Effects of percutaneous nephrolithotomy in the treatment of medullary sponge kidney with calculi / 中华外科杂志

Objective@#To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi.@*Methods@#A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People′s Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ2 test.@*Results@#There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P>0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs. 0, χ2=15.400, P=0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs. (68.5±30.1) minutes, t=3.543, P=0.000) and hospitalization time ((15.1±8.3) days vs. (10.1±3.6) days, t=4.816, P=0.000) were longer, the creatinine level increased ((101.2±62.6) μmol/L vs. (71.3±23.6) μmol/L, t=3.777, P=0.000), the rate of stone free decreased (27.5% vs. 83.1%, χ2=51.840, P=0.000) and the rate of complications increased (29.9% vs. 11.7%, χ2=8.114, P=0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs. (13.0±10.9) g/L, t=-0.260, P=0.795).@*Conclusions@#Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

Medullary Sponge Kidney on Retrograde Pyelography / 전남의대학술지

A woman aged 31 had recurrent urinary tract infection with bloody urine. A series image of medullary sponge kidney presented by intravenous urography (IVU) was detected dynamically by retrograde pyelography (RP). Other than ultrasonography and IVU, RP is also a reliable method to detect medullary sponge kidney.

Application of flexible ureteroscopic lithotripsy in treatment of medullary sponge kidney stones / 局解手术学杂志

Objective To investigate the clinical efficacy and safety of flexible ureteroscopic lithotripsy ( FURL) using holmium laser for medullary sponge kidney stones. Methods A flexible ureteroscope was placed into renal calyx via a ureteral access sheath ( UAS) . The stones underlying the mucosa were found,and then broken by holmium laser following incision of renal papillary mucosa. The stone fragments were washed or clamped out. The remission of clinical symptoms and incidence of perioperative complications were observed,and a KUB plain film was rechecked postoperatively. Results Stones underlying mucosa were found and broken successfully in all 14 patients and there was no serious bleeding. Back pain symptoms of patients were relieved in 3 to 7 days postoperatively or after the removal of double J stent. The stone fragments were mainly discharged spontaneously. The rechecking KUB showed the amount of stones of most patients was significantly re-duced three months after operation. Conclusion FURL using holmium laser is effective for the treatment of medullary sponge kidney stones as it can significantly reduce the loads of stones without serious complications. It’ s a minimally invasive,effective,safe and suitable way which is suitable for further spread of clinical application.

Medullary Sponge Kidney on Retrograde Pyelography / 전남의대학술지

A woman aged 31 had recurrent urinary tract infection with bloody urine. A series image of medullary sponge kidney presented by intravenous urography (IVU) was detected dynamically by retrograde pyelography (RP). Other than ultrasonography and IVU, RP is also a reliable method to detect medullary sponge kidney.

Lesão renal aguda em rim esponjoso / Acute renal injury in medullary sponge kidney

O rim esponjoso é alteração anatômica renal benigna diagnosticada geralmente na investigação de nefrolitíase. O objetivo deste artigo é descrever o caso de um paciente com diagnóstico de rim esponjosodurante um episódio de lesão renal aguda por ácido úrico. O doente apresentou-se ao Hospital Universitário de Brasília com hematúria, dor lombar e calafrios, uremia, creatinina sérica elevada e hiperuricemia marcante. A ultrassonografia de rins mostrou nefrocalcinose, confirmada por tomografia computadorizada, que sugeriu o diagnóstico de rim esponjoso. Houve melhora significativa da função renal com redução da hiperuricemia, hidratação vigorosa e alcalinização urinária.

Medullary sponge kidney is a benign renal anatomical alteration often diagnosed upon investigation of nephrolithiasis. This article describes the case of a patient diagnosed with medullary sponge kidney during anepisode of acute kidney injury caused by elevated serum uric acid levels. The patient sought medical treatment at the Brasilia university hospital presenting with hematuria, back pain and chills, uremia, elevated serumcreatinine and marked hyperuricemia. Ultrasonography of the kidneys showed nephrocalcinosis, confirmed by CT scan. The results were highly suggestive of the diagnosis of medullary sponge kidney. There was a significant improvement in renal function with reduction of hyperuricemia, hydration and urine alkalinization.

Medullary Sponge Kidney Detected in the Pediatric Age

PURPOSE: Medullary sponge kidney (MSK) is a rare congenital disease characterized by diffuse ectasia or dilatation of precalyceal collecting tubules. MSK incidence and prevalence in the general population is uncertain and only a few patients are reported especially in the pediatric age. There has been increasing reports of patients with MSK who have other malformative disorders. Also several case reports concerning about etiological association of some genes. METHODS: Collaborative study through nation-wide survey was done to investigate the incidence and etiological association of some genes such as GDNF gene, ATP6V1B1, ATP6V0A4 gene in developing MSK in Korean children. RESULTS: Four cases of MSK who have various other malformative disorders were collected. There are no mutations of GDNF gene, ATP6V1B1, ATP6V0A4 gene in all patients. CONCLUSION: MSK is one of the very rare diseases in pediatric age. The etiological association of GDNF gene , ATP6V1B1, ATP6V0A4 gene in developing MSK in Korean children is not proved.

