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Renal calcification in preterm infants: pathophysiology and long-term sequelae
F Ezzedeen1, R D Adelman, C E Ahlfors
1Department of Pediatrics, School of Medicine, University of California, Sacramento 95817.
Insights
Nephrocalcinosis in preterm infants receiving loop diuretics often resolves but can persist. Renal function may be compromised despite calcification improvement, highlighting the need for ongoing monitoring.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Pharmacology
Background:
- Preterm infants with chronic lung disease often require loop diuretics.
- Loop diuretic use is associated with an increased risk of nephrocalcinosis.
- Nephrocalcinosis is a significant concern in the long-term health of preterm infants.
Purpose of the Study:
- To examine the clinical course and outcomes of nephrocalcinosis in preterm infants treated with loop diuretics.
- To assess the resolution of renal calcification and its impact on renal function over time.
- To identify risk factors associated with nephrocalcinosis in this vulnerable population.
Main Methods:
- Retrospective analysis of 17 preterm infants with chronic lung disease and nephrocalcinosis.
- Evaluation of clinical data, including diuretic use and risk factors.
- Serial assessments of renal calcification, renal length, and renal function (serum creatinine, GFR) via imaging and laboratory tests.
Main Results:
- Nephrocalcinosis was diagnosed at a mean age of 12 weeks and associated with furosemide therapy and multiple risk factors.
- In nine infants followed for up to 4.5 years, calcification improved in five, with four showing complete resolution.
- Renal length was normal in most kidneys, but abnormal renal function (creatinine, GFR) was noted in four of nine patients.
Conclusions:
- Renal calcification in preterm infants is linked to risk factors including furosemide, and tends to decrease in the first year.
- While calcification may resolve, some infants may experience persistent renal function impairment.
- Long-term monitoring of renal function is crucial for preterm infants who develop nephrocalcinosis.
Abstract:
We examined the clinical course of 17 preterm infants with chronic lung disease who received loop diuretics and developed nephrocalcinosis; nine of them were followed for up to 4.5 years. The mean gestational age was 26.8 weeks (SD 2.2 weeks), and mean birth weight was 830 gm (SD 276 gm). The diagnosis of renal calcification was made at a mean age of 12 weeks (SD 6.5 weeks) by abdominal x-ray examination, screening abdominal ultrasound studies or, both. Calcification was associated with both furosemide therapy and the presence of multiple potential risk factors. Renal calcification, length, and function were subsequently evaluated in nine patients at a mean age of 21.3 months (SD 15.3 months). Improvement in calcification occurred in five patients, with total resolution in four. Renal length, determined by ultrasound examination and corrected for body length, was normal in 17 of 18 kidneys. Serum creatinine values and calculated glomerular filtration rates were abnormal in four of nine patients. We conclude that renal calcification in preterm infants is associated with multiple risk factors, including furosemide usage, and tends to diminish during the first year of life. However, renal function may remain compromised in some patients.