Medullary Sponge Kidney Medication

  • Author: Amit K Ghosh, MD, DM, FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Jan 5, 2012
 

Medication Summary

Thiazide therapy, in addition to restriction of animal protein intake, and aggressive diuresis may be helpful in patients with medullary sponge kidney and hypercalciuria.

Patients with medullary sponge kidney who demonstrate risk factors for stone formation (ie, hypocitraturia, hypercalciuria, hyperuricosuria, hyperoxaluria) should be considered for treatment with potassium citrate to prevent stone formation.[8]

Next

Diuretics

Class Summary

The primary role of thiazide diuretics is to decrease hypercalciuria.

View full drug information

Hydrochlorothiazide (Esidrix, Microzide, HydroDIURIL)

 

This agent inhibits the reabsorption of sodium in distal tubules, causing increased excretion of sodium and water, as well as of potassium and hydrogen ions. Its use is indicated in patients with medullary sponge kidney with hypercalciuria.

Previous
Next

Urinary Alkalinizing Agents

Class Summary

Patients with medullary sponge kidney who demonstrate risk factors for stone formation (ie, hypocitraturia, hypercalciuria, hyperuricosuria, hyperoxaluria) should be considered for treatment with potassium citrate to prevent stone formation.

View full drug information

Potassium citrate (Urocit K)

 

Potassium citrate is a potassium-based alkalinizer. The starting dose of potassium citrate is 20 mEq/day and should be adjusted to keep a urinary citrate level of 450 mg/day and a urinary pH level of less than 7.5.

Previous
 
Contributor Information and Disclosures
Author

Amit K Ghosh, MD, DM, FACP  Professor of Medicine, Mayo Medical School; Consultant in General Internal Medicine, Director of International Program, Mayo Clinic

Amit K Ghosh, MD, DM, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, Minnesota Medical Association, and Society of General Internal Medicine

Disclosure: Mayo Clinic Foundation Royalty Editor of book, author

Coauthor(s)

Karthik Ghosh, MD  Consultant, Associate Professor of Medicine, Department of Internal Medicine, Mayo Medical School

Karthik Ghosh, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Eleanor Lederer, MD Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Dept of Veterans Affairs Grant/research funds Research

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Fick GM, Gabow PA. Hereditary and acquired cystic disease of the kidney. Kidney Int. Oct 1994;46(4):951-64. [Medline].

  2. Gambaro G, Feltrin GP, Lupo A, et al. Medullary sponge kidney (Lenarduzzi-Cacchi-Ricci disease): a Padua Medical School discovery in the 1930s. Kidney Int. Feb 2006;69(4):663-70. [Medline].

  3. Yagisawa T, Kobayashi C, Hayashi T, et al. Contributory metabolic factors in the development of nephrolithiasis in patients with medullary sponge kidney. Am J Kidney Dis. Jun 2001;37(6):1140-3. [Medline].

  4. Forster JA, Taylor J, Browning AJ, et al. A review of the natural progression of medullary sponge kidney and a novel grading system based on intravenous urography findings. Urol Int. 2007;78(3):264-9. [Medline].

  5. Levine E, Hartman DS, Meilstrup JW, et al. Current concepts and controversies in imaging of renal cystic diseases. Urol Clin North Am. Aug 1997;24(3):523-43. [Medline].

  6. Palubinskas AJ. Renal pyramid structure opacification in excretory urography and its relation to medullary sponge kidney. Radiology. Dec 1963;81:963-70. [Medline].

  7. Higashihara E, Nutahara K, Tago K, et al. Medullary sponge kidney and renal acidification defect. Kidney Int. Feb 1984;25(2):453-9. [Medline].

  8. Fabris A, Lupo A, Bernich P, et al. Long-term treatment with potassium citrate and renal stones in medullary sponge kidney. Clin J Am Soc Nephrol. Sep 2010;5(9):1663-8. [Medline].

  9. Lang EK, Macchia RJ, Thomas R, et al. Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria. Urology. Mar 2003;61(3):528-32. [Medline].

  10. McPhail EF, Gettman MT, Patterson DE, Rangel LJ, Krambeck AE. Nephrolithiasis in Medullary Sponge Kidney: Evaluation of Clinical and Metabolic Features. Urology. Oct 17 2011;[Medline].

 
Previous
Next
 
IVU-like, volume-rendered (VR) computed tomography (CT) scan of both kidneys demonstrates brushlike densities throughout multiple papillae of both kidneys consistent with renal tubular ectasia. Correlation of the stone disease with the ectatic tubules is diagnostic of medullary sponge kidney. Image courtesy of Dr. Terri J. Vrtiska, Consultant, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Unenhanced coronal, volume-rendered (VR) computed tomography (CT) scan of the kidneys demonstrates 2 small calculi in the midportion of the right kidney and 2 small calculi in the lower pole of the left kidney (arrowheads). A large, low-density lesion in the lower pole of the right kidney and a small, low-density lesion in the upper pole of the left kidney (short arrows) were shown to represent benign simple renal cysts on the contrast-enhanced CT scans. Image courtesy of Dr. Terri J. Vrtiska, Consultant, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Table 1. Clinical Features of Medullary Sponge Kidney and Etiologic Correlation
Frequency Clinical Findings Etiology
Common*Nephrolithiasis (calcium oxalate, calcium apatite)Hypercalciuria



Increased oxalate concentration



Tubular acidification defects



Hypocitraturia



Hematuria (gross 10-20%, microscopic)Acute pelvic obstruction



UTI, renal stones, or absence of both



UTISterile pyuria common even in absence of stones



Presence of renal stones



RareChronic kidney diseaseRepeated urinary obstruction



Repeated pyelonephritis due to urease-producing organisms (Proteus)



*Asymptomatic
Table 2. Radiologic Appearance in Medullary Sponge Kidney
Radiologic Test Appearance
Plain radiographNormal or enlarged kidney



Medullary nephrocalcinosis indicated by isolated, single or multiple precaliceal concretions or clusters of grapelike calcifications



Excretory urogram*Papillary blush



Faint pyramidal striation



Papillary streaking or brushlike appearance



Precaliceal tubular dilatation filled with contrast



Papillary blush and multiple precaliceal dilatation



Bouquet of flowers



CT scanPapillary calcification



Hyperdense papilla



Ectasia of precaliceal tubules



*Findings limited to medullary pyramids
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.