Nephrocalcinosis and nephrolithiasis in infants with congestive heart failure treated with furosemide,☆☆,,★★

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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. ( J PEDIATR 1994;125:149-51)

Section snippets

CASE REPORTS

The clinical, laboratory, and renal ultrasonographic data of the five children are presented in the Table. All patients had complex congenital heart disorders that resulted in congestive heart failure. The two children with trisomy 21 had complete atrioventricular canal, which in both was associated with pulmonary hypertension. The two children with Noonan syndrome had lesions in the pulmonary artery tree, including pulmonic stenosis. The fifth child had hypoplasia of the right side of the

DISCUSSION

Nephrocalcinosis and nephrolithiasis have been observed in up to 64% of very LBW premature infants treated with furosemide,2, 5, 7 but have not been reported in other patient populations. Of the five children observed by us, three were born at term and the other two were slightly premature. The birth weights of the latter two were greater than those of previously reported premature infants with furosemide-induced renal calcifications.1, 7 Moreover, in these two children, treatment with the loop

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From the Divisions of Nephrology and Cardiology, and Department of Pathology, Children's Mercy Hospital, University of Missouri at Kansas City

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Supported in part by The Sam and Helen Kaplan Research Fund in Pediatric Nephrology.

Reprint requests: Uri Alon, MD, Section of Pediatric Nephrology, Children's Mercy Hospital, 2401 Gillham Rd., Kansas City, MO 64108.

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0022-3476/94/$3.00 + 0 9/26/55231

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