Should We Screen Preterm Infants for Nephrocalcinosis? An Evidence-based Decision

Shahirose S Premji; Majeeda Kamaluddeen

Disclosures

Pediatr Health. 2010;4(1):24-35. 

In This Article

Abstract and Introduction

Abstract

Nephrocalcinosis is increasingly recognized in premature infants in the neonatal intensive care unit based on ultrasound findings of increased echogenicity in medullary pyramids. Nephrolithiasis with obstruction of the urinary tract, urinary tract infection and hematuria may occur in the short-term, and renal dysfunction (e.g., glomerulus, proximal tubules and distal tubules), hypercalciuria, decreased growth of the kidney and hypertension may occur in the long-term. The primary goal of this review is to use the WHO's screening criteria to determine whether nephrocalcinosis is a suitable condition for screening. The scientific, medical, economic and ethical merit of screening premature infants for nephrocalcinosis is appraised to answer the following question, "should preterm infants be screened for nephrocalcinosis?"

Introduction

Nephrocalcinosis refers to diffuse and fine calcification (i.e., deposits of calcium crystals) within the medullary pyramids of the renal parenchyma.[1,101] The incidence of nephrocalcinosis in premature infants younger than 32 weeks of age or 1500 g bodyweight varies from 2.5%[2] to 64%.[3] The etiology of nephrocalcinosis is unknown; however, multiple factors are thought to predispose premature infants.[4–6] Although nephrocalcinosis may resolve spontaneously, there may be long-term sequelae (e.g., deterioration of renal function).[1,5,7–9] Screening programs may identify disease early, confirm diagnosis with appropriate tests and ensure timely treatment to prevent or attenuate adverse consequences.[10,11] In this review, the WHO screening criteria for disease will be used to determine whether nephrocalcinosis is a suitable condition for screening.[10] For the purpose of this review, disease is defined more broadly to include a condition, such as nephrocalcinosis, that may be accompanied by pain, renal dysfunction and distress resulting from the sequelae of the disease (e.g., hospitalization owing to signs and symptoms of renal dysfunction).

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