{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.medullary-sponge-kidney","code":"thing-q119280","url":"https://ver.cy/models/thing/q119280/","name":"medullary sponge kidney","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.STA"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Medullary sponge kidney is a developmental renal malformation characterized by cystic dilatation of collecting ducts in the renal papillae and medulla, predisposing to nephrocalcinosis, kidney stones and urinary tract infections.","purpose":"Enable an agent to recognize medullary sponge kidney, record the evidence and complication burden, and support clinician-directed evaluation and follow-up.","scope":{"in":["Evidence of collecting-duct ectasia and its distribution within and between kidneys","Diagnostic confidence and distinction from other causes of medullary calcification","Associated stones, urinary infections, hematuria, and pain","Measured urinary stone-risk factors and renal function","Condition-specific follow-up needs and links to complication management"],"out":["General kidney anatomy and normal collecting-duct physiology","Full diagnostic and treatment models for urinary stones and urinary tract infections","Autosomal dominant tubulointerstitial kidney disease and polycystic kidney diseases","Independent models of hyperparathyroidism and renal tubular acidosis","Detailed prescribing, procedural technique, and emergency treatment protocols"],"boundaries":[]},"distinguishingFeatures":["Require evidence addressing medullary or papillary collecting-duct dilatation; renal calcification alone does not establish the defining abnormality. [NLM MeSH](https://www.ncbi.nlm.nih.gov/mesh/68007691)","Record whether excretory imaging demonstrates contrast within dilated collecting ducts, producing a characteristic paintbrush pattern. [Differential diagnosis study](https://pubmed.ncbi.nlm.nih.gov/6729542/)","Distinguish stones or nephrocalcinosis accompanying collecting-duct ectasia from stones or nephrocalcinosis without demonstrated ectasia. [Biopsy-confirmed study](https://pubmed.ncbi.nlm.nih.gov/25615853/)","Check the anatomical distribution of cystic change before equating the diagnosis with a broader cystic kidney disorder. [Imaging case report](https://pubmed.ncbi.nlm.nih.gov/6740360/)"],"structure":{"bundles":[{"id":"identity-and-anatomical-boundary","name":"Identity and anatomical boundary","description":"Define the collecting-duct abnormality represented by this registry entry.","layers":[{"id":"defining-lesion","name":"Defining lesion","description":"Capture the anatomical evidence underlying the condition label.","findings":[{"id":"medullary-papillary-duct-ectasia","name":"Medullary and papillary duct ectasia","description":"The defining abnormality involves dilatation of collecting ducts in medullary and inner papillary regions. [NLM MeSH](https://www.ncbi.nlm.nih.gov/mesh/68007691)","questions":[{"text":"What evidence identifies dilated collecting ducts in the medullary or papillary region?","id":"medullary-papillary-duct-ectasia-q01","kind":"definition"},{"text":"Which report or clinician established that the abnormality belongs to the collecting ducts?","id":"medullary-papillary-duct-ectasia-q02","kind":"provenance"}]}]},{"id":"extent-and-neighbouring-conditions","name":"Extent and neighbouring conditions","description":"Map involved anatomy and preserve boundaries with other renal disorders.","findings":[{"id":"distribution-without-diagnostic-conflation","name":"Distribution without diagnostic conflation","description":"Record the reported distribution and distinguish the diagnosis from other cystic disorders or causes of medullary nephrocalcinosis.","questions":[{"text":"Which kidney, segments, or papillae are reported as involved?","id":"distribution-without-diagnostic-conflation-q01","kind":"measurement"},{"text":"What supports collecting-duct ectasia rather than a different cystic disorder or calcification without ectasia?","id":"distribution-without-diagnostic-conflation-q02","kind":"boundary"}]}]}]},{"id":"diagnostic-evidence-and-confidence","name":"Diagnostic evidence and confidence","description":"Connect the diagnosis to interpretable observations and their limitations.","layers":[{"id":"imaging-observations","name":"Imaging observations","description":"Record findings together with the protocol that produced them.","findings":[{"id":"contrast-demonstrated-duct-pattern","name":"Contrast-demonstrated duct pattern","description":"Contrast within dilated collecting ducts can produce the characteristic paintbrush appearance described in diagnostic literature. [Differential diagnosis study](https://pubmed.ncbi.nlm.nih.gov/6729542/)","questions":[{"text":"Did the study include an excretory phase capable of showing contrast within collecting ducts?","id":"contrast-demonstrated-duct-pattern-q01","kind":"provenance"},{"text":"Did the report describe duct ectasia or a paintbrush pattern, or only stones and medullary calcification?","id":"contrast-demonstrated-duct-pattern-q02","kind":"boundary"}]}]},{"id":"evidence-reconciliation","name":"Evidence reconciliation","description":"Resolve differences between diagnostic labels and underlying evidence.","findings":[{"id":"confidence-and-discordance","name":"Confidence and discordance","description":"Preserve original wording, subsequent interpretations, and unresolved disagreement rather than