Resolution of medullary nephrocalcinosis in children with metabolic bone disorders

Abstract

Ultrasonographic resolution of nephrocalcinosis (NC) has been reported in children with furosemide-induced NC, but not in other entities. We report the cases of four children with metabolic bone disease, two with hypophosphatasia and two with X-linked hypophosphatemic rickets, in whom we observed resolution of renal calcifications. At the time of ultrasonographic resolution of NC, 3 of the patients were on anticalciuric diuretics, and all 4 had normal urinalysis, serum creatinine and electrolyte profiles, as well as estimated creatinine clearance. In 3 of the children, evidence of mild tubular dysfunction was found. It thus seems that in some children with bone and mineral disorders who develop NC, ultrasonographic resolution of the renal calcifications can be seen; however, mild tubular dysfunction may remain and require follow-up. Further studies are suggested to explore the possible role of anticalciuric diuretics in promoting the resolution of NC.

Three-Year Growth Hormone Treatment in Short Children with X-Linked Hypophosphatemic Rickets: Effects on Linear Growth and Body Disproportion

“…GH therapy was well tolerated and not associated with progression of leg bowing, hypercalciuria, or nephrocalcinosis. Instead, ultrasonographic examination revealed resolution of nephrocalcinosis in several of our patients with and without GH treatment and at a rate similar to previous observations in non-GH-treated pediatric XLH patients (39).…”

Nephrocalcinosis and urolithiasis in children

“…27 Distinguishing both entities may be problematic even with newer imaging techniques, and hence endoscopic inspection of the papillae may be the only option to truly verify the accurate diagnosis of NC. 27 It was reported that NC may disappear over time; 28,29 however, this was only determined by repeated ultrasound examinations. Risk factors for UL/NC include genetic abnormalities in epithelial transport, metabolic disturbances, anatomical abnormalities, and urinary tract infections in the majority of pediatric patients.…”

Acute Vitamin D Toxicity in an Infant

“…There are some reports of reversibility especially in cases with furosemide-induced nephrocalcinosis and nephrocalcinosis occurring after treatment in X-linked hypophosphatemic rickets (12, 13). Resolution of vitamin D induced nephrocalcinosis has not been reported in the literature.…”