Medullary sponge kidney with IgA nephropathy: a case report and literature review

BACKGROUND

Medullary sponge kidney (MSK)is rare in association with glomerulonephritis. We report a patient with medullary sponge kidney, and the kidney biopsy revealed a diagnosis of IgA nephropathy.

CASE PRESENTATION

A 27-year-old female presented with hematuria and proteinuria, and imaging studies indicated the presence of medullary spongy kidney. With appropriate preparation, a kidney biopsy was performed. Considering the patient's clinical and pathological characteristics, the final diagnosis was determined to be medullary sponge kidney associated by IgA nephropathy. The combination of corticosteroids and angiotensin receptor blockers (ARBs) proved to be significantly effective in reducing proteinuria in the current case. To the best of our knowledge, this is the first reported case that demonstrates the coexistence of MSK and IgA nephropathy.

CONCLUSIONS

Administering precise therapy based on renal pathology can potentially enhance outcomes for patients with renal conditions, necessitating the need for clinicians to be vigilant about differential diagnosis in order to reduce the rates of missed diagnoses and misdiagnosis.

The impact of kidney stone disease on quality of life in high-risk stone formers

OBJECTIVE

To assess the impact of kidney stone disease (KSD) and its treatment on the health-related quality of life (HRQOL) of high-risk stone formers with hyperparathyroidism, renal tubular acidosis, malabsorptive disease, and medullary sponge kidney.

PATIENTS AND METHODS

The Wisconsin Stone Quality of Life questionnaire was used to evaluate HRQOL in 3301 patients with a history of KSD from 16 institutions in North America between 2014 and 2020. Baseline characteristics and medical history were collected from patients, while active KSD was confirmed through radiological imaging. The high-risk group was compared to the remaining patients (control group) using the Wilcoxon rank-sum test.

RESULTS

Of 1499 patients with active KSD included in the study, the high-risk group included 120 patients. The high-risk group had significantly lower HRQOL scores compared to the control group (P < 0.01). In the multivariable analyses, medullary sponge kidney disease and renal tubular acidosis were independent predictors of poorer HRQOL, while alkali therapy was an independent predictor of better HRQOL (all P < 0.01).

CONCLUSIONS

Among patients with active KSD, high-risk stone formers had impaired HRQOL with medullary sponge kidney disease and renal tubular acidosis being independent predictors of poorer HRQOL. Clinicians should seek to identify these patients earlier as they would benefit from prompt treatment and prevention.

Exploring the relationship of supernumerary recurrent renal calculi formation and tick-borne infections: a case report

A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation.

Weeping sponge kidney: an unusual phenomenon that should be considered in cases of severe renal haemorrhage

AIM

To describe the clinical presentation, imaging evaluation, endovascular management, and outcomes of multifocal renal capsular haemorrhage, "weeping sponge kidney", and to identify associated risk factors and the pathophysiological mechanism behind this condition.

MATERIALS AND METHODS

This is a case series in which clinical information for each of the cases was collected retrospectively from electronic patient notes as well as the radiology information and picture archiving and communication systems.

RESULTS

Four consecutive cases were included in the series. All of the cases were treated successfully with embolisation. Three of the four patients had chronic renal failure with renal atrophy, which are patient factors that appear to be associated with multifocal renal capsular haemorrhage. Based on the procedural findings and the published literature, a pathophysiological mechanism is described to explain this condition and the relevance of the collateral arterial supply to the kidney in such cases is discussed.

CONCLUSION

Small subcapsular haematomas are usually self-limiting but in patients with renal failure, there may be an increased risk of developing a weeping sponge kidney, which can be life-threatening. The endovascular treatment for multifocal haemorrhage differs from that for a single bleeding point, especially if preservation of renal function is not a priority.

Retrograde intrarenal surgery for stones associated with renal anomalies: caliceal diverticulum, horseshoe kidney, medullary sponge kidney, megacalycosis, pelvic kidney, uretero-pelvic junction obstruction

PURPOSE OF REVIEW

Nowadays, due to the increase of imaging diagnosis, we identify easily renal anomalies, and we can choose between a wide range of armamentarium to treat symptomatic stones in those challenging cases. However, there is a lack of evidence and consensus on its use. The aim of this narrative review is to collect all the available data about safety and efficacity of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones associated to a renal anomaly.

RECENT FINDINGS

Renal anomalies are uncommon findings and even more if it has to be associated with renal stones. After a literature review of the past 2 years, there are a small number of studies that compare the outcomes in patients who have been treated with minimally invasive modalities and they are mainly focus on RIRS.

