Medullary sponge kidney

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Última revisão: 11 Dec 2025

Última atualização: 05 Jul 2022

Medullary sponge kidney (MSK) is a rare, developmental abnormality characterised by ectatic (dilatory) or cystic malformations in the medullary collecting ducts of the kidney resulting in medullary cysts.

Most patients are asymptomatic and the condition may be diagnosed based on incidental findings following radiological investigation for other reasons.

May be present in 3% to 20% of patients with renal stones.

May present with flank pain, recurrent urinary tract infections (UTIs), haematuria (gross and microscopic), nephrolithiasis, and nephrocalcinosis.

No specific treatment, and for many patients the condition is normally benign. For patients with symptoms, treatment focuses on treating UTI, removing kidney stones, and preventing recurrent infections and stones.

Definição

MSK is a rare, developmental abnormality that can occur in one or both kidneys, characterised by ectatic or cystic malformations in the medullary collecting ducts. The medullary cysts can range from 1 to 7 mm in diameter. Their presence gives the medulla a sponge-like appearance. Most patients are asymptomatic.

História e exame físico

Principais fatores diagnósticos

presence of risk factors

Detalhes completos

Outros fatores diagnósticos

previous nephrolithiasis
flank pain
haematuria
costovertebral angle tenderness
dysuria
urinary urgency
increased frequency of urination
groin pain

Detalhes completos

Fatores de risco

hemi-hypertrophy
Beckwith-Wiedemann's syndrome
Caroli's disease
congenital hepatic fibrosis
Ehlers-Danlos' syndrome
family history of polycystic kidney disease
chronic kidney disease
hypercalciuria
female sex
hyperparathyroidism

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

urinalysis
urine culture
urea and creatinine
serum electrolytes
abdominal radiography
renal ultrasound
intravenous urography
non-contrast CT scan
CT urogram

Detalhes completos

Investigações a serem consideradas

24-hour urine monitoring
stone analysis

Detalhes completos

Algoritmo de tratamento

AGUDA

with urinary tract infection (UTI)

with nephrolithiasis

Colaboradores

Autores

Michael J. Choi, MD

Associate Professor of Medicine

Clinical Director of Nephrology

Johns Hopkins University School of Medicine

Baltimore

Declarações

MJC declares that he has no competing interests.

David S. Goldfarb, MD

Clinical Chief

Division of Nephrology

New York University School of Medicine

New York VA Medical Center

New York

Declarações

DSG is an author of several references cited in this topic.

Agradecimentos

Dr Michael J. Choi and Dr David S. Goldfarb would like to gratefully acknowledge Dr Amaka Edeani, a previous contributor to this topic.

Declarações

AE declares that she has no competing interests.

Revisores

Khashayar Sakhaee, MD

Internal Medicine Physician

UT Southwestern Medical Center

Dallas

Declarações

KS declares that he has no competing interests.

Eric N. Taylor, MD, MSc

Assistant Professor of Medicine

Harvard Medical School

Renal Division

Brigham and Women's Hospital

Channing Laboratory

Boston

Disclosures

ENT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Forster JA, Taylor J, Browning AJ, et al. A review of the natural progression of medullary sponge kidney and a novel grading system based on intravenous urography findings. Urol Int. 2007;78(3):264-9. Abstract

Imam TH, Patail H, Patail H. Medullary sponge kidney: current perspectives. Int J Nephrol Renovasc Dis. 2019;12:213-8.Full text Abstract

Gambaro G, Feltrin GP, Lupo A, et al. Medullary sponge kidney (Lenarduzzi-Cacchi-Ricci disease): a Padua Medical School discovery in the 1930s. Kidney Int. 2006 Feb;69(4):663-70. Abstract

Maw AM, Megibow AJ, Grasso M, et al. Diagnosis of medullary sponge kidney by computed tomographic urography. Am J Kidney Dis. 2007 Jul;50(1):146-50. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Distal renal tubular acidosis
- Renal papillary necrosis
- Tuberculosis of kidney
More Differentials
Guidelines
- Guidelines on urolithiasis
- Clinical guideline for urinary stone disease
More Guidelines
Patient information
Kidney stones
More Patient information
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Medullary sponge kidney

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

with urinary tract infection (UTI)

with nephrolithiasis

Colaboradores

Autores

Michael J. Choi, MD

Declarações

David S. Goldfarb, MD

Declarações

Agradecimentos

Declarações

Revisores

Khashayar Sakhaee, MD

Declarações

Eric N. Taylor, MD, MSc

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice