Primary hyperparathyroidism has been the most common clinical condition associated with nephrocalcinosis. These patients frequently visit outpatient departments (OPD) for repeated episodes of infection and pain abdomen but they are mostly referred for medical treatment of the underlying metabolic derangement and surgery is scarcely used as a definitive end management. Here, we are reporting an exemplary case of symptomatic nephrocalcinosis with primary hyperparathyroidism in which the patient was surgically rendered stone free and relieved off his symptoms. Sharing the success of this case might sway the current treatment protocols of patients diagnosed with nephrocalcinosis towards surgical definitive management, providing patients with relief of symptoms along with improvement in renal function.

A male patient in his forties with hypertension and chronic kidney disease presented with complaints of flank pain and lithuria for 3 years and was diagnosed to have bilateral medullary NC with right poorly functioning kidney having parathyroid adenoma. He underwent right inferior parathyroidectomy but continued to have pain symptoms and deteriorating kidney function.

After due consideration and planning, he underwent left sided staged percutaneous nephrolithotomy (PCNL) to achieve a near complete stone clearance. Currently, the patient is asymptomatic and doing well on follow-up.

The major hindrance to surgical management in cases of nephrocalcinosis remains the thought of surgically inaccessible stones and a high stone burden. We believe that, PCNL can offer simultaneous diagnostic and therapeutic benefits, as it can directly assess the stone burden and its accessibility for removal and provide surgical clearance of those stones, which, depending upon the volume of the stones, may be multi-staged.