SUMMARY

It is of extreme importance to know the advances on the stone treatment in anomalous kidneys. With the development of new laser technologies, RIRS is becoming a more interesting technique with high success rate and safety. Further studies are needed to make an accurate statement about the adequate surgical technique for each renal anomaly and also, clinical trials using new laser technologies.

Ultrasound Patterns and Disease Progression in Medullary Sponge Kidney in Adults

Our paper presents the ultrasound (US) patterns of a rare kidney disease-medullary sponge kidney (MSK)-that have not been described before in comparison with other causes of medullary hyperechogenicity and correlates them with the severity of the disease and prognosis. This is a clinical observational study of all US examinations in the Nephrology Department over a period of 6 years. The abdominal US focused on the kidneys was recorded. US characteristics of the medulla and cortex were analyzed. We found 10 patients with characteristic daisy flower (DF) kidneys. Positive diagnosis in association with other renal risk factors, prognosis, and evolution were evaluated. Two patterns of medullary hyperechogenicity were found and were correlated with disease severity and kidney function. The first pattern is a homogenous echogenicity of the medulla described as a "daisy-like" appearance. The second pattern: calcifications associated with medullar echogenicity, stone production, nephrocalcinosis, and impaired kidney function: "atypical daisy-like." Medullary hyperechogenicity can have more US patterns. In MSK, if the medullary echogenicity is homogenous the evolution is benign, whereas the second, inhomogeneous pattern, has a variable clinical presentation with nephrocalcinosis and the outcome is more severe, leading to chronic kidney disease and impairing the quality of life.

Detailed Nephro-urological Management of a Case of Medullary Sponge Kidney with Distal Renal Tubular Acidosis and Obstructive Uropathy

Medullary sponge kidney (MSK) is a rare renal malformation characterized by precalyceal tubular ectasia of the renal collecting ducts that clinically manifests as recurrent renal stones, distal renal tubular acidosis (dRTA), osteoporosis, and nephrocalcinosis. In this case report, we present the case of a woman with a severe form of MSK associated with dRTA. She had extensive nephrocalcinosis and obstructive uropathy caused by a large upper ureteric stone in the left kidney. The stone was disintegrated by flexible ureteroscopic laser lithotripsy. Her initial biochemical derangements were identified and corrected with a Polycitra-K solution and hydrochlorothiazide, leading to reduced stone load and osteopenia 1 year later.

Single-Cell Gene Expression Analysis in Patients with Medullary Sponge Kidney and a Retrospective Study

OBJECTIVE

To establish better diagnosis thinking and provide advanced understanding of MSK, the CT imaging features, clinical characteristics, and the expression of suspected genes in the kidney spatiotemporal immune zonation and fetal renal development were investigated.

METHODS

17 patients with MSK hospitalized in our hospital were selected as our research subjects. Human Phenotype Ontology, MalaCards: The Human Disease Database, GeneCards: The Human Gene Database, Human Protein Atlas, and Single Cell Expression Atlas were used to analyze this disease.

RESULTS

In our 17 patients, the incidence of MSK tended to be the same in male and female, and the onset age of MSK was probably 31-50 years old. The top one related disease of MSK was nephrocalcinosis and the most frequent phenotype related to MSK was nephrolithiasis. In addition, the expression of HNF1B, CLCN5, GDNF, ATP6V0A4, ATP6V1B1, LAMA2, RET, ACAN, and ABCC8 has been implicated in both human kidney immune zonation and fetal kidney development.

CONCLUSIONS

HNF1B, CLCN5, GDNF, ATP6V0A4, ATP6V1B1, LAMA2, RET, ACAN, and ABCC8 could be independent indicators for the diagnosis and preventive intervention of MSK patients, and abnormal kidney development due to mutations in key genes was the underlying cause of MSK.

Nephrocalcinosis in adolescent girl with medullary sponge kidney and mild hemihypertrophy: A case report

RATIONALE

Medullary sponge kidney (MSK) is a rare congenital abnormality characterized by cystic dilatation of the medullary collecting tubules. The disorder is likely to be complicated by nephrocalcinosis, urolithiasis, tubular dysfunctions, and urinary tract infections. In addition, it may be rarely associated with extrarenal anomalies.

