RESUMO
INTRODUCTION: Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications. CASE REPORT: We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure. REMARKS: Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure.
INTRODUCCION: La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido, que se presenta en un 15 a 57% de los casos. En cambio la litiasis renal es extremadamente infrecuente con muy pocas publicaciones al respecto. CASO CLINICO: Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidronefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis. COMENTARIOS: La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento.
Assuntos
Antibacterianos/efeitos adversos , Ceftriaxona/efeitos adversos , Cálculos Renais/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Antibacterianos/administração & dosagem , Apendicite/tratamento farmacológico , Ceftriaxona/administração & dosagem , Criança , Humanos , Cálculos Renais/diagnóstico , Masculino , Pancreatite/diagnóstico , Pancreatite/etiologiaRESUMO
BACKGROUND: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. METHODS: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. RESULTS: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. CONCLUSIONS: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.
Assuntos
Gota/complicações , Cálculos Renais/epidemiologia , Adulto , Doenças Assintomáticas/epidemiologia , Benzobromarona/uso terapêutico , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diuréticos/uso terapêutico , Dislipidemias/tratamento farmacológico , Feminino , Gota/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Cálculos Renais/induzido quimicamente , Cálculos Renais/química , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Citrato de Potássio/uso terapêutico , Prevalência , Fatores Sexuais , Ultrassonografia , Uricosúricos/uso terapêuticoRESUMO
PURPOSE: To investigate the anti-urolithiatic effect of cow urine ark (medicinal distilled cow urine) on ethylene glycol (EG) induced renal calculi. MATERIALS AND METHODS: 36 male Wistar rats were randomly divided into 6 equal groups. Group I animals served as vehicle control and received distilled water for 28 days. Group II to VI animals received 1% v/v EG in distilled water for 28 days. Group II served as EG control. Group III and IV (preventive groups) received cow urine ark orally for 28 days in doses of 1 mL/kg and 2 mL/kg, respectively. Group V and VI (treatment groups) received 1 mL/kg and 2 mL/kg cow urine ark orally, respectively from 15th to 28th days. 24-hour urine samples were collected on day 0 and 28. Urine volume and oxalate levels were measured. On day 28, blood was collected for biochemical parameters. Animals were sacrificed and kidneys were harvested, weighed and histopathologically evaluated for calcium oxalate (CaOx) crystals. To calculate the percentage of inhibition of mineralization, simultaneous flow static in-vitro model was used. RESULTS: EG significantly increased urine oxalate, serum creatinine, blood urea level; kidney weight and CaOx deposits. Provision of cow urine ark resulted in significantly lower levels of urine oxalate, serum creatinine, blood urea and CaOx depositions as compared to Group II. (p value < 0.05) It also significantly restored kidney weight. (p value < 0.05) Cow urine ark inhibited 40% and 35% crystallization of CaOx and calcium phosphate, respectively. CONCLUSION: Cow urine ark is effective in prevention and treatment of EG induced urolithiasis in Wistar rats.
Assuntos
Cálculos Renais/tratamento farmacológico , Urina/química , Animais , Bovinos , Creatinina/análise , Etilenoglicol , Cálculos Renais/induzido quimicamente , Cálculos Renais/patologia , Masculino , Tamanho do Órgão , Distribuição Aleatória , Ratos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Ureia/sangueRESUMO
Purpose To investigate the anti-urolithiatic effect of cow urine ark (medicinal distilled cow urine) on ethylene glycol (EG) induced renal calculi. Materials and Methods 36 male Wistar rats were randomly divided into 6 equal groups. Group I animals served as vehicle control and received distilled water for 28 days. Group II to VI animals received 1% v/v EG in distilled water for 28 days. Group II served as EG control. Group III and IV (preventive groups) received cow urine ark orally for 28 days in doses of 1 mL/kg and 2 mL/kg, respectively. Group V and VI (treatment groups) received 1 mL/kg and 2 mL/kg cow urine ark orally, respectively from 15th to 28th days. 24-hour urine samples were collected on day 0 and 28. Urine volume and oxalate levels were measured. On day 28, blood was collected for biochemical parameters. Animals were sacrificed and kidneys were harvested, weighed and histopathologically evaluated for calcium oxalate (CaOx) crystals. To calculate the percentage of inhibition of mineralization, simultaneous flow static in-vitro model was used. Results EG significantly increased urine oxalate, serum creatinine, blood urea level; kidney weight and CaOx deposits. Provision of cow urine ark resulted in significantly lower levels of urine oxalate, serum creatinine, blood urea and CaOx depositions as compared to Group II. (p value < 0.05) It also significantly restored kidney weight. (p value < 0.05) Cow urine ark inhibited 40% and 35% crystallization of CaOx and calcium phosphate, respectively. Conclusion Cow urine ark is effective in prevention and treatment of EG induced urolithiasis in Wistar rats. .
