Nephrocalcinosis

• 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 ).

The disorder may eventually result in acute obstructive uropathy or chronic obstructive uropathy, leading to eventual kidney failure . The disorder is discovered when symptoms of renal insufficiency / renal failure , obstructive uropathy, or urinary tract stones develop.

Nephrocalcinosis is relatively common in premature infants, partly from intrinsic kidney calcium losses and partly from enhanced calcium excretion when they are given loop diuretics.

Prevention:
Prompt treatment of causative disorders, including renal tubular acidosis , may help prevent nephrocalcinosis.

Symptoms:
There are no symptoms initially.

Symptoms of associated disorders may include:

• 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
  • may be 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 is nonspecific for nephrocalcinosis 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 in diet 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 (CONSULT YOUR HEALTH CARE PROVIDER FIRST!)

Conditions that result from the disorder should be treated in their usual manner.

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)

Call Your Healthcare Provider:
Call your health care provider if symptoms indicate that disorders associated with nephrocalcinosis may be present

Emergency symptoms include suddenly decreased urine output , seizures , vomiting blood , blood in the stools , and decreased consciousness .