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Urinary lithogenic and inhibitory factors were studied in 27 preterm infants; 16 had total parenteral nutrition (TPN) and 11 had breastmilk with an additional glucose-sodium chloride infusion. Urines were collected for 24 hours on day 2 (period A), day 3 (B), and once between days 4 and 10 (C). Urinary calcium oxalate saturation was calculated by the computer program EQUIL 2. Renal ultrasonography was performed every second week until discharge.The calcium/creatinine ratio increased in infants on TPN (A 0 91; C 1-68 mol/mol) and was significantly higher at period C than that in infants on breastmilk/infusion (A 0 52; C 0.36 In order to understand better the underlying mechanisms and the effect, if any, of TPN on the risk of renal calcification, we studied urinary lithogenic and inhibitory substances (for example citrate) and the urinary calcium oxalate saturation in preterm infants receiving either TPN or breastmilk with an additional glucose-sodium chloride infusion. In addition, renal ultrasound examinations were performed repeatedly.Patients and methods Preterm infants <35 weeks' gestation were studied. We excluded infants who were small for date and those with renal or intestinal disease, complex malformations, or cardiac anomalies. Thirty five infants entered the study; eight patients (six on TPN and two on breastmilk/infusion) were excluded because of an incomplete urine collection. Of the remaining 27 infants 16 had TPN and 11 received breastmilk/infusion. The decision about the form of nutrition was based on clinical grounds as randomisation was not acceptable for ethical reasons. Accordingly, infants on TPN were more critically ill and had a lower mean birth weight (table 1). For infants on TPN, Vamin glucose 7% containing 50 mmoUl sodium chloride, 20 mmoVl potassium, 2-5 mmol/l calcium, and 1-5 mmol/l magnesium and Intralipid 20% (Kabi Pharmacia, Stockholm, Sweden) were used with added vitamins and trace elements. TPN was started on the second day of life with one third of the final amount. The complete intake consisted of 35 ml amino acid solution, 10 ml fat emulsion, 60 ml glucose 10%, and 20 ml glucose 50% (expressed per kg and day) and was usually reached by the seventh day. Infants receiving breastmilk had an additional glucose-sodiumchloride infusion. No infant received dexamethasone or high doses (>1-5 mg/kg/day) of frusemide. The acid-base status was determined daily and was corrected as needed to keep the base excess to ±3 mmol/l.Urines were collected in plastic bags for 24 hours on day 2 (period A), day 3 (B), and once

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Hypercalciuria and nephrocalcinosis are not uncommon in patients with Wilson’s disease but have only once been reported as the presenting sign. We diagnosed Wilson’s disease in a 17-year-old male patient 6 years after his first episode of gross hematuria and 2 years after detection of hypercalciuria and nephrocalcinosis. Therapy with penicillamine resulted only in a moderate reduction of urinary calcium excretion but oxalate excretion increased.

The purpose of this study was to determine the effect of patient positioning on sonographic renal measurements and to test if the patient position alters the three-dimensional shape of the kidneys. The maximum longitudinal renal length and transverse renal width and depth were measured in the supine and prone position in 100 children (200 kidneys). Age ranged from 6 months to 16 years (mean age 5 years). The results were compared for statistically significant differences. The maximum measured longitudinal renal length was statistically significantly larger in the supine than in the prone position (supine position, left: 8.0 cm; right: 7.7 cm; prone position, left: 7.9 cm, right: 7.6 cm; P<0.001). There was no statistically significant change in the transverse diameters (width and depth, P>0.001) and renal volume ( P>0.001) in the supine vs. prone positions. Our results show that position-induced reshaping of the kidneys is unlikely to be responsible for the discrepancy in maximum longitudinal renal measurements comparing supine with prone positions. Position-dependent changes in the degree of filling of the renal calyces and pelvis as well as errors in caliper distance measurements for the different scan depths (supine vs. prone) are more likely to be responsible for the encountered differences. Consequently, we recommend to add prone renal length measurements in addition to the supine measurements. In follow-up examinations, renal length measurements should only be compared that have been collected in the same patient position.