Assuntos
Animais , Bovinos , Masculino , Ratos , Cálculos Renais/tratamento farmacológico , Urina/química , Creatinina/análise , Etilenoglicol , Cálculos Renais/induzido quimicamente , Cálculos Renais/patologia , Tamanho do Órgão , Distribuição Aleatória , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Ureia/sangueRESUMO
Antiepileptic drugs can cause some adverse effects ranging from mild to acute and serious ones. The inducing properties of some of them may result in vitamin D, vitamin K and estrogens catabolism and thus risk of fractures or efflux transport overexpression at the blood brain barrier and consequently lack of effect at the action site. Some are responsible for the formation of reactive metabolites, such as arene oxides or atropaldehyde intermediates, in skin, liver and other organs, causing hypersensitivity reactions or can enhance a commonly minor metabolic pathway increasing the formation of toxic metabolites. Drug-induced myopia and other visual problems have also been described with the use of antiepileptic agents. A pharmacological insight of the possible concentration-dependent mechanism involved in these reactions is given in this review and in some cases some preventive measures to revert them.
Assuntos
Anticonvulsivantes/efeitos adversos , Animais , Osso e Ossos/metabolismo , Relação Dose-Resposta a Droga , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Humanos , Hiperamonemia/induzido quimicamente , Cálculos Renais/induzido quimicamente , Campos Visuais/efeitos dos fármacosRESUMO
PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as â³harad â³ which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84 % at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.
Assuntos
Oxalato de Cálcio/síntese química , Cálculos Renais/induzido quimicamente , Fitoterapia , Extratos Vegetais/farmacologia , Terminalia/química , Análise de Variância , Sobrevivência Celular , Citoproteção , Relação Dose-Resposta a Droga , Células Epiteliais/efeitos dos fármacos , Rim/citologia , Cálculos Renais/tratamento farmacológico , Modelos Biológicos , Extratos Vegetais/uso terapêuticoRESUMO
PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as "harad" which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84% at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.
Assuntos
Oxalato de Cálcio/síntese química , Cálculos Renais/induzido quimicamente , Fitoterapia , Extratos Vegetais/farmacologia , Terminalia/química , Análise de Variância , Sobrevivência Celular , Citoproteção , Relação Dose-Resposta a Droga , Células Epiteliais/efeitos dos fármacos , Cálculos Renais/tratamento farmacológico , Rim/citologia , Modelos Biológicos , Extratos Vegetais/uso terapêuticoRESUMO
PURPOSE: To evaluate the prophylactic potential of herbal decoction from Rubus idaeus, a medicinal plant widely used in the Middle East to treat kidney stones, by assessing the effect of administration in experimentally induced calcium oxalate (CaOx) nephrolithiasis in mice. MATERIALS AND METHODS: This study was based on administration of glyoxylate and/or herbal treatments simultaneously for 12 days, followed by histological and biochemical tests. Group I was used as a negative control. Group II was only given daily intra-abdominal injection of glyoxylate (80 mg/Kg). Group III and IV were given 100 mg/kg/day and 200 mg/kg/day of aqueous extract of R. idaeus by gavage, respectively in addition to glyoxylate injection. To examine the effect of anti-oxidants on hyperoxaluria-induced changes in kidney, the enzymatic and non-enzymatic anti-oxidant levels were assessed. RESULTS: Significant reductions were obtained in the urinary oxalate, calcium and phosphorus values in the herbal-treated groups relative to untreated animals while creatinine excretion increased. Serum oxalate, calcium and creatinine were significantly reduced, while phosphorus was not significantly changed. Kidney content of calcium was higher in the untreated group. Mice in treated groups at 12 days had significantly more superoxide dismutase, catalase, glutathione reductase (GSH) and G6PD activities than the untreated group. Hyperoxaluria-induced generation of malondialdehyde (MDA) and protein carbonyls was significantly prevented in the treated groups. R. idaeus had a significantly high content of vitamin E in the herbal treated groups. The histology showed more CaOx deposition in the kidneys of untreated animals. CONCLUSION: Rubus idaeus has an impressive prophylactic effect on CaOx stones in nephrolithic mice. There is a possible role of lipid peroxidation in CaOx stone formation which may has a relationship with the major risk factors in urine including oxalate, calcium, phosphorus and MDA. Further experimental studies are required to elucidate the chemical constituents of the active ingredients of this interesting plant.
