Korean J Nephrol.  2001 Nov;20(6):1014-1020.

Medullary Nephrocalcinosis Associated with Long-term Furosemide Abuse in Adults

• Choi SC
• Kim YG
• Do JH
• Kim JA
• Han HJ
• Lee HH
• Yoon SJ
• Lee YK
• Huh W
• Kim DJ
• Oh HY
• Kim B
• Kim MK

Abstract

BACKGROUND: The use of furosemide is well recognized as a predisposing factor to nephrocalcinosis (NC) in infants. Although furosemide is widely used for various clinical settings in adults, the association of furosemide use and nephrocalcinosis in adults is not well established.
METHODS
We studied 18 consecutive adult patients(male : female=1 : 17, age range 21-59 years) who took furosemide habitually to control their weights or edema for a long-term period(range 3-25 years). NC was evaluated using renal ultrasonography(US), computed tomography(CT) and/or kidney biopsies. Patients were categorized into NC(+) and NC(-) groups while the difference in clinical features were investigated.
RESULTS
Renal US and CT revealed nephrocalcinosis in the bilateral medullary pyramids in 15(83.3 %) out of 18 patients. The duration of furosemide abuse was not different between NC(+) and NC(-) groups(10.1+/-1.7 years vs. 15.3+/-0.9, p>0.05). The daily dose of furosemide was higher in NC(+) group than the NC(-) group(538+/-174 vs. 67+/-13 mg/day, p<0.01), however. All patients showed a variable degree of renal insufficiency and there was no difference in creatinine clearance between two groups(p>0.05). The kidney biopsies performed in three patients showed focal tubulointerstitial fibrosis and atrophy and calcifications were observed at outer medullary tubulointerstitium.
CONCLUSION
Long-term furosemide abuse could cause medullary nephrocalcinosis in adults and the risk of developing of nephrocalcinosis is 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 and/or CT.

Keyword

Adult; Computed tomography; Furosemide; Nephrocalcinosis; Ultrasonography

MeSH Terms

Adult*
Atrophy
Biopsy
Causality
Creatinine
Edema
Fibrosis
Furosemide*
Humans
Infant
Kidney
Nephrocalcinosis*
Renal Insufficiency
Ultrasonography
Weights and Measures
Creatinine
Furosemide