Medullary sponge kidney

Introduction The medullary sponge kidney is a congenital cystic disease of the renal medulla, characterized by a fusiform or cystic dilatation of the papillary duct and collecting duct of the renal cone, accompanied by infection and formation of urinary calculi. On the cut surface of the kidney specimen, a spongy change in the medulla was observed.

Cause

The disease may be a hereditary disease, and it has been reported that there are more than 2 or more generations in the same family.

an examination

Related inspection

Renal MRI examination of intravenous urography

Spongiform kidneys are usually found when the urinary tract system is performed due to urinary tract symptoms in the patient, that is, when a urinary tract plain film or intravenous urography is performed.

1. Urinary plain film: Multiple positive stones in the kidney cone, the size and shape of the stones are irregular, as small as fine sand, up to 0.5 cm in diameter. The stones are arranged in a fan shape or a dense cluster, and the stones may be irregularly distributed in the respective cone portions.

2. Intravenous urography: In the case of intravenous urography, the first case is the filling of the cystic cavity of the renal cone. The development of the ureter is more clear when the ureter is pressurized. After the pressure is relieved, the renal pelvis and renal pelvis are evacuated. The contrast agent remains. The above characteristic changes cannot be shown during retrograde urography. The shadows around the renal cone or renal pelvis that are common on intravenous urography are: the contrast agent is fan-shaped in the dilated collecting tube and the nipple tube; the filling small cyst is grape-like; or it overlaps with the stone to form a density. Uniform patchy shadow; kidney small sputum widened, cup mouth large and flat.

Differential diagnosis

If the sponge kidney is free of complications such as infection, bleeding, stones, etc., there may be no special clinical symptoms. According to clinical and radiological changes, the initial symptoms of patients are divided into three categories: clinically no symptoms or only mild symptoms, only characteristic changes in excretory urography, but no urinary tract film Calcification; calcium deposition on the urinary tract plain film, the patient presented with urinary tract infection. This calcium deposition should be distinguished from primary hyperparathyroidism and renal tubular acidosis; due to chronic inflammation, tubular stones break out of the cone into the renal pelvis and renal pelvis, producing typical symptoms of stones.

1. Hematuria: This is the most common symptom, accounting for about 85%, and repeated attacks. The attack may be accompanied by low back pain or simultaneous discharge of fine sand-like stones. Generally, it is microscopic hematuria. It can also be seen that individual cases show painless macroscopic hematuria.

2. Renal colic: It can be an early symptom, often multiple episodes, accounting for about 50%. It is a symptom accompanying the discharge of stones, and the symptoms are relieved after the stones are discharged. In a few cases, stones gradually grow in the renal pelvis, or are incarcerated in the ureter, requiring surgery or gravel treatment.

3. Pyelonephritis: About 50% of patients with pyelonephritis, that is, intraductal papillary tubes, collecting ducts and dilated cysts, affecting the entire urinary tract, severe cases can spread to the kidney surrounding the cyst and affect Kidney function.

4. Systemic symptoms: In the later stages of the disease, renal function damage, especially damage to the renal tubular function, can cause systemic symptoms such as anemia, hypertension, edema, water and electrolyte disorders, and acid-base balance disorders.

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