Etiologies And Short-Term Outcome of Medullary Nephrocalcinosis in Children
Journal of Pediatric Nephrology,
Vol. 13 No. 1 (2025),
12 Ordibehesht 2026
https://doi.org/10.22037/jpn.v13i1.52033
Abstract
Background and Aim:
Hypercalciuria, hyperoxaluria, hereditary renal tubular disorders, and drug intoxication are the etiologies of nephrocalcinosis in children. This study was conducted to determine the etiologies and short-outcome (resolution rate) of nephrocalcinosis.
Methods
Children aged ≤18 years old with nephrocalcinosis who were referred to the nephrology clinic of an academic center from March 2003 to 2019 were considered for the study. Measurement of serum creatinine, sodium, potassium, calcium, phosphorous, blood gas analysis and random or 24-hour urine samplings for creatinine and calcium levels were the inclusion criteria.
Results
Of 49 cases, 43 met the inclusion criteria. They included 21 girls (48.8%). The median age of patients was two years (10 months - eight years). They followed up for a median of 9 months (1-34 months). Medullary nephrocalcinosis grades III, II, and I were reported in nine (20.9%), one (2.3%), and 33(76.8%) patients, respectively. The etiologies of nephrocalcinosis were unknown (41.8%), idiopathic hypercalciuria (34.9%), idiopathic hyperoxaluria (18.6%), distal RTA (9.3%). Hypophosphatemic rickets, Dent disease, and Bartter syndrome were found each in one patient. Seven cases (16.3%) had mixed abnormalities. Resolution of nephrocalcinosis at a follow-up of ≥ six months was uncommon (19.2%). The median weight-for-age Z score at presentation was -0.8 which reached to -0.36 at the last follow-up (P =0.011).
Conclusion
We found idiopathic hypercalciuria and idiopathic hyperoxaluria as the most common identified etiologies, respectively. Hereditary tubular disorders accounted for 16.3% of the cases. Resolution of nephrocalcinosis was uncommon even in nephrocalcinosis grades I, at a follow-up of ≥ six months.
Keywords: Medullary nephrocalcinosis; Hypercalciuria; Hyperoxaluria; Distal RTA; Outcome
- : Medullary nephrocalcinosis; Hypercalciuria; Hyperoxaluria; Distal RTA; Outcome
How to Cite
References
1. Wrong O: Nephrocalcinosis. In: Davison AM, Cameron JS, Grünfeld J: Oxford Textbook of Clinical Nephrology. Oxford University Press. 2005. P.1375
2. Sayer JA, Carr G, Simmons NL. Nephrocalcinosis: molecular insights into calcium precipitation within the kidney”. Clin Sci (Lond) 2004; 106(6):549-61.
3. Arons WL, Christensen WR, Sosman MC. Nephrocalcinosis visible by x-ray associated with chronic glomerulonephritis”. Ann. Intern. Med 1995; 42(2):260-82.
4. Schepens D, Verswijvel G, Kuypers D, Vanrenterghem Y. Images in nephrology. Renal cortical nephrocalcinosis. Nephrol. Dial. Transplant 2000;15(7):1080-2.
5. Diallo O, Janssens F, Hall M, Avni EF. Type 1 primary hyperoxaluria in pediatric patients: renal sonographic patterns”. AJR.Am. J Roentgenol 2004; 183(6):1767-70.
6. Harrison RB, Vaughan ED Jr. Diffuse cortical calcification in rejected renal transplants. Radiology 1978; 126(3):635-6.
7. Evan AP, Lingeman JE, Coe FL, et al. Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle. J Clin. Invest 2003; 111(5):607-16.
8. Dsouza E. Etiological profile of nephrocalcinosis among children a cross-sectional study”. Journal of Coastal. Life. Medicine 2023; 11(1):2375–2379.
9. Joung J, Cho H. Etiology and prognosis of nephrocalcinosis according to gestational age in Korean children.BMC. Pediatr 2023; 23:451.
