Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1993 Sep;69(3 Spec No):299–303. doi: 10.1136/adc.69.3_spec_no.299

Urinary saturation and nephrocalcinosis in preterm infants: effect of parenteral nutrition.

B Hoppe 1, A Hesse 1, T Neuhaus 1, S Fanconi 1, I Forster 1, N Blau 1, E Leumann 1
PMCID: PMC1029497  PMID: 8215570

Abstract

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). The oxalate/creatinine ratio was persistently higher with TPN (203 mmol/mol) than with breastmilk/infusion (98; 137). The citrate/creatinine remained constant with TPN (0.44 mol/mol), whereas it increased significantly with breastmilk/infusion (0.26; 0.49). Calcium/citrate rose considerably with TPN, but decreased with breastmilk/infusion to a significantly lower level than with TPN. The urinary calcium oxalate saturation increased with TPN (2.4; 4.5) and decreased with breastmilk/infusion (2.1; 1.5) to a significantly lower value than with TPN. Nephrocalcinosis developed in two infants on TPN. Mean daily calcium intake was similar in both groups, whereas protein, sodium, and phosphorus intake were significantly higher on TPN. It is concluded that the increase in urinary calcium oxalate saturation observed with TPN is due to the combined effect of an increased urinary calcium excretion and higher urinary oxalate/creatinine and calcium/citrate ratios. The changes observed are likely to be caused by TPN itself, which differs in several respects from breastmilk feeding.

Full text

PDF
299

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Campfield T., Braden G. Urinary oxalate excretion by very low birth weight infants receiving parenteral nutrition. Pediatrics. 1989 Nov;84(5):860–863. [PubMed] [Google Scholar]
  2. Classen A., Hesse A. Measurement of urinary oxalate: an enzymatic and an ion chromatographic method compared. J Clin Chem Clin Biochem. 1987 Feb;25(2):95–99. doi: 10.1515/cclm.1987.25.2.95. [DOI] [PubMed] [Google Scholar]
  3. Ezzedeen F., Adelman R. D., Ahlfors C. E. Renal calcification in preterm infants: pathophysiology and long-term sequelae. J Pediatr. 1988 Sep;113(3):532–539. doi: 10.1016/s0022-3476(88)80647-4. [DOI] [PubMed] [Google Scholar]
  4. Gilsanz V., Fernal W., Reid B. S., Stanley P., Ramos A. Nephrolithiasis in premature infants. Radiology. 1985 Jan;154(1):107–110. doi: 10.1148/radiology.154.1.3964925. [DOI] [PubMed] [Google Scholar]
  5. Hufnagle K. G., Khan S. N., Penn D., Cacciarelli A., Williams P. Renal calcifications: a complication of long-term furosemide therapy in preterm infants. Pediatrics. 1982 Sep;70(3):360–363. [PubMed] [Google Scholar]
  6. Jacinto J. S., Modanlou H. D., Crade M., Strauss A. A., Bosu S. K. Renal calcification incidence in very low birth weight infants. Pediatrics. 1988 Jan;81(1):31–35. [PubMed] [Google Scholar]
  7. Kamitsuka M. D., Peloquin D. Renal calcification after dexamethasone in infants with bronchopulmonary dysplasia. Lancet. 1991 Mar 9;337(8741):626–626. doi: 10.1016/0140-6736(91)91702-v. [DOI] [PubMed] [Google Scholar]
  8. Kenney I. J., Aiken C. G., Lenney W. Frusemide-induced nephrocalcinosis in very low birth weight infants. Pediatr Radiol. 1988;18(4):323–325. doi: 10.1007/BF02389002. [DOI] [PubMed] [Google Scholar]
  9. Moellering H., Gruber W. Determination of citrate with citrate lyase. Anal Biochem. 1966 Dec;17(3):369–376. doi: 10.1016/0003-2697(66)90172-2. [DOI] [PubMed] [Google Scholar]
  10. Muldowney F. P., Freaney R., Moloney M. F. Importance of dietary sodium in the hypercalciuria syndrome. Kidney Int. 1982 Sep;22(3):292–296. doi: 10.1038/ki.1982.168. [DOI] [PubMed] [Google Scholar]
  11. Murphy J. L., Mendoza S. A. Decreased urinary citrate in premature infants with lung disease. Child Nephrol Urol. 1990;10(2):76–80. [PubMed] [Google Scholar]
  12. Pak C. Y., Fuller C., Sakhaee K., Preminger G. M., Britton F. Long-term treatment of calcium nephrolithiasis with potassium citrate. J Urol. 1985 Jul;134(1):11–19. doi: 10.1016/s0022-5347(17)46962-x. [DOI] [PubMed] [Google Scholar]
  13. Parks J. H., Coe F. L. A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int. 1986 Jul;30(1):85–90. doi: 10.1038/ki.1986.155. [DOI] [PubMed] [Google Scholar]
  14. Robertson W. G., Peacock M., Heyburn P. J., Marshall D. H., Clark P. B. Risk factors in calcium stone disease of the urinary tract. Br J Urol. 1978 Dec;50(7):449–454. doi: 10.1111/j.1464-410x.1978.tb06189.x. [DOI] [PubMed] [Google Scholar]
  15. Schärer K., Manz F. Renal handling of citrate in children with various kidney disorders. Int J Pediatr Nephrol. 1985 Jan-Mar;6(1):79–88. [PubMed] [Google Scholar]
  16. Short A., Cooke R. W. The incidence of renal calcification in preterm infants. Arch Dis Child. 1991 Apr;66(4 Spec No):412–417. doi: 10.1136/adc.66.4_spec_no.412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Vanpeé M., Herin P., Zetterström R., Aperia A. Postnatal development of renal function in very low birthweight infants. Acta Paediatr Scand. 1988 Mar;77(2):191–197. doi: 10.1111/j.1651-2227.1988.tb10628.x. [DOI] [PubMed] [Google Scholar]
  18. Werness P. G., Brown C. M., Smith L. H., Finlayson B. EQUIL2: a BASIC computer program for the calculation of urinary saturation. J Urol. 1985 Dec;134(6):1242–1244. doi: 10.1016/s0022-5347(17)47703-2. [DOI] [PubMed] [Google Scholar]
  19. Woolfield N., Haslam R., Le Quesne G., Chambers H. M., Hogg R., Jureidini K. Ultrasound diagnosis of nephrocalcinosis in preterm infants. Arch Dis Child. 1988 Jan;63(1):86–88. doi: 10.1136/adc.63.1.86. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES