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Furosemide-related renal calcifications in the premature infant. A longitudinal ultrasonographic study
G J Downing1, J C Egelhoff, D K Daily
1Section of Neonatology, Children's Mercy Hospital, University of Missouri-Kansas City.
Insights
Chronic furosemide therapy in premature infants can cause kidney calcifications. Discontinuing furosemide therapy helps resolve these calcifications, while continued use is linked to significant renal morbidity.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Medical Imaging
Background:
- Premature infants on chronic furosemide are at risk for intrarenal calcifications.
- Loop diuretics like furosemide are commonly used for chronic lung disease in neonates.
Purpose of the Study:
- To investigate the correlation between furosemide therapy, clinical outcomes, and ultrasonographic findings of intrarenal calcifications in low birthweight infants.
- To assess the resolution and persistence of renal calcifications after discontinuing or continuing furosemide therapy.
Main Methods:
- Prospective longitudinal study involving renal ultrasonography in 117 premature infants.
- Sonographic follow-up to monitor intrarenal calcifications after furosemide discontinuation or continuation.
Main Results:
- 20 out of 117 infants developed intrarenal calcifications.
- 8 infants showed sonographic resolution of calcifications after stopping furosemide.
- Persistent calcifications were significantly associated with continued furosemide use (p < 0.001), leading to renal morbidity including nephrolithotomy and UTIs.
Conclusions:
- Discontinuation of furosemide therapy is associated with the resolution of intrarenal calcifications.
- Continued furosemide treatment in premature infants is linked to increased renal morbidity.
- Ongoing clinical and ultrasonographic monitoring is recommended for infants on furosemide therapy.
Abstract:
Low birthweight infants treated with chronic furosemide therapy are at risk for the development of intrarenal calcifications. A prospective longitudinal renal ultrasound investigation was conducted to study the correlation of diuretic therapy, clinical course and ultrasonographic findings. Of 117 premature infants studied ultrasonographically upon discharge from the hospital, 20 had intrarenal calcifications. Eight patients at age 16.3 +/- 2.6 months had sonographic resolution of renal calcifications, 6.6 +/- 1.1 months after furosemide therapy had been discontinued. Of the 12 patients with persistent calcifications, 4 died from severe pulmonary disease and autopsy in 3 of them confirmed the ultrasonographic diagnosis. All 12 children but 2 continued to receive furosemide for their chronic lung disease demonstrating significant association between chronic use of loop diuretics and persistence fo the renal calcifications (p less than 0.001). Two patients required nephrolithotomy and 4 suffered from recurrent urinary tract infections. In 4 patients, 5 kidneys were of small size and in 2 bilateral collecting system dilation was noted. We conclude that discontinuation of furosemide therapy is associated with resolution of the renal calcifications. On the other hand, continued treatment with furosemide is associated with high renal morbidity which indicates ongoing clinical and ultrasonographic follow-up.