Case scenario

30 year with history of recurrent renal stone. Analysis of stone came out to be calcium oxalate.

There is no family history of renal stone. IVP shows linear striatiation of papilla and occasionally

Medullary cystic collection of contrast and calcium. His serum chemistry:

Na 139

K   4.0

Cl  109

Hco 19

s.creatine  1.1

Urine Ph 5.8

Arterial Ph 7.37

Arterial Pco 34

Q.     what is the kidny disease?

          What is the acid base abnormality?

         What is the treatment?

Answere:

            Patient has medullary sponge kidney.

            It is complicated by hypercaciruea and metabolic acidosis which is normal

            Anion gap and positive anion gap type.

          In one fouth of medulary sponge kidny patients renal stone are formed.

          Oral alkali thrapy with bicarbonate or citrate salt can be given.

         Thiazide diruretic can be tried.

       Patient is encourage to increase oral fluid so that about 2 to 2.5 liter urine out put 

       Can be maintained.

       Sodium restriction up to not more than 2 gm in 24 hour.

       Proteins should be not more than 1 gm/kg /day.