PATIENT CONCERN

We present a case of 17-year old girl who was referred for metabolic evaluation of bilateral nephrocalcinosis. Physical examination showed signs of mild, left-sided hemihypertrophy involving the lower limb, buttock, trunk, face, and tongue. The imaging studies of kidneys including intravenous urography and contrast computed tomography showed numerous medullary calcification and a typical picture of MSK-"paint brush"/"bouquet of flowers" appearance of the dilated tubules within the renal medulla. Laboratory evaluation revealed sterile pyuria, hypercalciuria, and hypocitraturia.

INTERVENTION

The patient was subsequently treated with potassium citrate, hydrochlorothiazide, low sodium and low oxalate diet accompanied by high fluid intake.

OUTCOMES

After a 1-year therapy the normalization of calciuria and citraturia occurred and no progression of nephrocalcinosis was observed.

LESSONS

We conclude that MSK should always be considered as a cause of nephrocalcinosis. Since the final diagnosis requires specific imaging techniques, the concomitant extrarenal abnormalities such as hemihypertrophy may facilitate diagnostic decisions.

[A woman with urinary tract infections and flank pain]

A 52-year-old woman presented with recurrent urinary tract infections and flank pain. Both an abdominal CT-scan and a plain abdominal X-ray showed bilateral nephrocalcinosis and a kidney stone in the left ureter. These findings are suggestive of medullary sponge kidneys.

Nephrolithiasis in medullary sponge kidney: evaluation of clinical and metabolic features

OBJECTIVE

Medullary sponge kidney (MSK) is a disorder characterized by tubular dilation of renal collecting ducts and cystic dilation of medullary pyramids that has been associated with stone disease. The significance of nephrolithiasis and the mechanisms by which it occurs are incompletely understood. We describe clinical and metabolic features of nephrolithiasis in a cohort of patients with MSK.

METHODS

Records were reviewed of 56 patients, all with radiographic diagnosis of medullary sponge kidney and data collected pertaining to presentation, stone events and recurrences, stone composition, and metabolic profile to perform a descriptive study with median 3.7 years follow-up.

RESULTS

Nephrolithiasis was confirmed radiographically in 39/56 patients (69.6%). No patient without evidence of nephrolithiasis developed a stone event, whereas 13/39 (33%) of those with nephrolithiasis developed a recurrent stone event. Stones were composed of calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate apatite, and uric acid. Metabolic profile was obtained for 26 of 39 (67%) stone-forming patients demonstrating abnormalities in 22/26 (84.6%). These included hypercalciuria, 58% (15/26); low urine volume, 35% (9/26); hyperuricosuria, 27% (7/26); hypocitraturia, 19% (5/26); elevated urine sodium, 15% (4/26); and hyperoxaluria, 12% (3/26).

CONCLUSION

Many patients with MSK have no evidence of nephrolithiasis. Among those who do, recurrence is common, and metabolic profile and composition are varied as in the general stone-forming population.

Nephrolithiasis in medullary sponge kidney

Seventy-one patients with documented Medullary Sponge Kidney (MSK) and nephrolithiasis underwent complete metabolic evaluation. These patients constituted 7.3% of our calcium stone-forming population Metabolic anomalies (hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria) were observed in 82% of patients. No patient was hypercalcemic and none had hyperparathyroidism. Thus the patients with medullary sponge kidney and renal stones had the same spectrum of metabolic anomalies as the overall population of idiopathic stone formers. Although these patients may have anatomic anomalies which determine stasis of urine and infection causing stone formation, they should be evaluated and treated appropiately for any metabolic defect.

Coexistence of medullary sponge kidney and ulcerative colitis in the same patient: long-term follow-up

We describe a female patient with ulcerative colitis since the age of 17, who was accidentally diagnosed as having medullary sponge kidney 3 years after the establishment of diagnosis of inflammatory bowel disease. The diagnosis of renal disease was based on the typical appearance of both kidneys on abdominal ultrasound examination and on IV pyelography findings. All other well-known causes of medullary sponge kidney were excluded on the basis of the relevant laboratory investigation. So far, the patient experienced only one episode of urinary infection but no renal colic. Since the time of diagnosis of ulcerative colitis her renal function tests are perfectly normal. She is under maintenance treatment with mesalazine. The benign nature of the situation was explained to her. She was advised to drink at least one and a half litter of water daily, in order to reduce the risk of nephrolithiasis. The combination of the two disorders in our patient is probably the result of a chance. However, taking into account the potentially dangerous long-term results of medullary sponge kidney, we suggest that patients with ulcerative colitis must have a careful ultrasound examination of both kidneys at least at the time of diagnosis of the bowel disease, in order to exclude the possibility of medullary sponge kidney, as conservative measures could result in avoidance of potentially dangerous complications, such as renal stones and urinary infections.

