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10 years old female, mildly increased serum creatinine, “R/O hydronephosis”
Important findings? Dx? Cause(s)?
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Related study … U/S of “neck area” Final Dx?
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Answers
Medullary Nephrocalcinosis from parathyroid Adenoma
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  • Medullary Nephrocalcinosis: multiple areas of increases echogenicity involving all of the medullary pyramids; cortex is normal
  • Typical parathyroid adenoma: hypechoic, oval, solid mass adjacent to the posterior surface of the thyroid gland

Medullary Nephrocalcinosis – CT Correction
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Medullary Nephrocalcinosis:
95% of all nephrocalcinoses. Calcifications involving the distal convoluted tubules in the loops of Henle

Causes:

  • Endocrine: Hyperparathyroidism, paraneoplastic syndrome, cushing’s, DI
  • Alimentary: Milk-alkali, hypervitaminosis D, beryllium poisoning
  • Renal: Medullary Sponge kidney, RTA, Bartter’s syndrome
  • Drugs: Lasix, ACTH Rx, Vitamin E, other (e.g., sarcoid)
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