32 year old Malay lady with history of acute left loin pain and gross haematuria (blood in the urine) a week ago. The pain & haematuria have since subsided. She was referred for a KUB x-ray and ultrasound - just for a check!
KUB x-ray showed bilateral and multiple clusters of calcifications. The pattern is consistent with medullary nephrocalcinosis.
Ultrasound showed echogenic medullary pyramids bilaterally due to the calcium deposits.
Medullary nephrocalcinosis requires further investigation. The most likely causes are hyperparathyrodism and renal tubular acidosis.
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