Medullary sponge kidney associated with distal renal tubular acidosis in a 5-year-old girl

INTRODUCTION

Medullary sponge kidney (MSK) is characterized by cystic dilatation of the inner medullary collecting ducts, which causes the kidneys to resemble a sponge.

CASE REPORT

Although distal renal tubular acidosis (dRTA) is commonly observed in patients with MSK, we report a 5-year-old girl with MSK who had features of both dRTA (nephrocalcinosis, hypercalciuria, hypocitraturia) and proximal tubular dysfunction (hyperuricosuria, impaired tubular phosphate reabsorption and proteinuria).

DISCUSSION

Metabolic acidosis, hypercalciuria, hypocitraturia, tubular phosphate reabsorption and growth retardation in the patient improved with alkali therapy.

Nephronophthisis and medullary cystic kidney disease complex

Background. Nephronophthisis and medullary cystic kidney disease complex refers to the genetic heterogeneous group of inherited tubulointerstital nephritis. Nephronophthisis comprises at last 3 clinical manifestations, has the autosomal recessive pattern of inheritance, appears early in life and is the most frequent inherited kidney disease that causes terminal renal failure in childhood, while medullary cystic kidney disease has the autosomal dominant pattern of inheritance, is less frequent, and terminal renal failure appears later in life. These two forms have similar clinical and morphological findings but extrarenal manifestations, the median ages of occurrence of terminal renal failure, and siblings presence help us distinguish these diseases. Case report. In this article we illustrated the case of a 20- years old patient with the suspicion of having complex nephornophthisis and medullary cystic kidney disease based upon mild renal failure, seen in routinely taken laboratory findings and bilateral cysts in corticomedullary region of the kidneys verified on abdominal ultrasound examination. Conclusion. This disease should rise suspicion in children or adolescents with progressive renal failure, a typical clinical manifestation, blood and urine samples results, bilateral cysts in the corticomedullary region of the kidneys seen during ultrasound examination of the kidneys and family inheritance.

[Medullary sponge kidney (MSK) in association with glomerulonephritis (GNP)]

BACKGROUND

Medullary sponge kidney (MSK) is a congenital, non-hereditary anomaly characterized by dilation of the precalix ducts. It is often associated with other diseases, and its symptoms are linked to frequent complications, such as sepsis of the urinary system and the renal colic of nephrolithiasis. However, MSK is rare in association with glomerulonephritis (GNP), as can be seen from medical literature data that shows only one case (reported in 1974) in which MSK with a concomitant focal sclerosing glomerulonephritis was noted. In this report, we describe a case of MSK that was found after a routine renal echograph and biopsy of a mesangial GNP previously diagnosed at another center. The echographic results showing typical MSK was confirmed by means of RX urography and renal TC. The MSK-glomerulonephritis combination appears to be completely random, because the involved structures (the collecting duct and the glomerule) have different embryologic origin. Therefore, a pathogenic hypothesis common to the two anomalies seems rather unlikely.

CONCLUSIONS

Although MSK is a usually benign disease, because a compromise of glomerular filtration that occurs in approximately 10% of cases, proper diagnosis is important to allow prophylactic intervention aimed at the reduction of complications that could reduce overall renal function when associated with other nephropathies. Renal echography is an important diagnostic tool that may reveal more cases of MSK than previously reported.

[Cacchi Ricci disease associated with congenital hemihypertrophy]

OBJECTIVE

An uncommon case of medullary sponge kidney with congenital hemihypertrophy complicated by nephrocalcinosis and nephrolithiasis is reported here.

METHODS/RESULTS

A 29 year old female patient with multiple episodes of renal colic is presented. Clinical features, radiological findings and differential diagnosis in a patient with Cacchi-Ricci disease are discussed. At least twenty-nine cases associated with congenital hemihypertrophy have been reported previously.

CONCLUSIONS

A significant number of patients with medullary sponge kidney are asymptomatic. In many cases the diagnosis is made when a patient is evaluated by intravenous urography for some unrelated problem. However, medullary sponge kidney has been reported in association with rare congenital anomalies (Beckwith-Widemann syndrome and congenital hemihypertrophy) and these patients appear to be at risk of malignant neoplasms of the adrenal gland, kidney and liver, therefore they must be followed closely.

