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Media Gallery

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.

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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
	UTI	Sterile pyuria common even in absence of stones Presence of renal stones
Rare	Chronic kidney disease	Repeated urinary obstruction Repeated pyelonephritis due to urease-producing organisms (Proteus)
*Asymptomatic

Table 2. Radiologic Appearance in Medullary Sponge Kidney

Radiologic Test	Appearance
Plain radiograph	Normal 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 scan	Papillary calcification Hyperdense papilla Ectasia of precaliceal tubules
*Findings limited to medullary pyramids

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