A Case of Nephrocalcinosis Associated with Primary Aldosteronism

Abstract

Herein, we report a 37-year-old man presenting with nephrocalcinosis associated with primary aldosteronism. Primary hyperaldosteronism is reported to facilitate urinary calcium excretion; however, renal calculi or calcinosis in this disorder has been rarely reported. The patient had renal dysfunction and calcification in the renal medulla on both kidneys. A kidney biopsy was performed. His renal dysfunction seemed to be mainly caused by hypertension and tubulointerstitial damage. Furthermore, von Kossa-positive stones were seen in some tubules. X-ray element analysis revealed that the stones were composed of calcium phosphate.

An Association of Chronic Hyperaldosteronism with Medullary Nephrocalcinosis

“…Nephrocalcinosis associated with hyperaldosteronism is rare, with only a handful of cases described in literature [ 3 – 6 ]. Hyperaldosteronism is known to facilitate Ca + excretion in urine [ 3 , 4 ].…”

“…Based on location, nephrocalcinosis can be divided into the cortical type – classically seen with acute tubular necrosis, and the medullary type – seen with several metabolic disorders. In nephrology, the term nephrocalcinosis is more or less synonymous with the medullary type, which is around 20 times more common than the cortical type [ 1 ] While the term nephrocalcinosis was first coined in association with hyperparathyroidism, a number of conditions have been linked to this condition since its original descriptions like medullary sponge kidney, renal tubular acidosis, papillary necrosis due to diabetes, sickle cell anaemia and tuberculosis [ 1 – 3 ]. The diagnosis is purely radiological and can be demonstrated on plain radiographs, ultrasound or computed tomography.…”

“…Basic pathophysiology of this condition includes sustained hypercalcemia and hypercalciuria, tubular delivery of calcium to the interstitium and subsequent deposition based on local conditions including the pH and inhibitory ions [ 1 ]. Aldosterone is reported to facilitate urinary calcium excretion and induce negative calcium balance [ 3 , 4 ]. It can thus be conjectured that a chronic, long- standing hyperaldosteronic state can cause super- saturation and crystallization of calcium in the interstitium and induce nephrocalcinosis.…”

“…It can thus be conjectured that a chronic, long- standing hyperaldosteronic state can cause super- saturation and crystallization of calcium in the interstitium and induce nephrocalcinosis. Very few cases exist in literature linking hyperaldosteronism with nephrocalcinosis [ 3 – 6 ].…”

Dyes and Stains: from molecular structure to histological application

“…Heart diseases and calcifications in circulatory system are currently of great relevance, being Von Kossa staining a useful tool to identify calcifications in arteries and aortic valves, as well as to study pharmacological treatments and the potential protective effect of new drugs (108)(109). Others recently described applications of Von Kossa staining include nephrocalcinosis identification and determination of osteogenic differentiation of periosteal cells by visualizing of calcium nodules, being also interesting the possibility to characterize the molecular pathways associated to this process (110)(111).…”