[Percutaneous resection of renal pelvic fibroepithelial polyp with medullary sponge kidney: a case report]

Benign polyp of the renal pelvis is extremely rare. We report a case of fibroepithelial polyp in the renal pelvis complicated with medullary sponge kidney successfully treated by percutaneous resection. The patient had recurrent bilateral renal stones because of medullary sponge kidney. Percutaneous resection of renal pelvic polyps was carried out through a 26 Fr Amplatz sheath using a 24 Fr resectoscope. Pathological diagnosis was a fibroepithelial polyp. The etiology of this polyp was suggested to be chronic irritation of renal stone.

[Description of a case of Cacchi Ricci disease associated with hyperparathyroidism in the setting of multiple endocrine disease]

The authors present a case of a 36 years old woman applied to them for a follow up of sponge kidney disease and in whom they discovered a primary hyperparathyroidism. Further investigations discovered a medullary thyroid carcinoma. So this patient present multiple endocrine neoplasia (MEN) type 2A confirmed by microscopic and genetic analysis. This observation enlarged the discussion upon the nature of the relationship between kidney disease and primary hyperparathyroidism. Elsewhere it recommended to check systematically genetic markers of MEN type 2A if there is an association with sponge kidney disease and primary hyperparathyroidism.

Two Afro-Trinidadian siblings with end-stage renal disease

The case histories of two Afro-Trinidadian brothers aged 8 and 11 years who developed end-stage renal disease (ESRD) are presented. Neither had had cause in the past to seek medical attention for any renal-related illness. At presentation both had anaemia, growth failure and other clinical and laboratory evidence of ESRD. Kidney histology in one child was consistent with familial juvenile nephronophthisis (NPH). This is a common cause of ESRD in children in other countries but it has not been recognized previously in Trinidadian and other West Indian children, and should be considered as a possible aetiology in West Indian children presenting with renal failure.

Medullary sponge kidney associated with congenital hemihypertrophy

Medullary sponge kidney is a developmental disorder characterized by ectatic and cystic malformation of the collecting ducts and tubules. Clinical manifestations include urinary tract infections, renal stones, and hematuria. It can be associated with other developmental disorders. A case of medullary sponge kidney associated with congenital hemihypertrophy, complicated by nephrocalcinosis and nephrolithiasis, is reported here.

Management of lithiasis in medullary sponge kidneys

Twenty-four patients with medullary sponge kidneys (MSKs), diagnosed on a recent IVU, and renal lithiasis were treated by extracorporeal shock wave lithotripsy (ESWL). A detailed history regarding frequency of renal colic and urinary tract infection (UTI) was recorded and compared to the post-ESWL frequency of the symptoms. Our results show that the stone clearance rate is similar to that of non-MSK patients but there is a great reduction in the frequency of renal colic and UTI.

[Prevalence of medullary sponge kidney in patients with and without nephrolithiasis]

Reports on the prevalence of medullary sponge kidneys have given conflicting results. The present work is aimed at defining the prevalence of this abnormality in renal stone formers compared with a non-stone-forming control population by strict radiological criteria. Three separate studies have been carried out: the retrospective analysis of 191 intravenous urographies, which had been performed in 1988; the respective prospective analysis of 104 consecutive intravenous urographies and of 149 consecutive urographies, which had been performed at the end of intravenous digitalized subtraction renal angiographies. The 444 patients were classified according to presence or absence of nephrolithiasis. After exclusion of 70 patients (16%) of which the X-ray didn't fulfill the quality criteria, urographies were classified as 'medullary sponge kidneys', 'papillary blush' or 'negative' according to the radiological aspect of the papillae. Diagnosis of medullary sponge kidneys was based on presence of at least three linear or round papillary opacities seen in at least on papilla even of one kidney on late films (at least ten minutes after injection of contrast medium), taken without ureteral obstruction or abdominal compression. Overall results reveal that prevalence of a medullary sponge kidney in renal stone formers (8.5%) is significantly (p < 0.01) higher than in the control population (1.5%) and higher than what has been generally reported. Results of the retrospective and of both prospective analysis did not significantly differ. The best diagnostic tool to unmask medullary sponge kidneys remains urography.

