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Abdomen » Kidneys/Ureters
Cortical nephrocalcinosis
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Author(s) :
Livia Rios
 
Presentation A 7-year-old boy diagnosed with renal tubular acidosis presents with delay in growth. A renal ultrasound was performed.
 
 
 
Caption: Sagittal image of the right kidney
Description: There is increased cortical echogenicity noted in the right kidney. No acoustic shadowing is seen.
 
 
 
Caption: Sagittal image of the right kidney
Description: The striking increase in cortical echogenicity is noted again in this image. This is suggestive of cortical nephrocalcinosis. Note the sparing of the renal pyramids [medullary portion of the kidneys].
 
 
 
Caption: Sagittal magnified image of right kidney
Description: The pattern of calcification seen in cortical nephrocalcinosis is again well appreciated in this image.
 
Differential Diagnosis Cortical nephrocalcinosis
 
Final Diagnosis Cortical nephrocalcinosis due to renal tubular acidosis
 
Discussion  Calcification within the renal parenchyma is known as nephrocalcinosis. This can be either cortical or medullary in location.
Cortical nephrocalcinosis is relatively uncommon and can occur in
1. Acute cortical necrosis. This can occur following abruptio placenta, placenta previa, septic abortion, drugs, toxins and severe dehydration. In children, it may occur following severe dehydration, fever, sepsis.
2. Chronic glomerulonephritis
3. Chronic hypercalcemia
4. Ethylene glycol poisoning
5. Primary oxalosis
6. AIDS associated infections
7. Sickle cell disease
8. Rejected renal transplants
In children, renal tubular acidosis is a common cause of nephrocalcinosis.

According to an article by Schepens, et al, cortical nephrocalcinosis can exhibit 3 patterns:
1. The most common pattern is a thin peripheral band or rim of calcification, often extending into the septal cortex.
2. A second pattern is 2 parallel lines of calcification known as tram track appearance.
3. The least common pattern is punctate calcification distributed randomly in the cortex.
This case demonstrates both a band and punctate forms of calcification.
 
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