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Published on: June 2, 2022
Etiology and longitudinal kidney outcomes in children with nephrocalcinosis: a retrospective cohort study
Mihriban İnözü1,2, Sibel Çetince Şenses2, Özlem Yüksel Aksoy2
1Faculty of Medicine, Department of Pediatric Nephrology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye.
Insights
Pediatric nephrocalcinosis can lead to declining kidney function over time, particularly in children with genetic causes. Early diagnosis and close monitoring are crucial for managing this condition.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Calcium Metabolism Disorders
Background:
- Nephrocalcinosis, characterized by calcium salt deposition in kidney parenchyma, affects children with various disorders.
- While increasingly recognized, long-term kidney outcomes and prognostic factors for pediatric nephrocalcinosis are poorly understood.
Purpose of the Study:
- To evaluate clinical characteristics, etiological spectrum, and longitudinal kidney outcomes in children with nephrocalcinosis.
- To identify factors associated with kidney function decline in this pediatric population.
Main Methods:
- Retrospective cohort study including 73 children diagnosed with nephrocalcinosis.
- Longitudinal analysis of 43 children with a median follow-up of 52 months.
- Assessment of estimated glomerular filtration rate (eGFR) changes and multivariable regression for prognostic factors.
Main Results:
- A significant decline in median eGFR was observed over the follow-up period (p=0.006).
- Kidney outcomes varied by etiology, with poorer outcomes in hereditary/genetic cases.
- Systemic/syndromic etiology, UTI history, and older age at diagnosis predicted eGFR decline; metabolic factors did not.
Conclusions:
- Pediatric nephrocalcinosis is associated with long-term kidney function decline, influenced by etiology and clinical factors.
- Highlights the need for early diagnosis, etiological evaluation, risk stratification, and close follow-up.
- Emphasizes the necessity of prospective studies to refine prognostic understanding and optimize care.
Background:
Nephrocalcinosis refers to the deposition of calcium salts within the kidney parenchyma and is a condition encountered in various metabolic, genetic, and systemic disorders in childhood. Nephrocalcinosis is increasingly recognized in children; however, data on long-term kidney outcomes and prognostic factors remain limited.
Methods:
This study was designed as a retrospective cohort study. We evaluated the clinical characteristics, etiological spectrum, and longitudinal kidney outcomes of children with nephrocalcinosis. Changes in estimated glomerular filtration rate (eGFR) over follow-up were assessed, and factors associated with kidney function decline were analyzed using multivariable regression.
Results:
Among 73 children with nephrocalcinosis, 43 were included in longitudinal analyses with a median follow-up of 52 months. Median eGFR declined significantly over time (p = 0.006). Kidney outcomes varied according to underlying etiology, with lower final eGFR observed in children with hereditary or genetic causes. In multivariable analysis, systemic/syndromic etiology, history of urinary tract infection, and older age at diagnosis were independently associated with greater eGFR decline, whereas traditional metabolic risk factors were not independently associated with longitudinal changes in kidney function.
Conclusion:
Our findings suggest that pediatric nephrocalcinosis may be associated with a decline in kidney function over long-term follow-up and that kidney outcomes are influenced by underlying etiological and clinical factors. Given the paucity of studies addressing the long-term prognosis of nephrocalcinosis, these results highlight the need for early diagnosis, careful etiological evaluation, individualized risk stratification, and close follow-up, particularly in high-risk subgroups. Furthermore, our study underscores the need for prospective studies to better characterize prognostic factors and optimize long-term care in children with nephrocalcinosis.
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