How are calcifications different from stones?
The stone forms in the cavities of the kidney - in the calyces and pelvis, lies freely and can move, blocking the outflow of urine and causing colic. Calcification is located in the kidney tissue itself; it is motionless and is not able to descend into the ureter. Therefore, single calcifications usually do not appear in any way. If the deposits involve the pyramids of both kidneys, they speak of medullary nephrocalcinosis; if the cortical layer is damaged, they speak of cortical nephrocalcinosis, which often becomes a consequence of severe kidney damage. Computed tomography helps to differentiate findings.
- The stone lies in the calyx or pelvis and can migrate
- Calcification is located in the kidney tissue and is immobile
- Medullary nephrocalcinosis - deposits in pyramids
- Cortical - in the cortical layer, after severe damage
- Small inclusions are often described as microliths
Reasons for appearance
Calcium deposition occurs when calcium levels in the blood or urine become excessive or when the acidity of the urine changes. Classic causes are primary hyperparathyroidism, in which the parathyroid glands produce too much hormone, overdose of vitamin D and calcium supplements, distal renal tubular acidosis, sarcoidosis. Local single calcifications often remain after suffering pyelonephritis, kidney tuberculosis, trauma or infarction of a tissue area. In premature infants, nephrocalcinosis is associated with long-term use of diuretics in the neonatal unit.
- Primary hyperparathyroidism
- Excess vitamin D and calcium supplements
- Renal tubular acidosis
- Sarcoidosis and other granulomatous diseases
- Consequences of pyelonephritis, tuberculosis, kidney injury
- Long-term use of loop diuretics
- Prolonged immobility
Symptoms and what it means
The calcifications themselves almost never hurt. Complaints appear when there is an underlying disease or when stones form in parallel. Then there may be attacks of pain in the side, blood in the urine, frequent urination and recurring infections. With severe nephrocalcinosis, the ability of the kidneys to concentrate urine gradually suffers: its volume increases, thirst and night urination appear. In advanced cases, filtration function decreases and creatinine increases. With hyperparathyroidism, bone pain and muscle weakness often come to the fore.
- Most often there are no complaints
- Pain in the side with accompanying stones
- Blood in urine
- Recurrent urinary tract infections
- Increased urine output and thirst
- Decreased renal function in widespread nephrocalcinosis
What examinations are needed
After an ultrasound finding, it makes sense to calmly undergo a basic examination, and not be limited to a repeat ultrasound. A general urine test will show crystals, red blood cells and inflammation, blood creatinine with a calculation of filtration rate will evaluate kidney function. Determine total and ionized calcium, phosphorus, parathyroid hormone and vitamin D; According to indications, daily urine is examined for calcium and its acidity is assessed. A CT scan without contrast will accurately show the location and extent of deposits and locate stones. If hyperparathyroidism is suspected, ultrasound of the parathyroid glands is added.
- Ultrasound of the kidneys in dynamics
- General urine test, daily urine for calcium
- Blood creatinine with GFR calculation
- Total and ionized calcium, phosphorus
- Parathyroid hormone and vitamin D
- MSCT of the kidneys and urinary tract without contrast
What to do and how to treat it
It is impossible to dissolve already formed calcifications; the goal of treatment is to stop their growth and eliminate the cause. In case of hyperparathyroidism, the altered parathyroid gland is removed; in case of excess vitamin D, it is discontinued; in case of tubular acidosis, drugs are prescribed that correct the acid-base state. General measures for everyone: sufficient amount of water during the day, reasonable limitation of salt, refusal of uncontrolled intake of calcium and vitamin D supplements. There is no need to completely eliminate dairy products - on the contrary, this can increase the excretion of calcium in the urine. If stones have formed, they are treated according to the rules of urolithiasis.
- Find and treat the underlying cause
- Drink enough water, especially in hot weather
- Do not take vitamin D and calcium unless prescribed
- Limit excess salt
- Don't give up dairy products completely
- Observation with ultrasound and tests at a time determined by the doctor