Urology Medical News about Recurrent pyelonephritis; sponge kidney

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Recurrent pyelonephritis as a sign of ‘sponge kidney’
Cleveland Clinic Journal of Medicine, 08/07/09

Chu H–Y et al. – Medullary sponge kidney causes extensive cystic dilation of medullary collecting tubules. It is usually an incidental finding in patients undergoing intravenous urography as part of the evaluation for infection, hematuria, or kidney stones. The classic urographic appearance is linear striations with small brushes or "bouquets of flowers", which represent the collection of contrast material in small papillary cysts. Medullary sponge kidney has long been considered a congenital disorder, but the genetic defect has not yet been identified, and the pathogenesis is not yet known. It has only rarely been reported in children. It is usually asymptomatic, but complications may occur, including nephrocalcinosis or lithiasis, urinary tract infection, renal tubular acidosis, and impaired urine concentrating ability.Intravenous urography is the gold standard for the diagnosis of medullary sponge kidney; computed tomography and ultrasonography are generally limited in their ability to clearly show the tubular ectasia. Treatment includes antibiotics for acute pyelonephritis and thiazide diuretics and potassium citrate to prevent stone formation and renal tubular acidosis. Due to its silent course, medullary sponge kidney should be considered not only as a cause of nephrocalcinosis and nephrolithiasis, but also as a distinct entity complicating recurrent pyelonephritis.

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