Nephrocalcinosis

Contributors: Cafer Zorkun M.D., PhD.

Overview
Nephrocalcinosis, once known as Albright's calcinosis after Fuller Albright, is a term originally used to describe deposition of calcium salts in the renal parenchyma due to hyperparathyroidism. It is now more commonly used to describe diffuse, fine, renal parenchymal calcification on radiology. During its early stages, nephrocalcinosis is visible on x-ray, and appears as a fine granular mottling over the renal outlines. These outlines eventually come together to form a dense mass.

It is most commonly seen as an incidental finding with medullary sponge kidney on an abdominal x-ray. However, it may be severe enough to cause (as well as be caused by) renal tubular acidosis or even end stage renal failure, due to disruption of the renal tissue by the deposited calcium.

Differential Diagnosis

 * Hyperparathyroidism
 * Medullary sponge kidney
 * Renal tubular acidosis
 * Hypercalcemia

Stages of nephrocalcinosis

 * Chemical nephrocalcinosis
 * Microscopic nephrocalcinosis
 * Macroscopic nephrocalcinosis

Causes of cortical nephrocalcinosis

 * Acute cortical necrosis. May be caused by:
 * Placenta abruptio
 * Placenta previa
 * Septic abortion
 * Transfusion reactions
 * Burns
 * Snake bite
 * Severe dehydration
 * Shock
 * Severe heart failure
 * Abdominal aortic surgery
 * Chronic glomerulonephritis
 * Alport syndrome
 * Prolonged hypercalcemia and/or hypercalciuria
 * Renal transplant rejection
 * Sickle cell disease (rare)
 * Vitamin B6 deficiency (pyridoxine deficiency) (rare)

Causes of medullary nephrocalcinosis

 * Medullary sponge kidney
 * Hyperparathyroidism
 * Renal tubular acidosis (specifically distal RTA)
 * Renal tuberculosis
 * Renal papillary necrosis
 * Hyperoxaluria

Other causes of hypercalcemia (and thus hypercalciuria)

 * Immobilization (leading to hypercalcemia and hypercalciuria)
 * Milk-alkali syndrome
 * Hypervitaminosis D
 * Sarcoidosis

Diagnostic Findings
Patient #1

Images courtesy of RadsWiki

Additional Resources

 * Genitourinary Imaging: Case Review Series - ISBN 0323037143

Nephrokalzinose