Objectives-To determine prospectively the incidence and cause of nephrocalcinosis in preterm infants. Study design-Inborn babies of gestation less than 32 weeks or birth weight less than 1500 g were eligible to be entered into a prospective observational study. Two renal ultrasound scans were performed, the first at 1 month postnatal age and the second at term or discharge. Data were collected on gestation, birth weight, sex, race, family history of renal calculi, oliguria on first day, respiratory support (ventilation, steroid, and oxygen dependency), and use of nephrotoxic drugs (gentamicin, vancomycin, and frusemide). Intake of fluid, calcium, and phosphate and plasma urea, creatinine, calcium, and phosphate were recorded for the first 6 weeks of life. Random urinary calcium/creatinine, oxalate/ creatinine, and urate/creatinine ratios and tubular absorption of phosphate were measured once at term. Results-A total of 101 preterm infants were studied. Twenty three (23%) had abnormal ultrasound scans. Sixteen (16%) had nephrocalcinosis. On univariate analysis, gestational age, male sex, duration of ventilation, oxygen dependency, duration and frequency of gentamicin treatment, toxic gentamicin/vancomycin levels, and postnatal dexamethasone were significantly associated with nephrocalcinosis. In addition, babies with nephrocalcinosis had a lower intake of fluid, calcium, and phosphate, longer duration of total parenteral nutrition, and higher urinary oxalate/creatinine and urate/ creatinine ratios than infants who did not have the condition. There was also a significant association with plasma urea and creatinine but not with plasma calcium or phosphate or urinary calcium. Multivariate analysis showed that the strongest predictors of nephrocalcinosis were duration of ventilation, toxic gentamicin/vancomycin levels, low fluid intake, and male sex. Conclusion-16% of babies born at less than 32 weeks gestation developed nephrocalcinosis. The multifactorial origin, in particular, the association with extreme prematurity and severity of respiratory disease, is confirmed. In addition, an association with male sex, frequency and duration of gentamicin use, and high urinary oxalate and urate excretion is shown. (Arch Dis Child Fetal Neonatal Ed 2001;85:F207-F213)

Objective To correlate renal calculi and other clinical factors with urinary biochemical analytes in patients with inflammatory bowel disease, and to investigate the relative importance of hyperoxaluria (associated with fat malabsorption) or reduced stone inhibitors in the development of calculi in these patients. Patients, subjects and methods Samples were obtained from 25 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects (controls). Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography. Urine oxalate and citrate were analysed using commercial enzymatic assays; magnesium was measured using atomic absorption and other analytes assayed using standard methods on automated analysers. Results Renal calculi were found in two patients with CD and in none with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in those with UC. Analysis of covariance showed an association between low urinary citrate/creatinine ratio and renal stones (P=0.02), and between a combined urinary citrate and magnesium deficit relative to calcium, as expressed in the CMC index ((citrater magnesium)/calcium), and renal stones (P=0.017). Changes in urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not associated with the presence of stones. There was no independent relationship between any clinical factor and the presence of stones. Conclusion Lower urinary concentrations of magnesium and citrate (stone inhibitors), relative to calcium (stone promoter; the CMC index) may be more important in lithogenesis in inflammatory bowel disease than is hyperoxaluria. In patients with a functioning colon, a low CMC index may predict likely stone-formers; this requires a prospective evaluation. Avoiding low urinary levels of magnesium and citrate may aid in preventing and treating renal calculi.

Scvcrc clilcval ntutritional ncurological dairiagc in a VOLIng Nigcrian detaincc. i'rip Gcoigr .led in press. 3 B3akcr JP,)ctskv AS, WessonDEl , e ta!. Ntutritional iisscssment: a comrparison ot clinical uldgemcrnt anid ohtective measurement' A nI ng,7 1ed 19X2;306: 969-72. 4 W'aterlon J(.. (lassificatirn and dctliniltoin o pro(tc'in-cloric nmalnlutritioni. BJI4J 1972:iii:566-9. 5 Siith R. Lessons t'rorim Atiicric-a; rescarch in the prisuiis can bring peace. B3117

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Plasma oxalate was measured on two occasions in 18 patients with end-stage renal failure on regular haemodialysis treatment: once while on a routine dose of vitamin C (100 mg/day) and subsequently after 2 weeks administration of a larger dose of vitamin C (500 mg/day). Pre- and post-dialysis concentrations were all markedly increased, reflecting the reduced glomerular filtration rate of end-stage renal failure. Both pre- and post-dialysis oxalate increased significantly following the increase in ascorbate dose but there was no significant correlation between plasma oxalate and ascorbate results. Considerations governing dosage of vitamin C in patients with chronic renal failure are discussed.

dCMP deaminase was partially purified from BHK-21/C13 cells grown in culture. The molecular weight of the enzyme was estimated by gel filtration and gradient centrifugation to be 130000 and 115000 respectively. The enzyme had a pH optimum of 8.4. Its activity versus substrate concentration curve was sigmoid, the substrate concentration at half-maximal velocity being 4.4mm. dCTP activated the deaminase maximally at 40mum, gave a hyperbolic curve for activity versus dCMP concentration and a K(m) value for dCMP of 0.91mm. dCTP activation required the presence of Mg(2+) or Mn(2+) ions. dTTP inhibited the deaminase maximally at 15mum; the inhibition required the presence of Mg(2+) or Mn(2+) ions. The enzyme was very heat-labile but could be markedly stabilized by dCTP at 0.125mm and ethylene glycol at 20% (v/v).

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