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Nephrocalcinosis and nephrolithiasis in infants with congestive heart failure treated with furosemide
U S Alon1, D Scagliotti, R E Garola
1Division of Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City 64108.
Insights
Furosemide therapy for congestive heart failure in children can lead to kidney calcifications (nephrocalcinosis and nephrolithiasis). Stopping the medication resolved calcifications in some cases, but residual kidney issues may persist.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Pharmacology
Background:
- Congestive heart failure in children often requires diuretic treatment.
- Furosemide is a common loop diuretic used for managing fluid overload.
Observation:
- Five children developed kidney calcifications (nephrocalcinosis and nephrolithiasis) during furosemide therapy.
- Renal calcifications were diagnosed via ultrasonography and autopsy.
- Discontinuation of furosemide led to resolution in two out of three patients.
Findings:
- Furosemide treatment is associated with an increased incidence of renal calcifications in pediatric patients.
- Residual renal morbidity, including decreased creatinine clearance, hematuria, and hypercalciuria, can occur.
- The study highlights a previously underestimated risk of renal calcifications with furosemide use.
Implications:
- Clinicians should consider the risk of nephrocalcinosis and nephrolithiasis when prescribing furosemide to children.
- Monitoring renal function and calcium levels is crucial during and after furosemide therapy.
- Further research is warranted to understand the mechanisms and long-term consequences of furosemide-induced renal calcifications.
Abstract:
Nephrocalcinosis and nephrolithiasis developed in five children after furosemide therapy for congestive heart failure. In four children renal calcifications were detected by ultrasonography and in one by autopsy. Discontinuation of the loop diuretic in three children resulted in resolution of the calcifications in two of the patients. Residual renal morbidity included reduced creatinine clearance, microscopic hematuria, and hypercalciuria. The phenomenon of renal calcifications associated with furosemide treatment is more frequent than previously recognized.