Metabolic Risk Factors and Treatment Effects of Extracorporeal Shock Wave Lithotripsy in the Medullary Sponge Kidney with Nephrocalcinosis / 대한비뇨기과학회지

PURPOSE: The medullary sponge kidney(MSK) is a congenital anomaly of the renal medulla characterized by fusiform and cystic dilatation of the collecting tubules confined to the renal pyramids. The aim of this study is to evaluate the metabolic risk factors and effect of extracorporeal shock wave lithotripsy(ESWL) and complications in an MSK with nephrocalcinosis. MATERIALS AND METHODS: We compared stone metabolic studies between 45 patients with MSK and 279 non-MSK patients. We evaluated the effect of ESWL for MSK. Group A patients received ESWL and follow-up within 3 months and Group B patients had a period of cessation for more than 6 months. The frequency of complications between group A and group B patients was compared. RESULTS: There were no statistically differences between the MSK group and non-MSK group of patients in the stone metabolic studies. Among the 45 patients with MSK, 26(58%) had one or several of the following metabolic disorders: hypocitraturia(36.7%), hypercalciuria(18.3%), hyperoxaluria(16.3%), hyperuricosuria(16.3%), low urine volume(12.4%). The percentage of patients that experienced more than 75% of a reduction of stone burden on plain films was 48.8%, 25?75% of the reduction was 35.6%, and less than 25% of the reduction was 15.6%. The most common complication was renal colic(17.7%). Renal colic and stone re-growth was shown to have a more significant association with group B patients as compared to group A patients. CONCLUSIONS: ESWL reduced the stone burden more than 75% in 48.8% of MSK patients with nephrocalcinosis, and prevented flank pain, and obstructive uropathy. Therefore, we plan to develop treatments that are more effective.

A Case of Distal Renal Tubular Acidosis Associated with Medullary Sponge Kidney

Renal tubular acidosis is a clinical state of systemic hyperchloremic acidosis resulting from impaired urine acidification. Medullary sponge kidney is a renal parenchymal malformation characterized by cystic dilatation of the collecting ducts. Although medullary sponge kidney is a congenital disease, it is rarely identified in childhood and is usually discovered in adulthood. Medullary sponge kidney patients may have defects in urinary acidification and concentration mechanism. We experienced a case of distal renal tubular acidosis associated with medullary sponge kidney. So, we report a case of distal renal tubular acidosis associated with medullary sponge kidney with a brief review of the related literature.

The Imaging Diagnosis of Medullary Sponge Kidney / 实用放射学杂志

Objective To explore the clinical value of imaging examinations of medullary sponge kidney with the literature reviewed.Methods The features of X-ray plain film (1 case),IVP (2 cases),B-mode US(3 cases) and CT images (9 cases) of medullary sponge kidney (MSK) in 11 cases were analysed retrospectively.Results X-ray plain film showed a cluster of round and oval high density images in renal papillae and renal medulla in one case one kidney.Collecting tubes were showed as like line,brush and sac like dilatation on IVP in 2 cases 3 kidneys.B-mode US revealed a cluster of high echo spots scattered in renal medulla in 3 cases 5 kidneys and sac like dilatation of collecting tubes in 2 cases 3 kidneys.CT images showed the stones of spongiform kidney scattered alone renal medulla in 9 cases 16 kidneys,while the stones covered by contrast media on enhanced CT images in 3 cases 5 kidneys,and enhanced stripes of high density projected from renal papillae to renal medulla.Conclusion X-ray plain film,IVP,B-made US and CT all can be used in diagnosing spongiform kidney.Plain film and IVP are yet the first selected methods and IVP is specific and direct in showing collecting tubes dilatation.B-mode US especially CT have a high showing rate of stone in spongiform kidney and can be helpful to evaluate the collecting tube dilatation.

Medullary Sponge Kidney

Medullary sponge kidney is uncommon disease and rare in children. It is characterized by localized dilatation of collecting ducts in renal pyramids. The diagnosis of medullary sponge ki-dney depends mainly upon intravenous and retrograde pyelography. This paper presented a case of medullary sponge kidney found in a 9-year-old boy during the study about enuresis, and a brief review of literature was made.

Five Cases of Medullary Sponge Kidney / 대한비뇨기과학회지

Medullary sponge kidney is a relatively common, congenital lesion of the renal medulla, which was first described by Lenarduzzi in 1939. Many urologists have been interested in its unknown pathogenesis and complications, such as nephrolithiasis and infection. We report 5 cases of medullary sponge kidney, diagnosed by excretory urography and the literature has been reviewed briefly.

Eight Cases of Medullary Sponge Kidney / 대한비뇨기과학회지

Medullary sponge Kidney is a clinical disease entity, which became apparent only when IVPs are done and may be uncovered when hematuria, urinary infection, nephrocalcinosis or frank stones come under investigation. The treatment is limited to the complications, chiefly infection and calculi. We have experienced 8 cases of medullary sponge kidney from 1964 to 1976, and following data were obtained. 1) Clinically, we observed hypertension in 3, flank pain in 4, gross hematuria in 4, renal calculi or calcification in 6 cases, and positive family history or congenital hemihypertrophy were observed in none. 2) In laboratory findings, anemia was present in 1, azotemia in none, hematuria in 5, proteinuria in 3 and urinary tract infection in 4 cases.