Nephrocalcinosis
Encyclopedia
Nephrocalcinosis, once known as Albright's calcinosis after Fuller Albright, is a term originally used to describe deposition of calcium
salts in the renal parenchyma
due to hyperparathyroidism
. It is now more commonly used to describe diffuse, fine, renal parenchymal calcification on radiology. During its early stages, nephrocalcinosis is visible on x-ray
, and appears as a fine granular mottling over the renal outlines. These outlines eventually come together to form a dense mass.
It is most commonly seen as an incidental finding with medullary sponge kidney
on an abdominal x-ray.
However, it may be severe enough to cause (as well as be caused by) renal tubular acidosis
or even end stage renal failure, due to disruption of the renal tissue by the deposited calcium.
, polyuria
and polydipsia
:
There are several causes of nephrocalcinosis that are typically acute and present only with renal failure
. These include tumor lysis syndrome
, acute phosphate nephropathy, and occasional cases of enteric hyperoxaluria
.
And other causes of hypercalcemia (and thus hypercalciuria
)
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
salts in the renal parenchyma
Parenchyma
Parenchyma is a term used to describe a bulk of a substance. It is used in different ways in animals and in plants.The term is New Latin, f. Greek παρέγχυμα - parenkhuma, "visceral flesh", f. παρεγχεῖν - parenkhein, "to pour in" f. para-, "beside" + en-, "in" + khein, "to pour"...
due to hyperparathyroidism
Hyperparathyroidism
Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone . The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels...
. It is now more commonly used to describe diffuse, fine, renal parenchymal calcification on radiology. During its early stages, nephrocalcinosis is visible on x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
, and appears as a fine granular mottling over the renal outlines. These outlines eventually come together to form a dense mass.
It is most commonly seen as an incidental finding with medullary sponge kidney
Medullary sponge kidney
Medullary sponge kidney is a congenital disorder of the kidneys characterized by cystic dilatation of the collecting tubules in one or both kidneys. In people with nephrolithiasis, the frequency of medullary sponge kidney has been reported by various authors to be 1221%. The disease is bilateral...
on an abdominal x-ray.
However, it may be severe enough to cause (as well as be caused by) renal tubular acidosis
Renal tubular acidosis
Renal tubular acidosis is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. When blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid...
or even end stage renal failure, due to disruption of the renal tissue by the deposited calcium.
Stages of nephrocalcinosis
- Chemical nephrocalcinosis
- Microscopic nephrocalcinosis
- Macroscopic nephrocalcinosis
Symptoms of nephrocalcinosis
Though this condition is usually asymptomatic, if symptoms are present they are usually related to the causative process, (eg, hypercalcemia). These include renal colicRenal colic
Renal colic is a type of abdominal pain commonly caused by kidney stones.-Presentation:The pain typically begins in the abdomen and often radiates to the hypochondrium or the groin. The pain is often colicky due to ureteric peristalsis, but may be constant...
, polyuria
Polyuria
Polyuria is a condition usually defined as excessive or abnormally large production or passage of urine . Frequent urination is sometimes included by definition, but is nonetheless usually an accompanying symptom...
and polydipsia
Polydipsia
Polydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα...
:
- Renal colic is usually caused by pre-existing nephrolithiasis, as may occur in patients with chronic hypercalciuriaHypercalciuriaHypercalciuria or hypercalcinuria is the condition of elevated calcium in the urine. Chronic hypercalcinuria may lead to impairment of renal function, nephrocalcinosis, and renal insufficiency....
. Less commonly, it can result from calcified bodies moving into the calyceal system. - Nocturia, polyuria, and polydipsia from reduced urinary concentrating capacity (ie, nephrogenic diabetes insipidusNephrogenic diabetes insipidusNephrogenic diabetes insipidus is a form of diabetes insipidus due primarily to pathology of the kidney. This is in contrast to central/neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone /Argenine Vasopressin...
) as can be seen in hypercalcemia, medullaryRenal medullaThe renal medulla is the innermost part of the kidney. The renal medulla is split up into a number of sections, known as the renal pyramids. Blood enters into the kidney via the renal artery, which then splits up to form the arcuate arterioles. The arcuate arterioles each in turn branch into...
nephrocalcinosis of any cause, or in children with Bartter syndromeBartter syndromeBartter syndrome is a rare inherited defect in the thick ascending limb of the loop of Henle. It is characterized by low potassium levels , increased blood pH , and normal to low blood pressure. There are two types of Bartter syndrome: neonatal and classic...
in whom essential tubular salt reabsorption is compromised.