[Medullary sponge kidney with severe renal function impairment: a case report]

The term medullary sponge kidney refers as a renal parenchymal malformation characterized by cystic dilatation of the collecting ducts. Although medullary sponge kidney is a congenital disease, it is rarely identified in childhood and is usually discovered in adulthood. We report a child with bilateral medullary sponge kidney who, in addition to typical urographic findings, presented an unfavorable evolution that ended in renal chronic insufficiency. This outlook is uncommon and is described in only 10% of affected subjects.

Papillary necrosis and medullary sponge kidney in a patient with hemoglobin SC

A 22-year-old woman with hemoglobin SC who was hematologically asymptomatic, developed gross hematuria associated with urinary tract infection, without any urological antecedents. Investigations revealed a unilateral hematuria due to papillary necrosis on the left kidney. Medullary sponge kidney was also discovered by radiologic investigations. Papillary cysts could play a role in the occurrence of papillary necrosis.

Urinary acidification and urinary excretion of calcium and citrate in women with bilateral medullary sponge kidney

Urinary acidification ability, acid-base status and urinary excretion of calcium and citrate were evaluated in 10 women with bilateral medullary sponge kidney (MSK) and in 10 healthy women. Patients with MSK had higher fasting urine pH compared to normal controls (p < 0.01). Four patients had incomplete renal tubular acidiosis (iRTA), 3 had hypercalciuria, and 5 patients had hypocitraturia. The 24-hour urinary excretion of calcium was increased in the females with MSK (5.23 +/- 0.78 mmol) compared to the healthy females (3.49 +/- 0.29 mmol) (p < 0.02), and increased in MSK patients with iRTA (7.32 +/- 1.45 mmol) compared to patients with normal urinary acidification (3.83 +/- 0.12 mmol) (p < 0.01). The patients with iRTA had reduced levels of plasma standard bicarbonate (20.5 +/- 1.0) after fasting compared to patients with normal urinary acidification (23.8 +/- 0.8) and healthy women (22.7 +/- 0.6) (p < 0.01), and reduced levels of 24-hour urinary excretion of citrate (0.93 +/- 0.25 mmol) compared to patients with normal urinary acidification (3.58 +/- 0.51) and healthy women (2.78 +/- 0.49) (p < 0.005). A positive correlation was found between the degree of acidosis during ammonium chloride loading and urinary excretion of calcium (r = 0.71, p = 0.02), and a negative correlation between the degree of acidosis during ammonium chloride loading and urinary citrate excretion (r = 0.87, p = 0.001). The results suggest that defective urinary acidification might play an important role in the mechanism of hypercalciuria and hypocitraturia in patients with medullary sponge kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of extracorporeal shock-wave lithotripsy in treatment of urolithiasis in patients with medullary sponge kidney

In an effort to identify the role of extracorporeal shock-wave lithotripsy (ESWL) in the treatment of patients with medullary sponge kidney, a retrospective review of our experience with the Dornier HM-3 lithotriptor is presented. From 1986-1991 17 patients with medullary sponge kidney ranging in age from twenty-eight to fifty-eight years received 31 treatments to a total of 24 renal units. Follow-up ranged from four to fifty-six months with an average follow-up of twenty-five months. ESWL appears to have a role in the treatment of symptomatic urolithiasis in patients with medullary sponge kidney. There may also be some benefit in treating parenchymal calcifications. No significant side effects from the treatment were noted.

Prophylactic role of extracorporeal shock wave lithotripsy in the management of nephrocalcinosis

Electromagnetic extracorporeal shock wave lithotripsy (ESWL) was performed with a standard Siemens Lithostar on parenchymal calcifications in 10 medullary sponge kidneys in order to evaluate the eventual benefit of preventive lithotripsy. The results of shock wave lithotripsy on precaliceal calcifications were disappointing and have been related to the lack of expansion during shock wave interaction and to the impaired drainage of particles. Three patients also had large impacted ureteric stones and in such cases ESWL remains the treatment of choice.

Experience using extracorporeal shock-wave lithotripsy to treat urinary calculi in problem kidneys

Seventeen patients with urolithiasis in problem kidneys which comprised horseshoe kidneys, medullary sponge kidneys (MSKs), polycystic kidneys and duplex kidneys presented to our hospital and were evaluated for treatment with extracorporeal shock-wave lithotripsy (ESWL). A total of 21 renal units were treated with ESWL. Auxiliary procedures included preoperative retrograde ureteral catheterization (1 horseshoe kidney) placement of a retrograde double-J catheter stent (1 MSK), percutaneous nephrolithotomy (PCNL; 2 MSKs) and postoperative PCNL (1 MSK). The outcome showed that 5 renal units (23.8%) were stone free, 15 renal units (71.4%) had a decreased stone load with residual stone and improved symptoms, and 1 renal unit (4.8%) had residual stone with persistent symptoms. We conclude that ESWL can be used as a primary management tool for calculi in problem kidneys.

