A 49-Year-Old Male with Abdominal Pain

Differential Diagnosis

• Constipation
• Gallstones
• Medullary nephrocalcinosis
• Nephrolithiasis

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Diagnosis

This patient was diagnosed with medullary nephrocalcinosis, indicated by calcifications overlying bilateral renal outline. These appear on the magnification views to be medullary in location (not cortical and not discrete nephrolithiasis).

Learnings/What to Look for

• Nephrocalcinosis refers to the deposition of calcium in the kidney parenchyma and tubules, most common in the medulla
• Etiologies can be summed up in the mnemonic “HAM HOP”
  • H: hyperparathyroidism
  • A: (renal tubular) acidosis
  • M: medullary sponge kidney
  • H: hypercalcemia/hypercalciuria
  • O: oxalosis
  • P: papillary necrosis
• Often, the same entities may also lead to nephrolithiasis (renal calculi)

Pearls for Urgent Care Management

• Treatment is directed at the underlying cause of the nephrocalcinosis
• Management of nephrocalcinosis is aimed at reducing abnormal levels of calcium, phosphate, and oxalate in the blood and urine
• Examples of treatment options include increased fluid intake, restriction of sodium, restriction of animal protein, and increased potassium intake

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).