Ultrasound diagnosis of renal calcification in infants on chronic furosemide therapy

Abstract

We describe seven infants who developed renal calcification and bone demineralization following furosemide therapy with average daily doses of as little as 0.75 mg/kg per day. Renal calcifications were present in all seven cases and were more readily detected with ultrasonography than with plain films. Renal calculi were seen in four patients, sonographically demonstrated as echogenic foci in the dependent portion of the collecting system, usually accompanied by acoustic shadowing. One patient developed nephrocalcinosis, sonographically observed as echogenic medullary pyramids plus punctate, shadowing parenchymal calcifications. In two patients the location of the calcification could not be determined.

Frusemide-induced nephrocalcinosis in very low birth weight infants

“…Reports from North America have established the association of frusemide therapy and nephrocalcinosis in very low birth weight infants [1][2][3][4][5]. These babies had at least 10 days frusemide treatment, and usually 3 weeks or more.…”

“…Other American authors have since described the radiographic and sonographic findings of frusemide induced nephrocalcinosis [2][3][4][5]. To our knowledge, no similar reports have been published in Britain.…”

Nephrocalcinosis and Prematurity: Importance of Urate and Oxalate Excretion

“…Several authors have noted this complication with a variable frequency [5][6][7][8][9][10]. In a large review o f the literature, Adams and Rowe [29] point-ed out that, in most cases, specific clinical or biological or therapeutic circumstances cannot be found, and that it is im possible to incriminate a sole cause in all patients.…”

“…The frequent administration of parent eral nutrition has been incriminated by several authors [4,5,8,9], but this was not observed in all cases. Because of the lack of specific standards for preterm infants, we used the normal values of oxalate excretion for children proposed by Barratt [23] and the ratio recommended by Leumann ct al.…”

Nephrocalcinosis in Premature Infants

“…These calcium oxalate deposits may be identified on plain films of the abdomen but are more readily detected by ultrasound. 1,2 Estimates of the incidence of nephrocalcinosis in premature infants have varied considerably. Jacinto et al 3 have reported a 65% incidence of nephrocalcinosis, whereas Short and Cooke 4 reported a 27% incidence in very low birth weight infants.…”