Nephrocalcinosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Nephrocalcinosis (NC) is a condition where calcium salt deposits form in the renal parenchyma.
  • NC is related but distinct from nephrolithiasis, where deposits form in the renal collecting system (1).
  • Although primarily considered a radiographic diagnosis and often discovered incidentally on radiographic imaging, NC can portend more serious kidney and systemic disease (2).
  • Range of symptoms: asymptomatic to vague, nonspecific findings or symptoms related to underlying cause of hypercalcemia
  • Descriptive types of NC based on radiographic location (2):
    • Medullary type: most commonly related to metabolic disorders; the most common type of NC (95%)
    • Cortical type: most commonly associated with renal tubular acidosis and necrosis
    • Diffuse
    • Microscopic: noted only on histologic examination of renal tissue

Epidemiology

Incidence
Difficult to determine due to multiple etiologies


Prevalence
  • 7–41% of preterm newborns (3)
  • Up to 20% of patients with hyperparathyroidism

Etiology and Pathophysiology

Two primary mechanisms:

  • Intratubular NC: crystal adherence to damaged tubular epithelium leading to translocation or obstruction
  • Interstitial NC: plaque formation in the ascending loops of Henle and invade the medullary interstitium (4)
Genetics
  • Increased prevalence of NC with certain hereditary disorders:
    • Dent disease
    • Familial hypomagnesemia with hypercalciuria and NC
    • Primary hyperoxaluria
    • Bartter syndrome
    • Liddle syndrome (5)

Risk Factors

  • Medullary
    • Primary hyperparathyroidism
    • Renal tubular acidosis
    • Prematurity
    • Hereditary disorders
    • Hyperthyroidism
    • Granulomatous diseases such as sarcoidosis
    • Oversupplementation of phosphate and vitamin D
    • Multiple myeloma
    • Cushing syndrome
    • Chronic steroid use
    • Metastatic neoplasm
    • Medullary sponge kidney
    • Milk-alkali syndrome
    • Hyperuricemia
    • Sickle cell disease
  • Cortical
    • Renal infarct, ischemia, or toxins
    • Hyperoxaluria
    • Chronic glomerulonephritis
    • Alport syndrome
    • Autosomal recessive polycystic kidney disease
    • Opportunistic intrarenal infections such as Mycobacterium avium or Pneumocystis carinii pneumonia

General Prevention

Prevention of preterm birth

Commonly Associated Conditions

  • Hypercalcemia
  • Hypercalciuria
  • Renal tubular acidosis
  • Hyperoxaluria
  • Urinary stasis
  • Hyperparathyroidism
  • Treatment of hypoparathyroidism
  • Medullary sponge kidney
  • Osteoporosis

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Citation

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TY - ELEC T1 - Nephrocalcinosis ID - 816447 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816447/all/Nephrocalcinosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -