Randall plaque versus renal stone?

A 43-year-old patient has just left the office. Her primary care physician had dutifully evaluated her recent complaint of vague abdominal pain with an abdominal ultrasound. The multiple, small, punctate hyperechoic lesions in the kidney were deemed concerning for renal calculi and an abdominal computed tomography (CT) scan was ordered to better delineate these "renal stones". The CT report revealed "multiple bilateral punctate calcifications consistent with possible nephrolithiasis versus nephrocalcinosis," and the patient was referred to urology clinic for further evaluation. In our clinic the patient was interviewed and examined and the scan was carefully reviewed. The patient denied symptoms of renal colic and physical examination demonstrated no costovertebral angle tenderness. No hydronephrosis or evidence of urinary obstruction could be seen on the scan, and we provided a diagnosis of Randall plaques and nephrocalcinosis. The patient was reassured that there were no stones to treat and there was no need for surgery. General lifestyle and dietary modification counseling for stone prevention were provided, and the patient was discharged from our clinic, happy with her benign diagnosis.