Do you recommend bone mineral density testing in your patients with recurrent nephrolithiasis secondary to medullary sponge kidney?

A majority of patients classified as MSK do not have that disease. They are calcium phosphate stone formers with multiple duct of Bellini crystal plugs. Most of those have idiopathic hypercalciuria and in that genetic syndrome bone mineral loss is not at all uncommon. Some patients - but by no means the majority - of patients with authentic MSK form calcium oxalate stones and lack hypercalciuria. So faced with the Dx of MSK I sort out the patients by stone type, urine calcium, and decide on bone...

That’s an interesting question. I have not, unless the patient is female and menopausal or perimenopausal. However, many of these patients are hypercalciuric, and I believe you could make a case for it.

Stephen B. Erickson, MD.