Ulinski Tim, Sabot Jean-François, Bourlon Isabelle, Cochat Pierre
Department of Paediatrics, Hôpital Edouard Herriot, 3, place d'Arsonval, 69437 Lyon cedex 03, France.
Eur J Pediatr. 2004 Apr;163(4-5):239-40. doi: 10.1007/s00431-004-1400-6. Epub 2004 Feb 7.
Nephrocalcinosis and/or urinary calculi are rare in infants. Furosemide treatment during the neonatal period, vitamin D intoxication, hereditary diseases such as hyperoxaluria or distal tubular acidosis are among the most common aetiologies. We report the case of a 6-month-old boy with an extra-hepatic biliary duct atresia treated by the Kasai procedure and a gastro-oesophageal reflux treated with a silicate containing milk thickener (Gelopectose, 5.5% colloidal silicate) since the neonatal period. He did not present any other endogenous risk factor for urinary stone formation (normal urinary calcium/creatinine ratio; normal urinary magnesium excretion). The nephrolithiasis was discovered as the boy presented painful episodes of macroscopic haematuria. Ultrasound examination revealed bilateral nephrocalcinosis and multiple bilateral calculi without infection or urinary obstruction. Infrared spectroscopy revealed silicate as the major component suggesting silicate absorption to be responsible for the described symptoms. After replacement of the silicate-containing agent by a silicate-free milk thickener, the lesions were completely reversible as confirmed by repeated renal ultrasound examinations over a 2-month period.
Silicate-containing milk thickeners can be responsible for urinary calculi and/or nephrocalcinosis.
肾钙质沉着症和/或尿路结石在婴儿中较为罕见。新生儿期使用速尿治疗、维生素D中毒、高草酸尿症或远端肾小管酸中毒等遗传性疾病是最常见的病因。我们报告了一例6个月大的男孩，患有肝外胆管闭锁，接受了Kasai手术治疗，自新生儿期起患有胃食管反流，使用含硅酸盐的牛奶增稠剂（Gelopectose，5.5%胶体硅酸盐）进行治疗。他没有出现任何其他尿路结石形成的内源性危险因素（尿钙/肌酐比值正常；尿镁排泄正常）。当该男孩出现肉眼血尿疼痛发作时，发现了肾结石。超声检查显示双侧肾钙质沉着症和多发双侧结石，无感染或尿路梗阻。红外光谱显示硅酸盐为主要成分，提示硅酸盐吸收是导致所述症状的原因。在用不含硅酸盐的牛奶增稠剂替代含硅酸盐的制剂后，通过2个月内反复的肾脏超声检查证实病变完全可逆。
含硅酸盐的牛奶增稠剂可导致尿路结石和/或肾钙质沉着症。
