medullary sponge kidney

Medullary and papillary duct ectasia

The defining abnormality involves dilatation of collecting ducts in medullary and inner papillary regions. [NLM MeSH](https://www.ncbi.nlm.nih.gov/mesh/68007691)

1. What evidence identifies dilated collecting ducts in the medullary or papillary region? definition
2. Which report or clinician established that the abnormality belongs to the collecting ducts? provenance

Distribution without diagnostic conflation

Record the reported distribution and distinguish the diagnosis from other cystic disorders or causes of medullary nephrocalcinosis.

1. Which kidney, segments, or papillae are reported as involved? measurement
2. What supports collecting-duct ectasia rather than a different cystic disorder or calcification without ectasia? boundary

Contrast-demonstrated duct pattern

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/)

1. Did the study include an excretory phase capable of showing contrast within collecting ducts? provenance
2. Did the report describe duct ectasia or a paintbrush pattern, or only stones and medullary calcification? boundary

Confidence and discordance

Preserve original wording, subsequent interpretations, and unresolved disagreement rather than silently upgrading suggestive evidence.

1. Is the diagnosis suspected, supported, confirmed by a clinician, or disputed, and on what basis? provenance
2. Would expert review of existing imaging resolve uncertainty before considering another examination? action

Ductal and urinary stone burden

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/)

1. Where are discrete stones, ductal deposits, and nephrocalcinosis reported, and which locations remain uncertain? measurement
2. Which dated episodes involved stone passage, obstruction, intervention, or recovered stone analysis? provenance

Urine chemistry with context

Record measured calcium, citrate, volume, and pH with collection quality, treatment exposure, and laboratory interpretation; do not infer abnormalities from the diagnosis.

1. What do available 24-hour urine studies show, with units and evidence of collection completeness? measurement
2. If an acidification disorder is suspected, what independent assessment supports it beyond a single urine pH? boundary
3. Which documented abnormality is the clinician's prevention plan intended to address? action

Hematuria and pain context

Record hematuria and pain separately from the structural diagnosis, including alternative explanations and unresolved attribution.

1. When do pain or hematuria occur relative to documented stones, infection, or obstruction? measurement
2. What other causes have been considered when symptoms lack a matching urinary finding? boundary

Acute complication evidence

Capture symptoms, cultures, imaging, renal function changes, and the clinician's assessment of urgency.

1. What evidence supports symptomatic infection, obstruction, or their coexistence in this episode? provenance
2. Has the episode received clinician triage, and what escalation or follow-up was specified? action

Renal function and additional disease

Maintain dated renal function measurements and distinguish documented complications from possible additional renal disease.

1. What is the creatinine and eGFR trajectory, including measurements during and after acute episodes? measurement
2. If function declines, what evidence addresses obstruction, infection, medication effects, or an additional kidney disorder? boundary

Complication-focused care response

Link each intervention to its intended complication or measured risk factor and record response, tolerability, and review criteria.

1. Which intervention targets recurrent stones, infection, symptoms, or a documented urinary abnormality? action
2. Have symptomatic episodes, procedures, or measured urinary risk factors changed over a defined follow-up interval? measurement
3. What findings trigger reassessment of the diagnosis, prevention plan, or specialist follow-up? action

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these kinds and varieties hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Typical measurements

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these typical measurements hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of medullary sponge kidney this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. 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? provenance