The use of extracorporeal shock wave lithotripsy for medullary sponge kidneys

A number of patients with medullary sponge kidney recurrently form and pass stones with the risk of developing an obstructive nephropathy. These patients may benefit from extracorporeal shock wave lithotripsy to the medullary collections, as this appears to reduce the frequency of symptomatic stone passage.

Use of low-osmolality contrast medium does not increase prevalence of medullary sponge kidney

To assess the prevalence of intrapapillary linear collections of contrast medium as well as of homogeneous papillary blush on excretory urograms obtained with a low-osmolality contrast medium, iohexol was used in 300 patients. Intrapapillary linear collections of contrast medium (ie, three or more linear collections of contrast material within a papilla) were found in 10 (9.5%) of the 105 patients with renal stone disease and two (1.0%) of the 195 patients without nephrolithiasis (P less than .001). These prevalences are similar to those found in a previous study with use of a high-osmolality contrast medium (sodium amidotrizoate). The difference in the prevalence of homogeneous papillary blush between stone formers and non-stone formers was nonsignificant. The authors conclude that intrapapillary linear collections of contrast medium on excretory urograms obtained with use of a low-osmolality contrast medium should be considered to have the same clinical significance as those on excretory urograms obtained with use of a high-osmolality contrast medium, that is, as indicating the presence of medullary sponge kidney.

Medullary sponge kidneys and unilateral Wilms tumour in a child with Beckwith-Wiedemann syndrome

The occurrence of a Wilms tumour in a 4-year-old girl with bilateral medullary sponge kidney. Beckwith-Wiedemann syndrome and congenital hemihypertrophy demonstrates the close relationship between these disorders. Another six cases from the literature with congenital hemihypertrophy and with medullary sponge kidney are discussed, two of them also developed intraabdominal neoplasm.

Postpartum hypercalcemia in a patient with medullary sponge kidneys

Previous associations of primary hyperparathyroidism-induced hypercalcemia and medullary sponge kidney (MSK) have been reported. In this report, we describe a lactating woman MSK noted to be hypercalcemic throughout lactation, without evidence of hyperparathyroidism. After the baby was weaned, the serum calcium returned to normal. A bone biopsy performed while the patient was hypercalcemic was consistent with hyperparathyroidism, suggesting the presence of a parathyroid-like protein produced during lactation.

Medullary sponge kidney on axial computed tomography: comparison with excretory urography

To evaluate features of medullary sponge kidney (MSK) on computed tomography (CT), 4-mm-thick axial slices without intravenous contrast material were first made in 13 patients through 24 kidneys which showed images of MSK on excretory urograms. On CT, papillary calcifications were found in eleven kidneys. In five of these kidneys, the calcifications were not detectable on plain films. Some hyperdense papillae (attenuation value 55-70 Hounsfield units) without calcification were found in four other kidneys. Nine kidneys appeared normal. Ten of these 24 kidneys were reexamined by a second series of 4-mm-thick axial slices, 5 min after intravenous injections of 50 ml of Urografin. Images suggesting possible ectasia of precaliceal tubules were found in only four kidneys. These images appear much less obvious and characteristic on CT than on excretory urogram and do nothing more than suggest the possibility of MSK. In conclusion, the sensitivity of CT in the detection of MSK is markedly lower than that of excretory urography. In the most florid cases of the disease, CT can only show images suggesting the possibility of MSK. On the other hand, CT appears much more sensitive than plain films and tomograms of excretory urography in the detection of papillary calcifications, the most frequent complication of MSK.

Secondary urolithiasis

Urolithiasis may be associated with a wide range of unrelated conditions that in various ways predispose to the development of urinary tract calculi. The most common such conditions are urinary tract infection, structural abnormalities of the urinary tract, drugs, and foreign bodies. Evaluation of patients must rule out other underlying metabolic disorders. Treatment must address not only the calculi but also the correction or elimination of the predisposing factors.

Polycystic disease of the kidney coexisting with medullary sponge kidney

A case of simultaneous adult polycystic kidney disease and medullary sponge kidney is reported. Such an occurrence is rare but suggests that these two conditions share a common pathogenesis.

