Journal Article

Medullary nephrocalcinosis associated with long‐term furosemide abuse in adults

Yoon‐Goo Kim, Bohyun Kim, Mi‐Kyung Kim, Shi‐Jung Chung, Hyeok‐Jun Han, Jeong‐Ah Ryu, Yoon‐Ha Lee, Kyu‐Beck Lee, Jee Yun Lee, Wooseong Huh and Ha‐Young Oh

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 16, issue 12, pages 2303-2309
Published in print December 2001 | ISSN: 0931-0509
Published online December 2001 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/16.12.2303
Medullary nephrocalcinosis associated with long‐term furosemide abuse in adults

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Background. The use of furosemide is well recognized as a predisposing factor of nephrocalcinosis in infants. Although furosemide is widely used for various medical conditions in adults, its association with nephrocalcinosis in adults is not well established.

Methods. We studied 18 consecutive adult patients (male:female ratio 1:17, age range 21–59 years) who habitually took furosemide to control weight or oedema for long periods of time (range 3–25 years). The daily dose of continuous intake of furosemide ranged from 40 to 2800 mg. Nephrocalcinosis was evaluated using renal ultrasonography (US), computed tomography (CT), or kidney biopsies.

Results. Renal US and CT revealed bilateral nephrocalcinosis of the medullary pyramids in 15 (83.3%) out of 18 patients. The duration of furosemide abuse was similar between nephrocalcinosis positive (NC(+)) and nephrocalcinosis negative (NC(−)) groups. The daily dose of furosemide was nearly 10 times higher in the NC(+) group (range 120–2800 mg, mean 538 mg) than the NC(−) group (range 40–80 mg, mean 67 mg). All patients showed variable degrees of renal insufficiency and there was no difference in creatinine clearance between the NC(+) and NC(−) groups (P>0.05). Kidney biopsies performed in three patients showed focal tubulo‐interstitial fibrosis and atrophy and calcifications were observed in outer medullary tubulo‐interstitium.

Conclusions. Long‐term furosemide abuse can cause medullary nephrocalcinosis in adults, and the risk of developing of nephrocalcinosis seems to be correlated with the daily dose of furosemide. We suggest that long‐term furosemide abuse should be suspected in adult patients when medullary nephrocalcinosis is incidentally detected by US or CT.

Keywords: adult; computed tomography; furosemide; nephrocalcinosis; ultrasonography

Journal Article.  3487 words.  Illustrated.

Subjects: Nephrology

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