Bilateral nephrocalcinosis

This patient has bilateral nephrocalcinosis following parathyroid removal. 

Renal ultrasound imaging shown below:

Ultrasound imaging findings of nephrocalcinosis:

* Increased echogenicity of the renal medulla (the pyramids are normally hypoechoic to the cortex).

* Echogenic materials with a variable degree of acoustic shadowing in the region of the renal pyramids.

* Twinkling artifacts (due to the presence of calcium crystals) on color Doppler imaging.

The prognosis and management of nephrocalcinosis: depends on the underlying cause. In the case of this patient, who developed nephrocalcinosis due to calcium supplements, the prognosis is generally good. The patient will need to be monitored for the development of kidney stones, and they may need to make changes to their diet and medication regimen.

Additional information about ultrasound imaging in nephrocalcinosis:

* Grading: echogenicity of the renal medulla is usually graded on a scale of 1 to 3, with 1 being the mildest and 3 being the most severe.

* The acoustic shadowing caused by nephrocalcinosis can be variable in degree. In some cases, the shadowing may be so severe that it obscures the underlying renal parenchyma.

* The twinkling artifacts on color Doppler imaging are caused by the movement of calcium crystals within the renal medulla.

In our patient:

This patient was on high doses of calcium supplements, due to hypocalcemia following surgery to remove the parathyroids. This can cause nephrocalcinosis by following means:

• Increased urinary calcium excretion. When the body takes in more calcium than it needs, it will try to get rid of the excess calcium through the urine. This can lead to increased urinary calcium excretion, which can increase the risk of nephrocalcinosis.
• Formation of calcium deposits. When the urinary calcium concentration is high, it can precipitate out of the urine and form calcium deposits in the kidneys. These calcium deposits can eventually lead to nephrocalcinosis.
• Inflammation. The formation of calcium deposits in the kidneys can cause inflammation. This inflammation can damage the kidneys and make them more susceptible to nephrocalcinosis.

In the case of the patient who was on high doses of calcium supplements, the high doses of calcium likely caused increased urinary calcium excretion and the formation of calcium deposits in the kidneys. This eventually led to nephrocalcinosis.

Note: It is important to note that not everyone who takes calcium supplements will develop nephrocalcinosis. The risk of developing nephrocalcinosis from calcium supplements is increased in people who have a high risk of kidney stones, such as people who have a family history of kidney stones or who have other medical conditions that increase the risk of kidney stones.

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Nephrocalcinosis ultrasound imaging