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Journal of Ultrasound in Medicine, Vol 13, Issue 10 777-782, Copyright © 1994 by American Institute of Ultrasound in Medicine
Nephrocalcinosis in very low birth weight neonates: sonographic patterns, histologic characteristics, and clinical risk factors
M. E. Katz, M. G. Karlowicz, R. D. Adelman, A. L. Werner and M. J. Solhaug
Department of Radiology, Children's Hospital of The King's Daughters, Norfolk, Virginia.
Fifty infants weighing less than 1200 grams at birth who survived at least
3 weeks were enrolled in this study, of whom 14 (28%) developed sonographic
evidence of nephrocalcinosis by 9 weeks, despite median total furosemide
dose of only 2 mg/kg. Risk factors for development of neonatal
nephrocalcinosis were white race (P < 0.01) and positive family history
of kidney stones (P < 0.001). Sonography demonstrated echogenic foci
measuring 2 to 9 mm near the papillary tips in most infants with
nephrocalcinosis even though the kidneys apparently had not progressed
through the stages of diffuse medullary echogenicity that Patriquin and
Robitaille postulated are the sonographic correlates of the
Anderson-Carr-Randall progression, a leading theory of renal calculus
formation. The presence of intratubular calcifications in the two patients
studied post mortem also is contrary to the Anderson-Carr-Randall theories
that center on interstitial calcium deposition. Although neonatal
nephrocalcinosis shares some clinical risk factors (white race and positive
family history of renal calculi) with renal calcium deposition in older
children and adults, the prevalent theories of renal calcium deposition do
not account for its sonographic or histologic manifestations.
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