silently upgrading suggestive evidence.","questions":[{"text":"Is the diagnosis suspected, supported, confirmed by a clinician, or disputed, and on what basis?","id":"confidence-and-discordance-q01","kind":"provenance"},{"text":"Would expert review of existing imaging resolve uncertainty before considering another examination?","id":"confidence-and-discordance-q02","kind":"action"}]}]}]},{"id":"stones-and-urinary-phenotype","name":"Stones and urinary phenotype","description":"Characterize stone formation and measured urinary contributors.","layers":[{"id":"stone-localization-and-history","name":"Stone localization and history","description":"Distinguish imaging burden from clinically active stone episodes.","findings":[{"id":"ductal-and-urinary-stone-burden","name":"Ductal and urinary stone burden","description":"A biopsy-confirmed study found enlarged inner medullary collecting ducts containing small stones; record stone location when demonstrated rather than assuming all calcification represents freely passing calculi. [Biopsy-confirmed study](https://pubmed.ncbi.nlm.nih.gov/25615853/)","questions":[{"text":"Where are discrete stones, ductal deposits, and nephrocalcinosis reported, and which locations remain uncertain?","id":"ductal-and-urinary-stone-burden-q01","kind":"measurement"},{"text":"Which dated episodes involved stone passage, obstruction, intervention, or recovered stone analysis?","id":"ductal-and-urinary-stone-burden-q02","kind":"provenance"}]}]},{"id":"measured-metabolic-contributors","name":"Measured metabolic contributors","description":"Document individual urine chemistry and any separate acidification assessment.","findings":[{"id":"urine-chemistry-with-context","name":"Urine chemistry with context","description":"Record measured calcium, citrate, volume, and pH with collection quality, treatment exposure, and laboratory interpretation; do not infer abnormalities from the diagnosis.","questions":[{"text":"What do available 24-hour urine studies show, with units and evidence of collection completeness?","id":"urine-chemistry-with-context-q01","kind":"measurement"},{"text":"If an acidification disorder is suspected, what independent assessment supports it beyond a single urine pH?","id":"urine-chemistry-with-context-q02","kind":"boundary"},{"text":"Which documented abnormality is the clinician's prevention plan intended to address?","id":"urine-chemistry-with-context-q03","kind":"action"}]}]}]},{"id":"clinical-manifestations-and-complications","name":"Clinical manifestations and complications","description":"Track symptoms and acute events without treating them as diagnostic proof.","layers":[{"id":"symptoms-and-attribution","name":"Symptoms and attribution","description":"Connect symptoms to contemporaneous investigations.","findings":[{"id":"hematuria-and-pain-context","name":"Hematuria and pain context","description":"Record hematuria and pain separately from the structural diagnosis, including alternative explanations and unresolved attribution.","questions":[{"text":"When do pain or hematuria occur relative to documented stones, infection, or obstruction?","id":"hematuria-and-pain-context-q01","kind":"measurement"},{"text":"What other causes have been considered when symptoms lack a matching urinary finding?","id":"hematuria-and-pain-context-q02","kind":"boundary"}]}]},{"id":"infection-and-obstruction","name":"Infection and obstruction","description":"Represent acute urinary events that change the care priority.","findings":[{"id":"acute-complication-evidence","name":"Acute complication evidence","description":"Capture symptoms, cultures, imaging, renal function changes, and the clinician's assessment of urgency.","questions":[{"text":"What evidence supports symptomatic infection, obstruction, or their coexistence in this episode?","id":"acute-complication-evidence-q01","kind":"provenance"},{"text":"Has the episode received clinician triage, and what escalation or follow-up was specified?","id":"acute-complication-evidence-q02","kind":"action"}]}]}]},{"id":"renal-course-and-care-response","name":"Renal course and care response","description":"Track functional outcomes and the response to complication-focused care.","layers":[{"id":"functional-course","name":"Functional course","description":"Assess kidney function over time and investigate unexplained change.","findings":[{"id":"renal-function-and-additional-disease","name":"Renal function and additional disease","description":"Maintain dated renal function measurements and distinguish documented complications from possible additional renal disease.","questions":[{"text":"What is the creatinine and eGFR trajectory, including measurements during and after acute episodes?","id":"renal-function-and-additional-disease-q01","kind":"measurement"},{"text":"If function declines, what evidence addresses obstruction, infection, medication effects, or an additional kidney disorder?","id":"renal-function-and-additional-disease-q02","kind":"boundary"}]}]},{"id":"care-targets-and-review","name":"Care targets and review","description":"Make clinician-directed prevention and follow-up assessable.","findings":[{"id":"complication-focused-care-response","name":"Complication-focused care response","description":"Link each intervention to its intended complication or measured risk factor and record response, tolerability, and review criteria.","questions":[{"text":"Which intervention