenicity in ultrasound studies of neonates: Is it a normal phenomenon and what are the causes? J Clin Ultrasound 1993;21:25-31.  Back to cited text no. 5
    


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