Assuntos
Glioxilatos/uso terapêutico , Cálculos Renais/prevenção & controle , Extratos Vegetais/uso terapêutico , Rosaceae/química , Animais , Oxalato de Cálcio , Cálculos Renais/induzido quimicamente , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Fitoterapia/métodosRESUMO
PURPOSE: To evaluate the prophylactic potential of herbal decoction from Rubus idaeus, a medicinal plant widely used in the Middle East to treat kidney stones, by assessing the effect of administration in experimentally induced calcium oxalate (CaOx) nephrolithiasis in mice. MATERIALS AND METHODS: This study was based on administration of glyoxylate and/or herbal treatments simultaneously for 12 days, followed by histological and biochemical tests. Group I was used as a negative control. Group II was only given daily intra-abdominal injection of glyoxylate (80 mg/Kg). Group III and IV were given 100 mg/kg/day and 200 mg/kg/day of aqueous extract of R. idaeus by gavage, respectively in addition to glyoxylate injection. To examine the effect of anti-oxidants on hyperoxaluria-induced changes in kidney, the enzymatic and non-enzymatic anti-oxidant levels were assessed. RESULTS: Significant reductions were obtained in the urinary oxalate, calcium and phosphorus values in the herbal-treated groups relative to untreated animals while creatinine excretion increased. Serum oxalate, calcium and creatinine were significantly reduced, while phosphorus was not significantly changed. Kidney content of calcium was higher in the untreated group. Mice in treated groups at 12 days had significantly more superoxide dismutase, catalase, glutathione reductase (GSH) and G6PD activities than the untreated group. Hyperoxaluria-induced generation of malondialdehyde (MDA) and protein carbonyls was significantly prevented in the treated groups. R. idaeus had a significantly high content of vitamin E in the herbal treated groups. The histology showed more CaOx deposition in the kidneys of untreated animals. CONCLUSION: Rubus idaeus has an impressive prophylactic effect on CaOx stones in nephrolithic mice. There is a possible role of lipid peroxidation in CaOx stone formation which may has a relationship with the major risk factors in urine including oxalate, calcium, phosphorus and MDA. Further experimental studies are required to elucidate the chemical constituents of the active ingredients of this interesting plant.
Assuntos
Animais , Masculino , Camundongos , Glioxilatos/uso terapêutico , Cálculos Renais/prevenção & controle , Extratos Vegetais/uso terapêutico , Rosaceae/química , Oxalato de Cálcio , Cálculos Renais/induzido quimicamente , Camundongos Endogâmicos BALB C , Fitoterapia/métodosRESUMO
PURPOSE: Recurrence and persistent side effects of present day treatment for urolithiasis restrict their use, so an alternate solution, using phytotherapy is being sought. The present study attempted to evaluate the antilithiatic properties of Tribulus terrestris commonly called as "gokhru" which is often used in ayurveda to treat various urinary diseases including urolithiasis. MATERIALS AND METHODS: The activity of Tribulus terrestris was investigated on nucleation and the growth of the calcium oxalate (CaOx) crystals as well as on oxalate induced cell injury of NRK 52E renal epithelial cells. RESULTS: Tribulus terrestris extract exhibited a concentration dependent inhibition of nucleation and the growth of CaOx crystals. When NRK-52E cells were injured by exposure to oxalate for 72 h, Tribulus terrestris extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: The current data suggests that Tribulus terrestris extract not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role. Our results indicate that it could be a potential candidate for phytotherapy against urolithiasis.
Assuntos
Oxalato de Cálcio/química , Células Epiteliais/efeitos dos fármacos , Túbulos Renais/efeitos dos fármacos , Extratos Vegetais/farmacologia , Tribulus/química , Urolitíase , Animais , Cristalização , Modelos Animais de Doenças , Células Epiteliais/patologia , Cálculos Renais/induzido quimicamente , Túbulos Renais/citologia , Túbulos Renais/patologia , Fitoterapia , Extratos Vegetais/uso terapêutico , Extratos Vegetais/toxicidade , Ratos , Tribulus/toxicidade , Urolitíase/prevenção & controleRESUMO
PURPOSE: Recurrence and persistent side effects of present day treatment for urolithiasis restrict their use, so an alternate solution, using phytotherapy is being sought. The present study attempted to evaluate the antilithiatic properties of Tribulus terrestris commonly called as gokhru which is often used in ayurveda to treat various urinary diseases including urolithiasis. MATERIALS AND METHODS: The activity of Tribulus terrestris was investigated on nucleation and the growth of the calcium oxalate (CaOx) crystals as well as on oxalate induced cell injury of NRK 52E renal epithelial cells. RESULTS: Tribulus terrestris extract exhibited a concentration dependent inhibition of nucleation and the growth of CaOx crystals. When NRK-52E cells were injured by exposure to oxalate for 72 h, Tribulus terrestris extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: The current data suggests that Tribulus terrestris extract not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role. Our results indicate that it could be a potential candidate for phytotherapy against urolithiasis.
