The Natural History of Nephrocalcinosis in Premature Infants Treated With Loop Diuretics

No AccessJournal of UrologyStones1 Aug 1996The Natural History of Nephrocalcinosis in Premature Infants Treated With Loop Diuretics John C. IV Pope, Lisa A. Trusler, Areti M. Klein, William F. Walsh, Aida Yared, and John W. III Brock John C. IV PopeJohn C. IV Pope , Lisa A. TruslerLisa A. Trusler , Areti M. KleinAreti M. Klein , William F. WalshWilliam F. Walsh , Aida YaredAida Yared , and John W. III BrockJohn W. III Brock View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65792-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated the natural history of nephrocalcinosis in premature infants treated with furosemide and attempted to identify factors to predict infants most at risk. Materials and Methods: We evaluated 13 preterm infants in this longitudinal pilot study. During hospitalization and while receiving a loop diuretic nephrocalcinosis developed in each patient. Patients were divided into groups based on resolution (6) and nonresolution (7) according to spontaneous resolution of nephrocalcinosis at any point during followup. The 2 groups were compared to each other and to a control group. Results: Mean followup after discontinuation of furosemide in the resolution versus nonresolution groups was 10.3 and 7.7 months, respectively. Between the 2 groups there was no significant difference in average gestational age, birth weight, number of days hospitalized or on furosemide, or total furosemide dose. Mean calcium-to-creatinine ratio while receiving furosemide at the time nephrocalcinosis developed was 0.38 in the resolution group but 2.23 in the nonresolution group (p less than 0.005). Initial calcium-to-creatinine ratio in age matched infants who did not have nephrocalcinosis was 0.4. Frank renal stones developed in 2 of the 7 patients without resolution and 0 of the 6 with resolution. When nephrocalcinosis resolved, it was at a mean of 5.2 months following discontinuation of the diuretic. Conclusions: Early data indicate that nephrocalcinosis resolves in approximately 50 percent of premature infants 5 to 6 months after discontinuation of furosemide. The only factor that appears to be predictive of the infants who will have resolution is the calcium-to-creatinine ratio when nephrocalcinosis is diagnosed. In patients without resolution this ratio is much higher than in age adjusted normal controls, while in those with resolution it appears normal for age. References 1 : Nephrocalcinosis. Clin. Perinatol.1992; 19: 179. Google Scholar 2 : Nephrocalcinosis and nephrolithiasis in infants with congestive heart failure treated with furosemide. J. Ped.1994; 125: 149. Google Scholar 3 : Furosemide-related renal calcifications in the premature infant. Ped. Rad.1991; 21: 563. Google Scholar 4 : Renal calcification in preterm infants: pathophysiology and long-term sequelae. J. Ped.1988; 113: 532. Google Scholar 5 : Nephrolithiasis in infants: association with chronic furosemide therapy. AJR1983; 140: 107. Google Scholar 6 : Renal calcification incidence in very low birth weight infants. Pediatrics1988; 81: 31. Google Scholar 7 : Nephrocalcinosis in very low birth weight neonates: sonographic patterns, histologic characteristics, and clinical risk factors. J. Ultrasound Med.1994; 13: 777. Google Scholar 8 : The incidence of renal calcifications in low birth weight (LBW) infants on Lasix for bronchopulmonary dysplasia (BPD). Ped. Res.1986; 20: 359. Google Scholar 9 : The incidence of renal calcification in preterm infants. Arch. Dis. Child.1991; 66: 412. Google Scholar 10 : Renal calcium deposition in children: sonographic demonstration of the Anderson-Carr progression. AJR1986; 146: 1253. Google Scholar 11 : Renal calcifications: a complication of long-term furosemide therapy in preterm infants. Pediatrics1982; 70: 360. Crossref, Medline, Google Scholar 12 : Urolithiasis in pre-term neonates associated with furosemide therapy. J. Urol.1984; 132: 93. Link, Google Scholar 13 : Nephrocalcinosis associated renal function impairment in furosemide treated VLBW infants at 1 year of age. Ped. Res.1991; 29: 1252. Google Scholar 14 : Idiopathic hypercalciuria. In: Nephrolithiasis: Pathogenesis and Treatment. Chicago: Year Book Medical Publishers1988: 27. Google Scholar 15 : Hypercalciuria in clinical pediatrics. A review. Clin. Ped.1984; 23: 135. Google Scholar 16 : Urinary oxalate excretion in premature infants: effect of human milk versus formula feeding. Pediatrics1994; 94: 674. Google Scholar 17 : Citrate metabolism and the mechanism of renal calcification induced by magnesium depletion. Metabolism1967; 16: 345. Google Scholar 18 : Decreased urinary citrate in premature infants with lung disease. Child. Nephrol. Urol.1990; 10: 76. Google Scholar 19 : Uric acid metabolism in children. Ped. Clin. N. Amer.1990; 37: 391. Google Scholar From the Divisions of Pediatric Urology, Neonatology and Pediatric Nephrology, Children's Hospital of Vanderbilt University Medical Center, Nashville, Tennessee.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 156Issue 2SAugust 1996Page: 709-712 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information John C. IV Pope More articles by this author Lisa A. Trusler More articles by this author Areti M. Klein More articles by this author William F. Walsh More articles by this author Aida Yared More articles by this author John W. III Brock More articles by this author Expand All Advertisement PDF downloadLoading ...