10. Vaidya SR, Yarrarapu SNS, Aeddula NR. Nephrocalcinosis”. in: Stat Pearls [Internet]. Stat Pearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537205/Nephrocalcinosis. Accessed Jan 2025.
11. Ramya K, Krishnamurthy S, Sivamuruk P . Etiological profile of nephrocalcinosis in children from Southern India. Indian. Pediatr 2020; 57(5):415-419.
12. Bitzan M, Goodyer PR. Hypophosphatemic Rickets. Pediatr. Clin. North Am 2019; 66(1):179-207.
13. Piccoli GB, De Pascale A, Randone O, et al. Revisiting nephrocalcinosis: A single-centre perspective”. A northern Italian experience. Nephrology (Carlton) 2016; 21(2):97-107.
14. Mittal K, Anandpara K, Dey AK, et al. An association of chronic hyperaldosteronism with medullary nephrocalcinosis. Pl. Radiol 2015; 80:417-24.
15. Quinn CT, Johnson VL, Kim HY, et al. Renal dysfunction in patients with thalassemia”. Br .J .Haematol 2011; 153(1):111-7.
16. Habbig S, hard Beck BB, Hoppe B. Nephrocalcinosis and urolithiasis in children Kidney. International 2011; 80(12):1278-91
17. Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr. Nephrol 2010; 25:403.
18. Woo HA, Lee H, Choi YH, et al. Clinical outcomes of nephrocalcinosis in preschool-age children: association between nephrocalcinosis improvement and long-term kidney function. Front . Pediatr 2023; 11:1214704.
19. Rönnefarth G, Misselwitz J. Nephrocalcinosis in children. a retrospective survey. Members of the Arbeitsgemeinschaft für pädiatrische Nephrologie. Pediatr.Nephrol 2000; 14(10-11):1016-21.
20. Riordan L, Schaer M. Renal tubular acidosis. Compend. Contin. Educ Vet 2005; 27(7):513‐529.
21. Bokhari SRA, Zulfiqar H, Mansur A. Bartter Syndrome. In: Stat Pearls [Internet].https://www. ncbi.nlm . nih.gov / books/NBK442019/Bartter Syndrome. Accessed September 4, 2023.
22. Jagtap VS, Sarathi V, Lila AR, Bandgar T, Menon P, Shah NS . Hypophosphatemic rickets. Indian Journal of Endocrinology and Metabolism 2012;16(2): 177-182.
23. Edvardsson V. Urolithiasis in children. In: Avner ED, Harmon WE, Niaduet P, Yoshikawa N, Emma Goldstein SL. Pediatric nephrology .7th ed. Springer. 2016. P.1821-85
24. Hoppe B. Nephrocalcinosis in childhood. Journal of Pediatric Biochemistry 2014;4(2):111-118.
25. Mantan M, Bagga A, Virdi VS, Menon S, Hari P. Etiology of nephrocalcinosis in northern Indian children. Pediatr. Nephrol 2007; 22(6): 829-33
26. Jellouli M, Karoui W, Abidi K, et al. Nephrocalcinosis in Tunisian children.Tunis. Med 2016; 94(4):167-170.
27. Ammenti A, Pelizzoni A, Cecconi M, Molinari PP, Montini G. Nephrocalcinosis in children: a retrospective multicenter study. Acta. Paediatr 2009; 98(10):1628-31.
28. van Woerden CS, Groothoff JW, Wanders RJ, Davin JC, Wijburg FA.2003.” Primary hyperoxaluria type 1 in The Netherlands: prevalence and outcome”. Nephrol Dial Transplant 18(2): 273-9. https://doi.org/10.1093/ndt/18.2.273.
29. Mortazavi F, Ghergherehchi R.2012. “Causes of nephrocalcinosis in children referring to children's hospital of Tabriz”. Stud Med Sci 23 (2):172-177.
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