QuestionHi Dr. Aukerman,
I am a normally healthy 29 year old and am now 7 weeeks postpartum. A possible kidney stone was found on a late ultrasound at 36 weeks pregnant. I had another ultrasound earlier this week to confirm and my OB called me today saying they found no sign of kidney stones, but that I have nephrocalculosis and both of my kidneys look like they are hardening. He said he really doesn't know much about this and will send the results to my family doctor for follow up and testing of kidney function. During my pregnancy, both my blood pressure and urine test results were normal.
Can you kindly tell me what nephrocalculosis is and how the kidneys and body in general are usually affected by this abnormality or disorder?
Also, what types of tests and treatments would be usual for this condition?
Thank you very much for your time and assistance.
Kind Regards,
Autumn
AnswerIf you go to this site you will find more detail and can print off for your doctor to see and discuss.
http://www.nlm.nih.gov/medlineplus/ency/article/000492.htm
Medical Encyclopedia: Nephrocalcinosis
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000492.htm
Definition
Nephrocalcinosis is a kidney disorder involving deposition of calcium and oxalate or phosphate in the renal tubules and interstitium (the areas between the tubules). These deposits may result in reduced kidney function.
Causes, incidence, and risk factors
Nephrocalcinosis may be caused by a number of conditions:
Excess excretion of calcium by the kidney
Renal tubular acidosis
Medullary sponge kidney
Hypercalcemia (high calcium levels in the blood)
Renal cortical necrosis
Tuberculosis
Fragments of calcium oxalate or calcium phosphate may break free from the kidney and provide nuclei for formation of stones (nephrolithiasis). This may result in obstructive uropathy, possibly leading to eventual kidney failure if the obstructing stones are not passed in the urine or removed. Nephrocalcinosis may therefore be discovered when symptoms of renal insufficiency/renal failure, obstructive uropathy, or urinary tract stones develop.
This condition is relatively common in premature infants, partly from intrinsic kidney calcium losses and partly from enhanced calcium excretion when they are given loop diuretics.
Symptoms
There are generally no early symptoms. Later symptoms related to nephrocalcinosis and associated disorders may include the following:
Increased urine volume or urine output, decreased
Urinary hesitancy (difficulty initiating the flow of urine)
Dribbling of urinary incontinence
Decrease in the force of the urinary stream, stream small and weak
Increased urinary frequency or urgency
A need to urinate at night (nocturia)
Painful urination (burning or stinging with urination)
Feeling of incomplete emptying of the bladder
Blood in the urine
Flank pain or back pain
one or both sides
progressive
severe
spasm-like (colicky)
may radiate or move to lower in flank, pelvis, groin, genitals
Nausea, vomiting
Generalized swelling, fluid retention
Decrease in sensation, especially the hands or feet
Changes in mental status
drowsy, lethargic, hard to arouse
delirium or confusion
coma
Seizures
Blood in the vomit or stools
Easy bruising or bleeding
Signs and tests
An examination but may indicate disorders that occur as a consequence of nephrocalcinosis. There may be signs of fluid overload, such as abnormal heart and lung sounds, if kidney function is poor.
An abdominal film shows renal calcification.
An abdominal CT scan shows nephrocalcinosis.
Other tests may be performed to diagnose and determine the extent of associated disorders.
Treatment
The goal of treatment is reduction of symptoms. The cause of the disorder must be treated. If the cause is type 1 renal tubular acidosis, vitamin D and calcium should not be given to correct bone disorders associated with the condition because this will worsen nephrocalcinosis.
Medications that enhance calcium excretion should be discontinued. Never discontinue any medications without consulting your health care provider.
Conditions that result from the disorder should be treated in their usual manner.
Expectations (prognosis)
The outcome varies depending on the extent of complications and the cause of the disorder.
Complications
Acute renal failure
Chronic renal failure
Kidney stones
Obstructive uropathy (acute or chronic, unilateral or bilateral)
Calling your health care provider
Call your health care provider if symptoms indicate that disorders associated with nephrocalcinosis may be present.
Emergency symptoms include suddenly decreased urine output, and decreased consciousness related to calcium levels and/or kidney failure.
Prevention
Prompt treatment of causative disorders, including renal tubular acidosis, may help prevent nephrocalcinosis.
Update Date: 9/13/2005
