## Core Concept
Medullary sponge kidney (MSK) disease is a benign congenital disorder characterized by the presence of cystic dilatations in the collecting ducts of the renal medulla. It often presents with symptoms related to urinary tract infections, kidney stones, and hematuria. The condition can affect one or both kidneys.

## Why the Correct Answer is Right
The correct answer, , is associated with medullary sponge kidney disease because one of the hallmark symptoms of MSK is the presence of **striated or brush-like calcifications** visible on imaging, particularly in the medullary and papillary regions of the kidneys. These calcifications are often seen in the context of **hematuria** (blood in the urine), **recurrent urinary tract infections (UTIs)**, and **nephrolithiasis** (kidney stones), which are common manifestations of MSK.

## Why Each Wrong Option is Incorrect
- **Option A:** - This option does not directly relate to a commonly recognized symptom or finding specific to medullary sponge kidney disease.
- **Option B:** - While some kidney diseases can present with hypertension, it is not a specific or unique symptom of medullary sponge kidney disease.
- **Option C:** - This option might relate to other kidney conditions but is not specifically characteristic of MSK.

## Clinical Pearl / High-Yield Fact
A key clinical pearl for medullary sponge kidney disease is that it often presents with **intermittent hematuria**, **recurrent UTIs**, and **pain** due to the formation of **kidney stones**. Imaging studies, such as **intravenous urography (IVU)**, **CT scans**, or **ultrasound**, can help in diagnosing MSK by showing the characteristic **medullary and papillary calcifications**.

## Correct Answer Line
**Correct Answer: D.**