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Medullary nephrocalcinosis due to type 1 renal tubular acidosis

Case contributed by Vikas Shah
Diagnosis certain

Presentation

Known type 1 renal tubular acidosis and ovalocytosis. Assessment of renal calcification.

Patient Data

Age: 25 years
Gender: Female

Multiple foci of calcification in the region of both kidneys, and conforming to the expected contour of both kidneys, consistent with nephrocalcinosis. No ureteric or bladder stones. The spleen is enlarged.

Multiple hyperechoic foci which cause posterior acoustic shadowing involving the medullary regions of both kidneys. No hydronephrosis. Splenomegaly.

The scout image shows the same features as the abdominal radiograph, with multiple foci of calcification scattered in the location and in the expected contour of both kidneys. The CT KUB (acquired prone as the question was whether there were any ureteric stones) indicates dense medullary calcification in both kidneys, with no collecting system, ureteric, or bladder stones—Splenomegaly due to known hematological disease.

The 3D and cinematic rendered images serve to highlight the burden of medullary calcification.

Case Discussion

Type 1 renal tubular acidosis is a known cause of medullary nephrocalcinosis. This case highlights the typical features seen on radiography, ultrasound, and CT, and on post-processed 3D and cinematic rendered images.

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