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History

A 28-year-old female presents with a history of renal calculi and right flank pain. A selected image from her renal ultrasound is presented. 

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Findings

Grayscale ultrasound of the right kidney demonstrates hyperechogenicity in the renal medulla. 

Diagnosis

Medullary nephrocalcinosis

Answers

1. Based on the selected image, where is the salient abnormality?

  1. Calyxes
  2. Cortex
  3. Kidney capsule
  4. Medulla
  5. Renal sinuses

2. Which modality shows the earliest sign of this condition?

  1. Computed tomography
  2. Magnetic resonance imaging
  3. Radiography
  4. Renal scintigraphy
  5. Ultrasound

3. Which of the following is the least likely explanation for the findings in the selected image?

  1. Alport’s syndrome
  2. Hyperparathyroidism
  3. Medullary sponge kidney
  4. Papillary necrosis
  5. Tubular acidosis

Alport’s syndrome is associated with cortical nephrocalcinosis. The other conditions are associated with medullary nephrocalcinosis with hyperparathyroidism being the most common.

4. Which medication is associated with this condition in infants?

  1. Acetazolamide
  2. Captopril
  3. Furosemide
  4. Hydrochlorothiazide
  5. Spironolactone

5. What is the most likely explanation of the patients flank pain?

  1. Nephrocalcinosis
  2. Nephrolithiasis
  3. Pyelonephritis
  4. Pyonephrosis
  5. Renal infarction

While the renal ultrasound shows that the patient has nephrocalcinosis, flank pain is more commonly due to associated nephrolithiasis. 

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Additional Reading

 “Miscellaneous Diffuse Renal Diseases” by Pandey T, Jambhekar K, Shah H and Viswamitra S. Abdominal Imaging, Chapter 104, pp 1159-1174.

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