Medullary sponge kidney

Medullary sponge kidney (also known as Cacchi–Ricci disease) is a

Medullary sponge kidney
congenital disorder of the kidneys characterized by cystic dilatation of
the collecting tubules in one or both kidneys. Individuals with
medullary sponge kidney are at increased risk for kidney stones and
urinary tract infection (UTI). Patients with MSK typically pass twice
as many stones per year as do other stone formers without MSK.
While described as a "benign" disorder with a low morbidity rate, as
many as 10% of patients with MSK have an increased risk of
morbidity associated with frequent stones and UTIs. While some
patients report increased chronic kidney pain, the source of the pain,
when a UTI or blockage is not present, is unclear at this time. Renal
colic (flank and back pain) is present in 55% of patients. Women with
MSK experience more stones, UTIs, and complications than men.
MSK was previously believed not to be hereditary but there is more
[1][2]
evidence coming forth that may indicate otherwise.

Contents
Signs and symptoms
Complications
Cause
Medullary sponge as seen on an intravenous
Diagnosis
pyelogram
Treatment
Specialty Medical genetics, Nephrology
Epidemiology
Support & Awareness
References
External links

Signs and symptoms

Most cases are asymptomatic or are discovered during an investigation of blood in the urine. Symptomatic patients typically present
as middle-aged adults with renal colic, kidney stones, nephrocalcinosis and/or recurrent urinary tract infections; however, MSK also
may affect children very rarely. In addition to the typical clinical phenotype of recurrent stone disease, other clinical profiles have
[3]
now been recognized, that is, an indolent, almost asymptomatic MSK, and a rare form characterized by intractable pain.

Complications
Complications associated with medullary sponge kidney include the following:

Kidney stones[4]
Urinary tract infection (UTI)[4]
Blood in the urine[4]
Distal renal tubular acidosis(Type 1 RTA)[4]
 Chronic kidney disease(rarely)[4]
Marked chronic pain[4]

Cause
In recent studies, insight has been obtained on the genetic basis of this disease, supporting the hypothesis that MSK is due to a
disruption at the 'ureteric bud-metanephric mesenchyme' interface. This explains why so many tubular defects coexist in this disease,
and particularly a distal tubular acidification defect of which the highly prevalent metabolic bone disease is one very important
consequence. In addition to the typical clinical phenotype of recurrent stone disease, other clinical profiles have now been
recognized, that is, an indolent, almost asymptomatic MSK, and a rare form characterized by intractable, excruciating pain.[5] It was
previously believed that most cases of Medullary Sponge Kidney were sporadic however, recent studies show familial clustering of
MSK is common and has an autosomal dominant inheritance, a reduced penetrance, and variable expressivity.[6][7] Other theories
suggest that dilatation of a collecting duct may occur, caused by occlusion by uric acid during fetal life or resulting from tubular
[4]
obstruction due to calcium oxalate calculi secondary to infantile hypercalciuria.

A rare, autosomal recessive form is associated withCaroli disease.[4]

Diagnosis
Classically, MSK is seen as hyperdense papillae with clusters of small stones on ultrasound examination of the kidney or with an
abdominal x-ray. The irregular (ectatic) collecting ducts are often seen in MSK, which are sometimes described as having a
"paintbrush-like" appearance, are best seen on intravenous urography. However, IV urography has been largely replaced by contrast-
[8]
enhanced, high-resolution helical CT with digital reconstruction.

Treatment
Often, aggressive treatment is unnecessary for people with MSK disease that does not cause any symptoms (asymptomatic).[8] In
such cases, treatment may consist of maintaining adequate fluid intake, with the goal of decreasing the risk of developing kidney
stones (nephrolithiasis).[8] Cases of recurrent kidney stone formation may warrant evaluation for possible underlying metabolic
abnormalities.[8]

In patients with low levels of citrate in the urine (hypocitraturia) and incomplete distal renal tubular acidosis, treatment with
potassium citrate helps prevent the formation of new kidney stones.[8] Urinary tract infections, when they occur, should also be
treated.[8]

Patients with the more rare form of MSK marked by chronic pain typically require pain management. Non-obstructing stones in MSK
can be associated with significant and chronic pain even if they're not passing. The pain in this situation can be constant. It is not
certain what causes this pain but researchers have proposed that the small numerous stones seen in MSK may cause obstruction of the
small tubules and collecting ducts in the kidney which could lead to the pain. This pain can often be debilitating and treatment is
challenging. Narcotic medication even with large quantities is sometimes not adequate. Some success with pain control has been
[9]
reported using laser lithotripsy (called “ureteroscopic laser papillotomy”).