Assuntos
Animais , Ratos , Oxalato de Cálcio/química , Células Epiteliais/efeitos dos fármacos , Túbulos Renais/efeitos dos fármacos , Extratos Vegetais/farmacologia , Tribulus/química , Urolitíase , Cristalização , Modelos Animais de Doenças , Células Epiteliais/patologia , Cálculos Renais/induzido quimicamente , Túbulos Renais/citologia , Túbulos Renais/patologia , Fitoterapia , Extratos Vegetais/uso terapêutico , Extratos Vegetais/toxicidade , Tribulus/toxicidade , Urolitíase/prevenção & controleRESUMO
The objective of the present study was to evaluate the role of physical exercise as well as the influence of hydration with an isotonic sports drink on renal function in male Wistar rats. Four groups were studied over a period of 42 days: 1) control (N = 9); 2) physical exercise (Exe, N = 7); 3) isotonic drink (Drink, N = 8); 4) physical exercise + isotonic drink (Exe + Drink, N = 8). Physical exercise consisted of running on a motor-driven treadmill for 1 h/day, at 20 m/min, 5 days a week. The isotonic sports drink was a commercial solution used by athletes for rehydration after physical activity, 2 ml administered by gavage twice a day. Urine cultures were performed in all animals. Twenty-four-hour urine samples were collected in metabolic cages at the beginning and at the end of the protocol period. Urinary and plasma parameters (sodium, potassium, urea, creatinine, calcium) did not differ among groups. However, an amorphous material was observed in the bladders of animals in the Exe + Drink and Drink groups. Characterization of the material by Western blot revealed the presence of Tamm-Horsfall protein and angiotensin converting enzyme. Physical exercise and the isotonic drink did not change the plasma or urinary parameters measured. However, the isotonic drink induced the formation of intravesical matrix, suggesting a potential lithogenic risk.
Assuntos
Bebidas/efeitos adversos , Soluções Isotônicas/efeitos adversos , Cálculos Renais/induzido quimicamente , Rim/fisiologia , Condicionamento Físico Animal , Soluções para Reidratação/efeitos adversos , Animais , Biomarcadores/sangue , Biomarcadores/urina , Western Blotting , Masculino , Mucoproteínas/urina , Ratos , Ratos Wistar , Fatores de Risco , UromodulinaRESUMO
The objective of the present study was to evaluate the role of physical exercise as well as the influence of hydration with an isotonic sports drink on renal function in male Wistar rats. Four groups were studied over a period of 42 days: 1) control (N = 9); 2) physical exercise (Exe, N = 7); 3) isotonic drink (Drink, N = 8); 4) physical exercise + isotonic drink (Exe + Drink, N = 8). Physical exercise consisted of running on a motor-driven treadmill for 1 h/day, at 20 m/min, 5 days a week. The isotonic sports drink was a commercial solution used by athletes for rehydration after physical activity, 2 ml administered by gavage twice a day. Urine cultures were performed in all animals. Twenty-four-hour urine samples were collected in metabolic cages at the beginning and at the end of the protocol period. Urinary and plasma parameters (sodium, potassium, urea, creatinine, calcium) did not differ among groups. However, an amorphous material was observed in the bladders of animals in the Exe + Drink and Drink groups. Characterization of the material by Western blot revealed the presence of Tamm-Horsfall protein and angiotensin converting enzyme. Physical exercise and the isotonic drink did not change the plasma or urinary parameters measured. However, the isotonic drink induced the formation of intravesical matrix, suggesting a potential lithogenic risk.
Assuntos
Animais , Masculino , Ratos , Bebidas/efeitos adversos , Soluções Isotônicas/efeitos adversos , Cálculos Renais/induzido quimicamente , Rim/fisiologia , Condicionamento Físico Animal , Soluções para Reidratação/efeitos adversos , Western Blotting , Biomarcadores/sangue , Biomarcadores/urina , Mucoproteínas/urina , Ratos Wistar , Fatores de RiscoAssuntos
Diuréticos/farmacologia , Cálculos Renais/induzido quimicamente , Fitoterapia , Extratos Vegetais/farmacologia , Rubiaceae , Animais , Diuréticos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Frutas , Masculino , Extratos Vegetais/administração & dosagem , Ratos , Ratos WistarRESUMO
Nephrocalcinosis and nephrolithiasis developed in five children after furosemide therapy for congestive heart failure. In four children renal calcifications were detected by ultrasonography and in one by autopsy. Discontinuation of the loop diuretic in three children resulted in resolution of the calcifications in two of the patients. Residual renal morbidity included reduced creatinine clearance, microscopic hematuria, and hypercalciuria. The phenomenon of renal calcifications associated with furosemide treatment is more frequent than previously recognized.