targets recurrent stones, infection, symptoms, or a documented urinary abnormality?","id":"complication-focused-care-response-q01","kind":"action"},{"text":"Have symptomatic episodes, procedures, or measured urinary risk factors changed over a defined follow-up interval?","id":"complication-focused-care-response-q02","kind":"measurement"},{"text":"What findings trigger reassessment of the diagnosis, prevention plan, or specialist follow-up?","id":"complication-focused-care-response-q03","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of medullary sponge kidney this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain the condition in general terms from reputable medical sources.","Advise a person with severe flank pain, fever or blood in the urine to seek care."],"mustNot":["Diagnose the condition from symptoms or scans.","Recommend diet changes or medicines to a specific person for stone prevention.","Disclose a person's kidney health records without consent.","Promote unproven stone-dissolving products."],"requiresHuman":["Any treatment or procedure to remove stones."]},"ethics":{"considerations":["Recurrent stones cause severe pain and lost work, often with little recognition.","Accurate information prevents both alarm and neglect."],"affectedParties":["Patients","Their families","Employers of affected workers"]},"owners":{"steward":"Nobody owns the condition; patients and their clinicians answer for care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q12136","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.medullary-sponge-kidney","Wikidata: Q119280 (https://www.wikidata.org/wiki/Q119280)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic confidence: suspected | supported | clinician-confirmed | disputed; evidence and date required","Collecting-duct abnormality: ectasia demonstrated | suggestive appearance | not demonstrated | not assessable","Anatomical extent: left | right | bilateral | unknown; affected papillae or segments where reported","Imaging evidence: study, modality, protocol, date, report, and interpreting clinician","Stone and calcification burden: stone count, maximum diameter in mm, location; nephrocalcinosis recorded separately","Symptomatic complication burden: dated stone and infection episodes; hematuria and pain frequency; observation interval","Urinary metabolic profile: 24-hour volume in L/day, calcium and citrate in laboratory-reported units, urine pH","Renal function trajectory: serum creatinine in µmol/L or mg/dL; eGFR in mL/min/1.73 m²; dates","Complication attribution: manifestation linked to supporting evidence, alternative explanations, and clinician assessment"]},"recognition":{"applicability":"optional","items":["On imaging, small calcium deposits and widened ducts in the inner parts of the kidney, sometimes described as a paintbrush pattern."]},"capabilities":{"applicability":"required","items":["Assemble an evidence-linked diagnostic summary and identify missing anatomical confirmation.","Compare imaging reports for changes in stones, calcification, and obstruction.","Link recurrent stone episodes to available composition and urine studies.","Identify documented acute complications requiring clinician triage.","Prepare a follow-up agenda based on symptoms, renal function, and unresolved diagnostic questions."]},"hazards":{"applicability":"required","items":["Recurrent kidney stones and urinary infections.","Calcium deposits in the kidney can affect its function."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases ICD-10, issued by the World Health Organization, includes medullary sponge kidney under Q61.5 for medullary cystic kidney."]},"context":{"applicability":"required","items":["Medullary sponge kidney is encountered in renal imaging and in clinical evaluation of kidney stones, urinary tract infections or blood in the urine.","It may also be identified incidentally in someone without symptoms.","Documenting the malformation helps clinicians interpret collecting duct changes and assess associated complications over time."]}},"sources":[{"title":"Wikidata item Q119280: medullary sponge kidney","url":"https://www.wikidata.org/wiki/Q119280","note":"identity and sense of the item"},{"title":"Wikipedia: Medullary sponge kidney","url":"https://en.wikipedia.org/wiki/Medullary_sponge_kidney","note":"general description of the item"}],"openQuestions":["What diagnostic criteria and contemporary imaging protocols most reliably distinguish collecting-duct ectasia from medullary nephrocalcinosis without ectasia?","Which developmental or inherited mechanisms are established, and when does family history justify additional evaluation?","How often do urinary acidification defects and other metabolic abnormalities occur in rigorously confirmed cases rather than populations selected for recurrent stones?","What explains persistent pain when infection, obstruction, and a symptomatic stone are not demonstrated?","Which surveillance intervals and prevention strategies improve outcomes specifically in medullary sponge kidney, beyond evidence from general stone-forming populations?"],"resources":{"spec":"/models/things/publications/thing-q119280/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q119280/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T11:13:30Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:25+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties."},"score":1.0}}