eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Medullary Sponge Kidney: Treatment & Medication

Author: Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Nov 4, 2009

Treatment

Medical Care

No specific treatment for medullary sponge kidney (MSK) is warranted. If hypercalciuria-associated kidney stone disease is present, use of thiazide diuretics or other measures to reduce the hypercalciuria may be justified. Renal stones are managed in the same way as in individuals without medullary sponge kidney. Treat urinary tract infections (UTIs) with standard courses of antibiotics. Prophylactic antibiotics may help patients with medullary sponge kidney and recurrent UTIs. In patients with hemihypertrophy, serial screening should be performed to exclude a malignancy.

Surgical Care

Surgery is not needed for most patients with medullary sponge kidney.

Diet

Although decreased dietary calcium intake may decrease urinary calcium excretion, concern has been expressed that it might also result in skeletal undermineralization. Decreased sodium intake and increased potassium intake may improve urinary calcium excretion by themselves and are recommended in patients taking thiazide diuretics.

Activity

Because medullary sponge kidney is a nonprogressive condition with small medullary cysts, restriction of physical activity is unnecessary.

Medication

No medications are warranted for routine care of medullary sponge kidney (MSK). Use antibiotics in accordance with standard prescription practices to treat urinary tract infections (UTIs). See Urinary Tract Infection. Consider thiazide diuretics in patients with hypercalciuric urolithiasis.

Diuretics

Thiazide diuretics may be prescribed to patients who have medullary sponge kidney and hypercalciuria, with or without urolithiasis.


Hydrochlorothiazide (Esidrix, HydroDIURIL, Microzide)

Decreases hypercalciuria and reduces risk of urolithiasis by promoting calcium reabsorption in distal convoluted tubule.

Adult

50-100 mg/d PO

Pediatric

1-2 mg/kg/d PO

Thiazides may decrease effects of anticoagulants, antigout agents, and sulfonylureas; thiazides may increase toxicity of allopurinol, anesthetics, antineoplastics, calcium salts, loop diuretics, lithium, diazoxide, digitalis, amphotericin B, and nondepolarizing muscle relaxants

Documented hypersensitivity; anuria or renal decompensation

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients with renal disease, hepatic disease, gout, diabetes mellitus, or erythematosus

More on Medullary Sponge Kidney

Overview: Medullary Sponge Kidney
Differential Diagnoses & Workup: Medullary Sponge Kidney
Treatment & Medication: Medullary Sponge Kidney
Follow-up: Medullary Sponge Kidney
Multimedia: Medullary Sponge Kidney
References
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References

  1. 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].

  2. Carboni I, Andreucci E, Caruso MR, et al. Medullary sponge kidney associated with primary distal renal tubular acidosis and mutations of the H+-ATPase genes. Nephrol Dial Transplant. Sep 2009;24(9):2734-8. [Medline].

  3. Harris AM, Hall B, Kriss VM, Fowlkes JL, Kiessling SG. Rabson-Mendenhall syndrome: medullary sponge kidney, a new component. Pediatr Nephrol. Dec 2007;22(12):2141-4. [Medline].

  4. Abeshouse BS, Abeshouse GA. Sponge kidney: a review of the litrature and a report of five cases. J Urol. Aug 1960;84:252-67. [Medline].

  5. Avner ED. Medullary sponge kidney. In: Greenber A, Cheung AK, Coffman TM, et al, eds. NKF Primer on Kidney Disease. 1997.

  6. Osther PJ, Mathiasen H, Hansen AB, et al. Urinary acidification and urinary excretion of calcium and citrate in women with bilateral medullary sponge kidney. Urol Int. 1994;52(3):126-30. [Medline].

  7. Patriquin HB, O'Regan S. Medullary sponge kidney in childhood. AJR Am J Roentgenol. Aug 1985;145(2):315-9. [Medline].

  8. [Guideline] Tiselius HG, Alken P, Buck C, Gallucci M, Knoll T, Sarica K, Turk C. Guidelines on urolithiasis. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. [Full Text].

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Further Reading

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Keywords

medullary sponge kidney, MSK, medullary cysts, renal cyst, Beckwith-Wiedemann syndrome, BWS, hemihypertrophy, Caroli disease, Ehlers-Danlos syndrome, Marfan syndrome, Marfan's syndrome, pyloric stenosis, kidney stones, treatment, diagnosis

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Contributor Information and Disclosures

Author

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Uri S Alon, MD, Director of Research and Education, Department of Pediatrics, Division of Pediatric Nephrology, Children's Mercy Hospital of Kansas City; Professor, University of Missouri at Kansas City
Uri S Alon, MD is a member of the following medical societies: American Federation for Medical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Frederick J Kaskel, MD, PhD, Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine
Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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