Diagnotic Imaging of Nephrocalcinosis

Diagnotic Imaging of Nephrocalcinosis

1. Genito-Urinary System
Nephrocalcinosis

2. Mohamed Zaitoun
Assistant Lecturer-Diagnostic Radiology
Department , Zagazig University Hospitals
Egypt
FINR (Fellowship of Interventional
Neuroradiology)-Switzerland
[email protected]

5. Knowing as much as
possible about your enemy
precedes successful battle
and learning about the
disease process precedes
successful management

6. Nephrocalcinosis
a) Calculi
b) Nephrocalcinosis

7. a) Calculi :
1-Incidence
2-Radographic Features

8. 1-Incidence :
-5% of population
-If a stone passes into the ureter , there are
three areas of ureteric narrowing where
the stone may lodge :
a) Just past the UPJ
b) Where the ureter crosses the iliac vessels
c) At the UVJ (most common)

10. 2-Radographic Features :
a) Plain Radiography
b) U/S
c) IVP
d) CT

11. a) Plain Radiography :
-Radiopaque calculus , 90%
-Radiolucent calculi are best detected by
IVP
b) U/S :
-Hyperechoic focus (calculus) , posterior
shadowing , calculi 3 mm or less may not
be detected

14. c) IVP :
-Delayed and persistent nephrogram due to
ureteral obstruction
-Column of opacified urine extends in ureter
from renal pelvis to lodged calculus
(diminished or absent peristalsis)
d) CT :
-CT detects most calculi regardless of
calcium content

15. (a) IVP shows a normal flow from the kidneys, through the ureters, to
the bladder (white arrows), (b) shows a kidney stone blocking the
normal flow of urine in the ureter on the right

16. IVP (30-minute delay image) of the right kidney shows a moderately
hydronephrotic collecting system to the level of a proximal ureteral
stone (arrow)

17. On a scout image obtained before excretory urography, a calculus fills
nearly the entirety of a bifid right renal collecting system, giving it a
branched appearance that resembles the antlers of a stag

20. b) Nephrocalcinosis :
-Refers to renal parenchymal calcification
-The calcification may be dystrophic or metastatic
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1-Dystrophic calcification :
-There is deposition of calcium in devitalized tissue
, usually resulting from ischemia or necrosis
-This type occurs in infection, tumors , abscesses
and hematomas

21. T.B. autonephrectomy

22. T.B. autonephrectomy

24. 2-Metastatic nephrocalcinosis :
-Occurs most commonly with hypercalcemic
states caused by hyperparathyroidism ,
renal tubular acidosis and renal failure
-Classified according to calcium deposition
into cortical or medullary nephrocalcinosis

25. a) Cortical Nephrocalcinosis :
-Etiology :
1-Acute cortical necrosis
2-Chronic glomerulonephritis
3-Chronic hypercalcemic states
4-Ethylene glycol poisoning
5-Sickle cell disease
6-Rejected renal transplants
-U/S :
Cortical nephrocalcinosis is seen as increased cortical
echogenicity which may produce acoustic shadowing

30. b) Medullary Nephrocalcinosis :
-Etiology :
1-Hyperparathyroidism (40 %)
2-Renal tubular acidosis (20 %)
3-Medullary sponge kidney
4-Bone metastases
5-Chronic pyelonephritis , renal papillary necrosis
6-Cushing’s syndrome
7-Hyperthyroidism
8-Malignancy , sarcoidosis , sickle cell disease , vitamin D
excess and Wilson’s disease

31. -U/S :
Medullary nephrocalcinosis is apparent
when the medullary pyramids become
more echogenic than the adjacent cortex ,
with time , further calcium deposition and
stone formation occur with acoustic
shadowing becoming apparent