Nephrocalcinosis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Nephrocalcinosis is the term used to describe a state of calcium deposits or elevated calcium levels in the kidneys. This term is usually used to describe a general increase in the amount of kidney calcium. However, the term is not used for locally elevated calcium, as seen, for example, in calcified renal infarction and renal tuberculosis.
There are three categories of nephrocalcinosis, namely:
- Chemical nephrocalcinosis. There is an increase in the concentration of calcium in the renal cells (kidney), which causes side effects on the structure and function of the kidney. For example increased excretion of water, sodium, potassium, calcium, and magnesium.
- Microscopic nephrocalcinosis. In this category, there are calcium deposits in the form of crystals (in the form of oxalate or phosphate), which are only visible with the help of a microscope.
- Macroscopic nephcalcinosis. This is the category in which large areas of calcification can be seen.
Symptom
The category of nephrocalcinosis determines the symptoms experienced. Often, this condition has no symptoms or is asymptomatic and is only realized during investigations.
In chemical nephrocalcinosis symptoms of polyuria and polydipsia often appear due to relative resistance to vasopressin. In addition, increased peripheral vasoconstriction can lead to reversible hypertension. This complaint is observed to occur in approximately 50 percent of cases. Renal failure can occur due to hypercalcemic conditions, which if left in the long term can become irreversible.
In microscopic nephrocalcinosis, an increase in BUN ( blood urea nitrogen ) can occur, based on studies on rats. In addition, acute pyelonephritis and stone-induced obstruction may occur with renal failure.
In macroscopic nephrocalcinosis, various symptoms can occur. Urinary tract stones may appear with symptoms of renal colic which is marked by pain, hematuria (bleeding BAK), discharge of stones when urinating, or urinary tract infection (UTI). However, this situation is not always marked by the presence of stones in the urinary tract. Symptoms of polyuria, polydipsia, proteinuria, microscopic pyuria, and renal failure may also appear.
Reason
Nephrocalcinosis can be caused by various things, such as the presence of an underlying disease, drugs or supplements, and infection. Causes of nephrocalcinosis include:
- Primary hyperparathyroidism
- Distal renal tubular acidosis
- Hypervitaminosis D
- Various causes of increased calcium in the blood (hypercalcemia)
- Sarcoidosis
- Phosphate supplementation
- Osteoporosis, due to immobilization, menopause, aging, or steroids
- Hyperoxaluria, both primary ( familial ) and secondary
- Chronic diseases, such as Barter syndrome, primary hyperaldosteronism, Liddle syndrome, and so on
- Premature birth
- Use of drugs, eg acetazolamide
- AIDS-related infections
Diagnosis
In nephrocalcinosis, the role of supporting examinations is quite important to determine the increase in calcium in the kidney. Some of the checks that may be carried out are:
- Blood tests:
- Examination of serum calcium, phosphate, and albumin to determine the state of hypercalcemia
- Electrolyte checks and kidney function tests
- Parathyroid hormone examination
- TSH ( Thyroid Stimulating Hormone ) test
- Urine examination:
- Urine analysis by microscopy and urine culture
- 24-hour urine examination for calcium, oxalate, citrate, and protein
- Magnesium in urine
- Imaging:
- X-ray of the abdomen or KUB ( kidney ureter bladder )
- ultrasound
- CT scan
- Endoscope
- Kidney biopsy
Treatment
The goal of treatment is to reduce symptoms and prevent more calcium from depositing in the kidneys. If the cause of nephrocalcinosis is known, treatment should be given according to the main cause.
In hypercalcemic conditions, it is important to ensure adequate hydration, so normal saline will generally be given. In macroscopic nephrocalcinosis, thiazide diuretics reduced salt intake in the diet, and potassium, magnesium, or citrate supplementation may be considered.
The presence of urinary tract stones, especially those that cause obstruction, may require surgery. Examples are percutaneous nephrolithotomy, laser and shock wave lithotripsy, and so on.