NON-FUROSEMIDE-RELATED RENAL CALCIFICATIONS IN PREMATURE-INFANTS WITHBRONCHOPULMONARY DYSPLASIA

Renal calcification is a known complication of long-term furosemide th erapy in infants with bronchopulmonary dysplasia (BPD). In a prospecti ve study the clinical course and long-term renal sequelae of renal cal cifications of 19 consecutive premature neonates (birthweight < 1250 g ) with bronchopulmonary dysplasia who did not receive furosemide were examined. Infants were divided into two different groups on the basis of ultrasound evidence of renal calcifications (RC group) or absence o f renal calcifications (NRC group). Serial examinations, performed at the age of 1, 2, 3, 6, 9 and 12 months, showed that 12 infants at the mean age of 68.5 +/- 12.8 days of life had renal calcifications (63%), and 3 of them had nephrolithiasis; 8 had bilateral renal calcificatio ns. Among the 9 survivors, 2 had chronic renal calcifications at the a ge of 9 months; however, all normalized at the age of 12 months. Twelv e infants received hydrochlorothiazide and spironolactone (63%), 17 ha d prolonged courses of xanthines and dexamethasone (89.5%), while furo semide was not part of the routine pharmacological administration. Sta tistical analysis showed that birthweight, gestational age, Apgar scor e and length of parenteral nutrition were comparable in the RC and NRC group infants. Mean serum creatinine, creatinine clearance, fractiona l sodium excretion and urinary calcium excretion values during the 12- month study period were comparable in the RC and NRC groups. Mechanica l ventilation and hospital stay length were instead associated with re nal calcification occurrence. The strongest indicator of renal calcifi cation risk for this high-risk population is the severity of the unres olved acute lung disease, where different facets of respiratory manage ment, other than the addition of furosemide, represent sufficient stim uli and renal injury to potentiate stone formation.