Epidemiology
In the general population, the frequency of medullary sponge kidney disease is reported to be 0.02–0.005%; that is, 1 in 5000 to 1 in
20,000. The frequency of medullary sponge kidney has been reported by various authors to be 12 – 21% in patients with kidney
stones.[10] The disease is bilateral in 70% of cases.

Support & Awareness

Many patients with MSK find support in online support groups.
MSK awareness colors are purple, teal and green.

References
1. "Medullary Sponge Kidney"(http://kidney.niddk.nih.gov/kudiseases/pubs/medullaryspongekidney/). Retrieved
22 August 2012.
2. Goldfarb DS. "Evidence for inheritance of medullary sponge kidney".Kidney Int. 83 (2): 193–6.
doi:10.1038/ki.2012.417 (https://doi.org/10.1038/ki.2012.417). PMID 23364586 (https://www.ncbi.nlm.nih.gov/pubme
d/23364586).
3. Gambaro G, Danza FM, Fabris A. "Medullary Sponge Kidney".Curr Opin Nephrol Hypertens. 22 (4): 421–6.
doi:10.1097/MNH.0b013e3283622b86(https://doi.org/10.1097/MNH.0b013e3283622b86) . PMID 23680648 (https://
www.ncbi.nlm.nih.gov/pubmed/23680648).
4. Ghosh, Amit K. "Medullary Sponge Kidney"(http://emedicine.medscape.com/article/242886-overview)
. Medscape
Reference. Retrieved 1 January 2013.
5. Gambaro, Giovanni; Danza, Francesco M.; Fabris, Antonia (July 2013). "Medullary sponge kidney".
Current Opinion
in Nephrology and Hypertension. 22 (4): 421–426. doi:10.1097/MNH.0b013e3283622b86(https://doi.org/10.1097/M
NH.0b013e3283622b86). PMID 23680648 (https://www.ncbi.nlm.nih.gov/pubmed/23680648).
6. Fabris, Antonia; Lupo, Antonio; Ferraro, Pietro M; Anglani, Franca; Pei, ork;
Y Danza, Francesco M; Gambaro,
Giovanni. "Familial clustering of medullary sponge kidney is autosomal dominant with reduced penetrance and
variable expressivity". Kidney International. 83 (2): 272–277. doi:10.1038/ki.2012.378 (https://doi.org/10.1038/ki.201
2.378). PMID 23223172 (https://www.ncbi.nlm.nih.gov/pubmed/23223172).
7. Goldfarb, David S (February 2013). "Evidence for inheritance of medullary sponge kidney".Kidney International. 83
(2): 193–196. doi:10.1038/ki.2012.417 (https://doi.org/10.1038/ki.2012.417). PMID 23364586 (https://www.ncbi.nlm.n
ih.gov/pubmed/23364586).
8. Salant DJ]; Gordon CE (2012). "Chapter 284. Polycystic Kidney Disease and Other Inheritedubular
T Disorders".
Harrison's Principles of Internal Medicine(18th ed.). New York: McGraw-Hill. ISBN 978-0071748896.
9. "What is Medullary Sponge Kidney?"(http://www.kidneystoners.org/information/what_is_medullary_sponge_kidney/).
Retrieved 21 May 2014.
10. Ginalski, JM; Portmann L; Jaeger P (1990)."Does medullary sponge kidney cause nephrolithiasis?"(https://www.we
bcitation.org/5z6pxPn1K?url=http://www.ajronline.org/cgi/reprint/155/2/299.pdf)(PDF). American Journal of
Roentgenology. 155 (2): 299–302. doi:10.2214/ajr.155.2.2115256 (https://doi.org/10.2214/ajr.155.2.2115256).
PMID 2115256 (https://www.ncbi.nlm.nih.gov/pubmed/2115256). Archived from the original (http://www.ajronline.org/
cgi/reprint/155/2/299.pdf)(PDF) on 2011-06-01.

External links
Classification ICD-10: Q61.5 · D
ICD-9-CM: 753.17 ·
MeSH: D007691 ·
DiseasesDB: 7915
External eMedicine:
resources article/379323

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