Medullary sponge kidney (MSK) is a disorder of renal abnormality and genetic abnormality. Incidence of MSK is 0.5% to 1% worldwide. The pathophysiologic mechanism of MSK is the defect of interaction between glial cell line-derived neurotrophic factor (GDNF) and receptor tyrosine kinase (RET). Clinical manifestations of MSK are recurrent urolithiasis, nephrocalcinosis and pyelonephritis, and sometimes combination of type 1 renal tubular acidosis. The etiology of recurrent renal stone is due to hypercalcinuria, hypocitraturia and relative high urine pH. Treatment and prevention of renal stone formation by potassium citrate is recommended. Intravenous pyelography remains gold standard of diagnosis of MSK, despite of computer tomography and magnetic resonance imaging.