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PICTURES IN CLINICAL MEDICINE
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Medullary Nephrocalcinosis in a Furosemide Abuser Nobutaka Hirooka, Mai Tahara and Koichi Takebayashi Key words: nephrocalcinosis, furosemide abuse
(Intern Med 56: 233, 2017) (DOI: 10.2169/internalmedicine.56.7704)
Picture 1.
Picture 2.
A 31-year-old woman with a long history of furosemide abuse presented with abdominal pain. She had been using furosemide (>200 mg per day) for at least the last 15 years. She initially used furosemide to maintain her urinary volume and later for weight loss. Her abdominal pain was caused by paralytic ileus due to hypokalemia (2.1 mEq/L). Although abdominal and pelvic CT revealed no intestinal obstruction, bilateral nephrocalcinosis was observed (Picture 1, 2). The pattern of nephrocalcinosis was diffuse throughout the medullary pyramids. Her estmated glomerular filtration rate (eGFR) was normal (119.4 mL/min./1.73 m2). Gout, hyper-parathyroidism and other etiologies may cause nephrocalcinosis (1); however, there was no clinical evidence of these conditions. No hypercalciuria was observed. Although the risk of developing nephrocalcinosis is higher in premature infants, it can be caused by the longterm abuse of furosemide in adults (2). She was discharged
from hospital after undergoing medical treatment for ileus and hypokalemia. The authors state that they have no Conflict of Interest (COI).
References 1. Kim Y, Kim B, Kim M, et al. Medullary nephrocalcinosis associated with long-term furosemide abuse in adults. Nephrol Dial Transplant 16: 2303-2309, 2001. 2. Jacinto JS, Modanlou HD, Crade M, Strauss AA, Bosu SK. Renal calcification incidence in very low birth weight infants. Pediatrics 81: 31-35, 1988. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
KKR Mishuku Hospital, Department of General Medicine, Japan Received for publication May 12, 2016; Accepted for publication May 17, 2016 Correspondence to Dr. Nobutaka Hirooka, [email protected] Ⓒ 2017 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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PICTURES IN CLINICAL MEDICINE
□
Medullary Nephrocalcinosis in a Furosemide Abuser Nobutaka Hirooka, Mai Tahara and Koichi Takebayashi Key words: nephrocalcinosis, furosemide abuse
(Intern Med 56: 233, 2017) (DOI: 10.2169/internalmedicine.56.7704)
Picture 1.
Picture 2.
A 31-year-old woman with a long history of furosemide abuse presented with abdominal pain. She had been using furosemide (>200 mg per day) for at least the last 15 years. She initially used furosemide to maintain her urinary volume and later for weight loss. Her abdominal pain was caused by paralytic ileus due to hypokalemia (2.1 mEq/L). Although abdominal and pelvic CT revealed no intestinal obstruction, bilateral nephrocalcinosis was observed (Picture 1, 2). The pattern of nephrocalcinosis was diffuse throughout the medullary pyramids. Her estmated glomerular filtration rate (eGFR) was normal (119.4 mL/min./1.73 m2). Gout, hyper-parathyroidism and other etiologies may cause nephrocalcinosis (1); however, there was no clinical evidence of these conditions. No hypercalciuria was observed. Although the risk of developing nephrocalcinosis is higher in premature infants, it can be caused by the longterm abuse of furosemide in adults (2). She was discharged
from hospital after undergoing medical treatment for ileus and hypokalemia. The authors state that they have no Conflict of Interest (COI).
References 1. Kim Y, Kim B, Kim M, et al. Medullary nephrocalcinosis associated with long-term furosemide abuse in adults. Nephrol Dial Transplant 16: 2303-2309, 2001. 2. Jacinto JS, Modanlou HD, Crade M, Strauss AA, Bosu SK. Renal calcification incidence in very low birth weight infants. Pediatrics 81: 31-35, 1988. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).
KKR Mishuku Hospital, Department of General Medicine, Japan Received for publication May 12, 2016; Accepted for publication May 17, 2016 Correspondence to Dr. Nobutaka Hirooka, [email protected] Ⓒ 2017 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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