Coexisting nephrolithiasis and cholelithiasis in premature infants

Area of Science:

• Neonatal Medicine
• Pediatric Nephrology
• Pediatric Gastroenterology

Background:

• The simultaneous presence of nephrolithiasis and cholelithiasis is exceptionally rare in premature infants.
• Premature infants with severe health conditions like bronchopulmonary dysplasia and intraventricular hemorrhage are at higher risk.
• Prolonged diuretic use, particularly furosemide, is a common therapeutic intervention in this population.

Purpose of the Study:

• To report and analyze cases of coexisting kidney and gallstones in extremely low birth weight infants.
• To investigate the potential link between furosemide therapy and the formation/resolution of these stones.
• To evaluate the efficacy of ultrasound in diagnosing and monitoring these conditions.

Main Methods:

• Retrospective case series of four premature infants.
• Detailed review of medical records, focusing on birth weight, medical conditions, and medication history (specifically furosemide).
• Utilized ultrasound for the identification and serial monitoring of renal and biliary calculi.

Main Results:

• All four infants had birth weights under 1100 grams, severe bronchopulmonary dysplasia, and Grade III/IV intraventricular hemorrhages.
• Each infant received continuous furosemide therapy for at least 28 days.
• Renal stones resolved in all infants after discontinuing furosemide.
• Gallstones persisted in all infants after a mean follow-up of 13 months.
• Ultrasound proved effective for stone detection and management.

Conclusions:

• Prolonged furosemide therapy may contribute to nephrolithiasis in vulnerable premature infants.
• Cessation of furosemide can lead to the resolution of renal stones.
• Gallstones in this context appear less responsive to diuretic withdrawal.
• Ultrasound is a valuable tool for managing renal and biliary complications in neonates.
• Careful consideration of diuretic therapy is crucial to mitigate potential lithogenic risks.