eMedicine Specialties > Nephrology > Tubulointerstitial Diseases of the Kidney

Nephrocalcinosis: Follow-up

Author: Tibor Fulop, MD, Assistant Professor, Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center
Coauthor(s): Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology; Rupert Patel, MD, Physician, Division of Nephrology, Houston, Texas; Rajiv Gupta, MD, Assistant Professor, Department of Medicine, Texas A & M University Health Science Center; Consulting Staff, Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 21, 2009

Follow-up

Prognosis

  • The prognosis depends mainly on the etiology of the nephrocalcinosis.
  • The major long-term complication in patients with medullary nephrocalcinosis is renal failure.
    • Early treatment of reversible causes of renal failure, such as urinary infections, obstruction, and hypertension, is essential.
    • Once chronic renal failure has developed, treatment should focus on the appropriate management of chronic kidney disease and its complications.
    • Patients with idiopathic hypercalciuria and medullary sponge kidney have the least risk of renal failure and the best prognosis, whereas patients with primary type 1 hyperoxaluria have the worst prognosis.

Patient Education

Key points to emphasize include the following:

  • Nephrocalcinosis is usually an incidental finding.
  • Hypercalcemia or hypercalciuria are frequently present.
  • Nephrocalcinosis is more likely to be a consequence of the underlying abnormality than it is to be the cause.

Miscellaneous

Medicolegal Pitfalls

  • Nephrocalcinosis, although seemingly a simple finding, incorporates a large number of potential disease processes in the differential. An effort should be made describe the location and degree of nephrocalcinosis and to uncover the underlying metabolic abnormality or abnormalities.
  • In clinical practice, nephrocalcinosis is more commonly encountered as macroscopic nephrocalcinosis. Do not consider it synonymous with renal stone disease, because nephrocalcinosis has much broader metabolic implications.
  • Patients with a primary loin pain-hematuria syndrome experience a poorly understood combination of pain associated with hematuria. Some of these individuals have co-incidental nephrocalcinosis that, incorrectly, may be blamed for the generation of pain. However, any associated hypercalciuria or hyperuricosuria should be addressed aggressively.
 
Acknowledgments

The primary author would like to thank Dr. Gurvinder Suri, Renal Fellow at the University of Mississippi Medical Center - Nephrology Division, for his valuable peer review.



More on Nephrocalcinosis

Overview: Nephrocalcinosis
Differential Diagnoses & Workup: Nephrocalcinosis
Treatment & Medication: Nephrocalcinosis
Follow-up: Nephrocalcinosis
Multimedia: Nephrocalcinosis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Monk RD, Bushinsky DA. Nephrolithiasis and nephrocalcinosis. In: Johnson RJ, Feehally J, eds. Comprehensive Clinical Nephrology. 2nd ed. Mosby; 2003:731-4.

  2. Sands JM, Naruse M, Baum M, et al. Apical extracellular calcium/polyvalent cation-sensing receptor regulates vasopressin-elicited water permeability in rat kidney inner medullary collecting duct. J Clin Invest. Mar 15 1997;99(6):1399-405. [Medline]. [Full Text].

  3. Epstein FH. Calcium and the kidney. Am J Med. Nov 1968;45(5):700-14. [Medline].

  4. Jonsson KB, Zahradnik R, Larsson T, et al. Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia. N Engl J Med. Apr 24 2003;348(17):1656-63. [Medline]. [Full Text].

  5. Schiavi SC, Kumar R. The phosphatonin pathway: new insights in phosphate homeostasis. Kidney Int. Jan 2004;65(1):1-14. [Medline].

  6. Evan AP, Lingeman J, Coe F, et al. Renal histopathology of stone-forming patients with distal renal tubular acidosis. Kidney Int. Apr 2007;71(8):795-801. [Medline].

  7. Oguzkurt L, Karabulut N, Haliloglu M, et al. Medullary nephrocalcinosis associated with vesicoureteral reflux. Br J Radiol. Aug 1997;70(836):850-1. [Medline]. [Full Text].

  8. 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].

  9. Sanderson PH. Functional aspects of renal calcification in rats. Clin Sci (Lond). Feb 1959;18(1):67-79. [Medline].

  10. Al-Modhefer AK, Atherton JC, Garland HO, et al. Kidney function in rats with corticomedullary nephrocalcinosis: effects of alterations in dietary calcium and magnesium. J Physiol. Nov 1986;380:405-14. [Medline]. [Full Text].

  11. Karet FE. Inherited distal renal tubular acidosis. J Am Soc Nephrol. Aug 2002;13(8):2178-84. [Medline]. [Full Text].

  12. Scarpelli DG, Tremblay G, Pearce AG. A comparative cytochemical and cytologic study of vitamin D induced nephrocalcinosis. Am J Pathol. Mar 1960;36:331-53. [Medline]. [Full Text].

  13. Gobel U, Kettritz R, Schneider W, et al. The protean face of renal sarcoidosis. J Am Soc Nephrol. Mar 2001;12(3):616-23. [Medline]. [Full Text].

  14. Frick KK, Bushinsky DA. Molecular mechanisms of primary hypercalciuria. J Am Soc Nephrol. Apr 2003;14(4):1082-95. [Medline]. [Full Text].

  15. Markowitz GS, Stokes MB, Radhakrishnan J, et al. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol. Nov 2005;16(11):3389-96. [Medline]. [Full Text].

