Nephrocalcinosis

Nephrocalcinosis – General Information

Nephrocalcinosis is a kidney disorder in which the calcium is accumulated in high quantities in the substance of the kidneys. This calcium is deposit under the name of calcium phosphate (is a form of phosphoric acid, this calcium phosphate makes bones and teeth hard) and calcium oxalate. These fragments of calcium phosphate and calcium oxalate may “escape” from the kidney and transform into kidney stones, also called nephrolithiasis.

Nephrocalcinosis is caused by a number of conditions, such as:

• The excessive excretion of calcium by the kidneys
• Renal tubular acidosis is a disease in which the kidneys cannot excrete acids into the urine, causing the patient’s blood to remain too acid. If the renal tubular acidosis is not correctly treated it may lead to retardation, bone diseases, kidney stones and a progressive renal failure.
• Medullary sponge kidney – is a congenital defect in which the kidneys fill with pools of urine.
• Hypercalcemia – is a higher level of calcium in the blood.
• Renal cortical necrosis – is a rare disorder which is characterized by the destruction of cortical tissue, this disease results from renal arteriolar injury and leads to renal failure.
• Tuberculosis – is a common and deadly disease that is caused by mycobacteria.

Nephrocalcinosis is common in premature infants and it is caused partly form intrinsic kidney calcium loss and partly from the diuretics they are given, that favors the calcium excretion. This disease can result in acute obstructive uropathy or chronic obstructive uropathy that will lead to kidney failure.

Nephrocalcinosis – Symptoms

• Hematuria – when there is blood in the urine. Hematuria can be microscopic when there is very little blood in the urine and it can only be seen at a microscope and gross hematuria when there is enough blood in the urine that it can be seen without the microscope. 
• Hematemesis – when there is blood in the vomit or stools.
• Changes in the mental status:
• Drowsy, lethargic, hard to arouse
• Delirium or confusion
• Coma
• Patients may also experience a decrease in the force of the urinary stream, which can  be small and weak.
• Patients may experience a decrease in sensation, mostly in the hands and feet.
• Easy bruising or bleeding
• Generalized swelling and even fluid retention
• Back pain and flank pain. Flank pain is the pain situated in one side of the body between the upper abdomen and the back.
• Increased or decreased urine volume
• Increased urinary frequency or urgency
• Nocturia – the need to urinate at night
• painful urination, characterized by burning or stinging urination
• Urinary hesitancy – meaning the difficulty of initiating the urine flow
• Urinary incontinence – is associated with stress incontinence, which is an involuntary loss of urine during physical activity like: sneezing, laughing, coughing and exercise.
• Nausea and vomiting
• Seizures – are sudden changes in the behavior of patients with Nephrocalcinosis.

Nephrocalcinosis – Treatment

In the case of medullary sponge kidney the prognosis is excellent, as this dysfunction rarely leads to kidney failure. There is no treatment or therapy indicated for these cases, except those with complications. Also the patients that are really symptomatic surgery is an option by removing a part of the kidney, but it is not always effective as the medullary sponge kidney affects both kidneys. Acute obstructive uropathy is a sudden blockage in one or both ureters tubes that drain urine from the kidneys. The goal of the treatment is to relieve the blockage. The treatment consists in placing stents or drains in the ureter that may provide a relief of symptoms for a short time, but the only sure treatment in these cases is the surgery. If acute obstructive uropathy is accompanied by an infection, antibiotics may be given and there may be needed a nephrectomy if the function of the kidneys is poor or if the infection is very bad. Chronic obstructive uropathy is the prolonged or progressive blockage of urine flow in one or both kidneys. The scope of the treatment for Nephrocalcinosis in this case is to get rid of the blockage. In the case the blockage is situated at the bladder neck, a catheter is inserted in the bladder area in order to provide short term relief. Antibiotics may be needed in the case of an infection and if there is a kidney failure dialysis may be needed. If the blockage is situated in the ureters a stent or a nephrostomy tube may solve the problem but only temporarily, as only surgery can cure this type of blockage.