Medical and Surgical Care
Medical care
No specific treatment for medullary sponge kidney (MSK) is warranted. In a retrospective study of 97 adults with medullary sponge kidney, administration of oral potassium citrate to patients with at least one risk factor (hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia) resulted in a dramatic reduction in kidney stone stones (from 0.58 to 0.10 stones/patient/y). [12] Although these findings require confirmation in a prospective trial, the therapy is safe and inexpensive.
If hypercalciuria-associated kidney stone disease is present, use of thiazide diuretics or other measures to reduce the hypercalciuria may be justified. [13] Renal stones are managed in the same way as in individuals without medullary sponge kidney. [14] Treat urinary tract infections (UTIs) with standard courses of antibiotics. Prophylactic antibiotics may help patients with medullary sponge kidney and recurrent UTIs. In patients with hemihypertrophy, serial screening should be performed to exclude a malignancy.
Surgical care
Surgery is not needed for most patients with medullary sponge kidney.
Diet and Activity
Diet
Although decreased dietary calcium intake may decrease urinary calcium excretion, concern has been expressed that it might also result in skeletal undermineralization. Decreased sodium intake and increased potassium intake may improve urinary calcium excretion by themselves and are recommended in patients taking thiazide diuretics.
Activity
Because medullary sponge kidney is a nonprogressive condition with small medullary cysts, restriction of physical activity is unnecessary.
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Unenhanced coronal volume-rendered (VR) CT image of the kidneys demonstrates 2 small calculi in the mid portion of the right kidney and 2 small calculi in the lower pole of the left kidney (arrowheads). A large low-density lesion in the lower pole of the right kidney and a small low-density lesion in the upper pole of the left kidney (short arrows) were shown to represent benign simple renal cysts on the contrast enhanced CT images. Image courtesy of Dr. Terri J. Vrtiska, Consultant, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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CT image of both kidneys demonstrates brushlike densities throughout multiple papillae of both kidneys consistent with renal tubular ectasia. Correlation of the stone disease with the ectatic tubules is diagnostic of medullary sponge kidney. Image courtesy of Dr. Terri J. Vrtiska, Consultant, Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
