A Critical Appraisal of the Radiological Evaluation of Nephrocalcinosis

Abstract

Background/Aim: The level of agreement concerning the diagnosis of nephrocalcinosis (NC) based on ultrasonography (US), computed tomography (CT) or kidney/ureter/bladder (KUB) X-ray was assessed. Methods: Sequences of KUB+US+CT from 62 patients, 48 with at least one exam suggesting NC and 14 with pelvicalyceal calcifications (nephrolithiasis) were reviewed twice by 3 radiologists (firstly randomized and secondly presenting KUB+US+CT of each patient together). Results: The intraobserver concordance varied from 76 to 90% for KUB, 77 to 85% for US and 82 to 89% for CT. There was a significant change in diagnosis between the 1st and 2nd reviews for observer 1 in KUB and CT, for observer 2 in US, but not for observer 3. Evaluating patients’ exams together did not provide a better agreement. The highest sensitivity and specificity (92 and 89%, respectively) were only attained when 2 exams suggested NC diagnosis, being CT one of them. These enabled us to suggest that 33 out of 48 (62.5%) patients had NC (evidenced in US+CT+KUB (81.8%), US+CT (12.1%) or KUB+CT (6.1%). Conclusion: The low level of concordance renders the radiological diagnosis of NC difficult. Nephrocalcinosis should be confirmed by CT combined with either US or KUB.

Evaluation of Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease Patients

“…Hypercalciuria was not detected. A previous evaluation of 444 patients with nephrolithiasis and without ADPKD in our service (19) revealed 58% of hypercalciuria, 53% of hypocitraturia, 23% of hyperuricosuria, and Ͻ1% of hyperoxaluria; therefore, this sample of patients with ADPKDϩLIT presented a unique metabolic profile showing no hypercalciuria, 18% of hyperoxaluria, and the same figures of hypocitraturia (approximately 50%) when compared with patients with nephrolithiasis and without ADPKD. The reasons for a higher percentage of hyperoxaluria and the lack of hypercalciuria in this sample, as in other series (2) as well, are not clear.…”

Nephrocalcinosis: A Diagnostic Conundrum

“…Combined ultrasonography with CT had higher sensitivity (92%) and specificity of 89%, but there was lower concordance between CT and ultrasonography, making the radiologic diagnosis of nephrocalcinosis a challenge. 3 What is the pathophysiologic explanation of calcium deposition in the kidney? The exact pathogenesis of calcium deposition in nephrocalcinosis remains unclear.…”

Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease

“…However, studies have shown that the radiologist’s ability to detect NC is often not accurate 12,13 . The most sensitive radiological tool to detect NC is computed tomography and standard x-rays are used to follow the course of NC 14 .…”