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Hypertonic saline-induced urolithiasis presenting as acute renal failure in a child with traumatic brain injury: A

Jasper Bash1, Sarah Hecht1, Aaron Bayne1

  • 1Department of Urology, Oregon Health & Science University, Portland, OR, USA.

Urology Case Reports
|November 16, 2020
PubMed

Insights

Hypertonic saline treatment in a child with traumatic brain injury led to calcium phosphate stones. Prompt ureteral stenting and ureteroscopy resolved the obstruction, preventing recurrence.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Traumatic Brain Injury Management

Background:

  • Severe traumatic brain injury (TBI) necessitates intensive medical management, including fluid and electrolyte support.
  • Hypertonic saline is frequently used for managing intracranial hypertension in TBI patients.
  • Underlying renal tubular acidosis (RTA) can predispose individuals to nephrolithiasis.

Observation:

  • A 4-year-old female with severe TBI developed bilateral obstructing ureteral stones composed of calcium phosphate.
  • The stones appeared two weeks after initiating hypertonic saline therapy.
  • The patient had a history suggestive of incomplete type 1 renal tubular acidosis.

Findings:

  • Hypertonic saline administration, particularly in the context of renal tubular acidosis, can be a lithogenic risk factor.
  • Calcium phosphate stone formation was observed following high sodium and acid load.
  • Ureteral stenting and ureteroscopy provided successful treatment for the ureteral obstruction.

Implications:

  • Clinicians should consider the risk of nephrolithiasis in pediatric TBI patients receiving hypertonic saline, especially those with underlying renal conditions.
  • Screening for metabolic abnormalities like RTA may be warranted in susceptible patients.
  • Early intervention with ureteral stenting and ureteroscopy is effective in managing TBI-related ureteral stones.

Keywords:
Anti-epileptic drugsHypertonic salineNephrolithiasisPediatric

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