There are several causes of nephrocalcinosis that are typically acute and present only with renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. These include tumor lysis syndrome
Tumor lysis syndrome
In medicine , tumor lysis syndrome is a group of metabolic complications that can occur after treatment of cancer, usually lymphomas and leukemias, and sometimes even without treatment...
, acute phosphate nephropathy, and occasional cases of enteric hyperoxaluria
Hyperoxaluria
Hyperoxaluria is an excessive urinary excretion of oxalate. Individuals with hyperoxaluria often have calcium oxalate kidney stones. Sometimes called Bird's disease, after Golding Bird who was first to describe the condition.-Causes:...
.
Causes of cortical nephrocalcinosis
- Acute cortical necrosis. May be caused by:
- Placenta abruptio
- Placenta previa
- Septic abortionSeptic abortionA septic abortion or septic miscarriage is a form of miscarriage that is associated with a serious uterine infection. The infection carries risk of spreading infection to other parts of the body and cause septicaemia, a grave risk to the life of the woman.-Causes:A septic abortion can occur when...
- Transfusion reactions
- BurnBurnA burn is an injury to flesh caused by heat, electricity, chemicals, light, radiation, or friction.Burn may also refer to:*Combustion*Burn , type of watercourses so named in Scotland and north-eastern England...
s - Snake bite
- Severe dehydrationDehydrationIn physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
- Shock
- Severe heart failure
- Abdominal aorticAbdominal aortaThe abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta .-Path:...
surgerySurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
- Chronic glomerulonephritisGlomerulonephritisGlomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys...
- Alport syndromeAlport syndromeAlport syndrome or hereditary nephritis is a genetic disorder characterized by glomerulonephritis, endstage kidney disease, and hearing loss. Alport syndrome can also affect the eyes . The presence of blood in the urine is almost always found in this condition.It was first identified in a British...
- Prolonged hypercalcemia and/or hypercalciuriaHypercalciuriaHypercalciuria or hypercalcinuria is the condition of elevated calcium in the urine. Chronic hypercalcinuria may lead to impairment of renal function, nephrocalcinosis, and renal insufficiency....
- Renal transplant rejectionTransplant rejectionTransplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
- Sickle cell disease (rare)
- Vitamin B6Vitamin B6Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Several forms of the vitamin are known, but pyridoxal phosphate is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation...
(pyridoxine) deficiency (rare)
Causes of medullary nephrocalcinosis
- Medullary sponge kidneyMedullary sponge kidneyMedullary sponge kidney is a congenital disorder of the kidneys characterized by cystic dilatation of the collecting tubules in one or both kidneys. In people with nephrolithiasis, the frequency of medullary sponge kidney has been reported by various authors to be 1221%. The disease is bilateral...
- HyperparathyroidismHyperparathyroidismHyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone . The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels...
- Renal tubular acidosisRenal tubular acidosisRenal tubular acidosis is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. When blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid...
(specifically distal RTA) - Renal tuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
- Renal papillary necrosisRenal papillary necrosisRenal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla, which is supplied by the vasa recta.-Causes:Analgesic nephropathy is a cause of renal papillary necrosis. The damage is cumulative and most patients of renal papillary necrosis would have ingested at...
- HyperoxaluriaHyperoxaluriaHyperoxaluria is an excessive urinary excretion of oxalate. Individuals with hyperoxaluria often have calcium oxalate kidney stones. Sometimes called Bird's disease, after Golding Bird who was first to describe the condition.-Causes:...
And other causes of hypercalcemia (and thus hypercalciuria
Hypercalciuria
Hypercalciuria or hypercalcinuria is the condition of elevated calcium in the urine. Chronic hypercalcinuria may lead to impairment of renal function, nephrocalcinosis, and renal insufficiency....
)
- Immobilization (leading to hypercalcemia and hypercalciuria)
- Milk-alkali syndromeMilk-alkali syndromeIn medicine, milk-alkali syndrome, also called Burnett's syndrome in honour of Charles Hoyt Burnett, the American physician who first described it, is characterized by hypercalcemia caused by repeated ingestion of calcium and absorbable alkali...
- Hypervitaminosis DHypervitaminosis DHypervitaminosis D is a state of vitamin D toxicity.The recommended daily allowance is 400 IU per day. Overdose has been observed at 1925 µg/d...
- SarcoidosisSarcoidosisSarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...