[A case of medullary sponge disease associated with horseshoe kidney]

A 60-year-old man visited our hospital with complaints of micturition pain and interruption of urinary stream. X-ray examinations were performed, showing no bladder and urethral stone. However, KUB revealed bilateral multiple renal stones. Excretory urography showed a horseshoe kidney and a concentration of the contrast medium in the ectatic tubules at the pyramidal apices. Calculi were also located in these ectatic tubules. Thus, we considered that this was a very rare case of medullary sponge disease associated with horseshoe kidney. So far there has been no case report of medullary sponge disease with horseshoe kidney in our country.

Does medullary sponge kidney cause nephrolithiasis?

The prevalence of medullary sponge kidney in patients with nephrolithiasis and the issue of whether or not medullary sponge kidney has a role in the pathogenesis of renal stones are controversial. We studied the excretory urograms of 280 patients with nephrolithiasis and 280 patients without either nephrolithiasis or a history of renal stones to determine the frequencies of medullary sponge kidney in the two groups. The criterion for the diagnosis of medullary sponge kidney was the presence of a minimum of three linear or round collections of contrast material within one renal papilla. In the patients with nephrolithiasis, we also looked for biochemical evidence of metabolic causes of renal stones. The frequency of medullary sponge kidney was 12% in patients with nephrolithiasis compared with 1% in patients without nephrolithiasis. The statistical difference was highly significant (chi square = 27.1; p less than .001). Metabolic disorders accounting for the lithiasis were detected in 93% of the patients with stones without medullary sponge kidney. Such evidence was present in 60% of patients with stones and medullary sponge kidney. The statistical difference was significant (chi square = 25.8; p less than .001). Our results suggest that medullary sponge kidney is a cause of nephrolithiasis.

[Clinical studies on medullary sponge kidney evaluated from urolithiasis]

Thirty eight patients with medullary sponge kidney (MSK) were detected (4.3%) in 881 patients with urolithiasis diagnosed by drip infusion pyelography in 12 years from January 1974 to December 1985. Those with MSK were studied clinically and as to metabolism of urolithiasis. The results obtained were as follows: 1) Age distribution of the patients with MSK was the same as that of general stone formers. 2) Hematuria was observed in 20 patients (52.6%) and pyuria in 7, in whom 4 were positive by urine culture (E. coli in 3 and P. mirabilis in 1) and 2 of them had infective stones. 3) Renal function of the patients examined by PSP test (20 patients) and creatinine clearance test (21 patients) was normal in all of the patients but three with ureteral caliculi. Concentration tests performed by Fishberg method (12 patients) were disturbed in half of them. 4) Affected lesions wer detected at more than three pyramides in each kidney and the bilaterals were found in 32 patients (84.2%) and at less than two pyramides in each kidney and the unilateral or the bilaterals were shown in the other 6. 5) When urinary levels of calcium, phosphate, uric acid and citrate using 24 hours urine were compared with 37 patients with MSK and 100 general stone formers, there was no difference in hypercalciuria and hyperuricosuria accounting for the frequency of the patients with MSK and the general stone formers, but there was a tendency of increased frequency about hyperphosphaturia and hypocitraturia in the patients with MSK.(ABSTRACT TRUNCATED AT 250 WORDS)

Medullary sponge kidney and staghorn calculi

We describe a 65-year-old female with bilateral staghorn calculi who presented with a Proteus mirabilis perinephric abscess secondary to a ruptured lower pole hydrocalyx. Radiologic evidence was consistent with underlying medullary sponge kidney (MSK) disease. Despite expectations to the contrary, MSK, a disease notable for many risk factors capable of precipitating staghorn disease, is rarely associated with coexistent staghorn calculi. A discussion of the concurrent risk factors and a possible hypothesis regarding the lack of coexistence follows.

A case of normotensive primary aldosteronism with hypopituitarism, epilepsy, and medullary sponge kidney

A 55-year-old man with normotensive primary aldosteronism, hypopituitarism, epilepsy, and medullary sponge kidney is reported. Seventeen years before admission, he had been noted to have hypokalemia associated with high potassium clearance, suppressed plasma renin activity, metabolic alkalosis, and normal blood pressure as well as low urinary excretion of 17-hydroxycorticosteroids. He kept normotensive in spite of hyperaldosteronism until nine months after the initiation of replacement therapy with glucocorticoid and thyroxine for hypopituitarism, when he became hypertensive. Hypopituitarism seemed to play a role in keeping a normal blood pressure despite long-standing hyperaldosteronism.