Bilateral cortical nephrocalcinosis

Case contributed by Dr Mahmoud Ibrahim Mekhaimar

Presentation

Bilateral loin pain

Patient Data

Age: 15 years
Gender: Male
  • Thin rims of dystrophic calcification seen at the outer margins of the renal cortex (tramline), which extend into the medullary spaces along the column of Bertin on the left side.
  • no CT evidence of urolithiasis or back-pressure changes. 
  • the revised bone window clearly illustrates the calcifications. 

Case Discussion

  • the above described features are suggestive of bilateral cortical nephrocalcinosis with the typical appearance of thin rims of dystrophic calcification which may be deposited at the inner and outer margins of the renal cortex as a result of a major vascular insult that produces cortical necrosis, or rarely, as a consequence of glomerulonephritis, hyperoxaluria, and Alport syndrome, with the development of cortical nephrocalcinosis.
  • The pattern of parenchymal calcification is said to resemble a tramline or railroadtracks or less likely two thin parallel calcified tracks or multiple punctuate calcifications in random distribution (least common).
  • there is ​no correlation between the pattern of calcification and a specific cause

  • causes of cortical nephrocalcinosis can be remembered by the mnemonic:

COAG

  • C: cortical necrosis

  • O: oxalosis

  • A: Alport syndrome

  • G: (chronic) glomerulonephritis

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Case information

rID: 73165
Published: 28th Dec 2019
Last edited: 8th Jun 2020
Inclusion in quiz mode: Included

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