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Hyperechoic renal medullary pyramids in infants and children
P K Shultz1, J L Strife, C F Strife
1Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Increased echogenicity in children's renal medullary pyramids often indicates hypercalciuria. A systematic clinical evaluation, including urine calcium levels, helps diagnose underlying causes in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Clinical Diagnosis
Background:
- Increased echogenicity of renal medullary pyramids is an ultrasound finding in children.
- This finding can be associated with various clinical conditions, notably hypercalciuria.
Purpose of the Study:
- To investigate the clinical diagnoses associated with hyperechoic renal medullary pyramids in pediatric patients.
- To determine the utility of hypercalciuria in differentiating these diagnoses.
Main Methods:
- Retrospective review of 55 children with hyperechoic renal medullary pyramids on ultrasound.
- Analysis of clinical diagnoses, serum and urine calcium concentrations, and renal function.
Main Results:
- Hypercalciuria was a key differentiator. Drug-induced causes (furosemide, steroids, vitamin D) were identified.
- Other causes of hypercalciuria included renal tubular acidosis, Bartter syndrome, hyperparathyroidism, Williams syndrome, and medullary sponge kidney.
- Children with normal urine calcium included those with transient renal insufficiency and sickle cell disease.
Conclusions:
- A systematic clinical approach, including age, serum/urine calcium, and renal function, aids in diagnosing children with hyperechoic renal medullary pyramids.
- Identifying hypercalciuria is crucial for narrowing down the differential diagnosis.
- This approach facilitates specific diagnosis in pediatric cases presenting with this ultrasound finding.
Abstract:
Fifty-five children (34 boys, 21 girls; age range, 1 day to 18 years) with increased echogenicity of the renal medullary pyramids at ultrasound evaluation were identified. The clinical diagnoses associated with hyperechoic medullary pyramids could be separated based on the presence or absence of hypercalciuria. Patients with drug-induced hypercalciuria included 10 infants treated with furosemide, two treated with long-term steroid therapy, and one treated with excessive amounts of vitamin D. Other clinical conditions associated with hypercalciuria included renal tubular acidosis (n = 10), Bartter syndrome (n = 5), hyperparathyroidism (n = 3), Williams syndrome (n = 2) and medullary sponge kidney (n = 2). Ten children with transient renal insufficiency and three with sickle cell disease had normal urine calcium concentration. Isolated disease entities accounted for the remainder of cases. A specific diagnosis can usually be made in a patient with hyperechoic renal medullary pyramids by using a systematic clinical approach that includes evaluation of patient age, serum and urine calcium concentration, and renal function.