  16. Markowitz GS, Nasr SH, Klein P, et al. Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum Pathol. Jun 2004;35(6):675-84. [Medline].

  17. Hurst FP, Bohen EM, Osgard EM, et al. Association of oral sodium phosphate purgative use with acute kidney injury. J Am Soc Nephrol. Dec 2007;18(12):3192-8. [Medline]. [Full Text].

  18. Ori Y, Herman M, Tobar A, et al. Acute phosphate nephropathy-an emerging threat. Am J Med Sci. Oct 2008;336(4):309-14. [Medline].

  19. Balaban DH. Guidelines for the safe and effective use of sodium phosphate solution for bowel cleansing prior to colonoscopy. Gastroenterol Nurs. Sep-Oct 2008;31(5):327-34; quiz 334-5. [Medline].

  20. Leumann E, Hoppe B. The primary hyperoxalurias. J Am Soc Nephrol. Sep 2001;12(9):1986-93. [Medline]. [Full Text].

  21. Hoppe B, Langman CB. A United States survey on diagnosis, treatment, and outcome of primary hyperoxaluria. Pediatr Nephrol. Oct 2003;18(10):986-91. [Medline].

  22. Alon U, Lovell HB, Donaldson DL. Nephrocalcinosis, hyperparathyroidism, and renal failure in familial hypophosphatemic rickets. Clin Pediatr (Phila). Mar 1992;31(3):180-3. [Medline].

  23. Hoopes RR Jr, Shrimpton AE, Knohl SJ, et al. Dent Disease with mutations in OCRL1. Am J Hum Genet. Feb 2005;76(2):260-7. [Medline]. [Full Text].

  24. Benigno V, Canonica CS, Bettinelli A, et al. Hypomagnesaemia-hypercalciuria-nephrocalcinosis: a report of nine cases and a review. Nephrol Dial Transplant. May 2000;15(5):605-10. [Medline]. [Full Text].

  25. Weber S, Schneider L, Peters M, et al. Novel paracellin-1 mutations in 25 families with familial hypomagnesemia with hypercalciuria and nephrocalcinosis. J Am Soc Nephrol. Sep 2001;12(9):1872-81. [Medline]. [Full Text].

  26. Knoers NV. Inherited forms of renal hypomagnesemia: an update. Pediatr Nephrol. Sep 26 2008;[Medline].

  27. Schell-Feith EA, Moerdijk A, van Zwieten PH, et al. Does citrate prevent nephrocalcinosis in preterm neonates?. Pediatr Nephrol. Dec 2006;21(12):1830-6. [Medline].

  28. Schell-Feith EA, Kist-van Holthe JE, van der Heijden AJ. Nephrocalcinosis in preterm neonates. Pediatr Nephrol. Sep 17 2008;[Medline].

  29. Cozzolino M, Staniforth ME, Liapis H, et al. Sevelamer hydrochloride attenuates kidney and cardiovascular calcifications in long-term experimental uremia. Kidney Int. Nov 2003;64(5):1653-61. [Medline].

  30. Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol. Dec 23 2008;[Medline].

  31. Cheidde L, Ajzen SA, Tamer Langen CH, et al. A critical appraisal of the radiological evaluation of nephrocalcinosis. Nephron Clin Pract. 2007;106(3):c119-24. [Medline].

  32. Curry NS, Gordon L, Gobien RP, et al. Renal medullary "rings": possible CT manifestation of hypercalcemia. Urol Radiol. 1984;6(1):48-50. [Medline].

  33. Barre PE, Gascon-Barre M, Meakins JL, et al. Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis. Am J Med. Jun 1987;82(6):1259-62. [Medline].

  34. Sakhaee K, Nicar M, Hill K, et al. Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int. Sep 1983;24(3):348-52. [Medline].

  35. Bhagat SK, Chacko NK, Kekre NS, et al. Is there a role for tamsulosin in shock wave lithotripsy for renal and ureteral calculi?. J Urol. Jun 2007;177(6):2185-8. [Medline].

  36. [Best Evidence] Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. Dec 4 2008;359(23):2417-28. [Medline].

[ CLOSE WINDOW ]

Keywords

nephrocalcinosis, kidney, kidneys, kidney stones, kidney stone, hypercalcemia, hypercalciuria, hyperparathyroidism, nephrolithiasis, urinary stones, urinary stone, medullary nephrocalcinosis, crystal-induced nephropathy, increase in renal calcium content, microscopic nephrocalcinosis, macroscopic nephrocalcinosis, hypercalcemic nephropathy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Tibor Fulop, MD, Assistant Professor, Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center
Tibor Fulop, MD is a member of the following medical societies: American College of Physicians and American Society of Diagnostic and Interventional Nephrology
Disclosure: Nothing to disclose.

Coauthor(s)

Mahendra Agraharkar, MD, MBBS, FACP, FASN, Clinical Associate Professor of Medicine, Baylor College of Medicine, President & CEO, Space City Associates of Nephrology
Mahendra Agraharkar, MD, MBBS, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, and National Kidney Foundation
Disclosure: South Shore DaVita Dialysis Center  Ownership interest Other

Rupert Patel, MD, Physician, Division of Nephrology, Houston, Texas
Disclosure: Nothing to disclose.

Rajiv Gupta, MD, Assistant Professor, Department of Medicine, Texas A & M University Health Science Center; Consulting Staff, Veterans Affairs Medical Center
Rajiv Gupta, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Medical Editor

James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
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: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.