Hazza Issa A, Ghandour Manahil S, Almardini Reham I, Haddad Rana E, Salaita Ghazi M
Pediatric Department, Queen Rania Abdulla Children Hospital, Amman, Jordan.
Saudi J Kidney Dis Transpl. 2014 Jul;25(4):849-53. doi: 10.4103/1319-2442.135178.
Although hypercalcemia and hypercalciuria are known to occur in breast-fed pre-term infants, to the best of our knowledge, it has never been reported in a term baby previously. We report a term male baby who was followed-up during pregnancy for having bright kidneys, but a follow-up renal ultrasound (US) after birth had revealed normal scan. Laboratory investigations revealed normal serum calcium (Ca), phosphorous (PO₄) and alkaline phosphatase (ALP). The baby was being fed by breast milk. Follow-up US two months later showed early nephrocalcinosis along with hypercalcemia and hypercalciuria; by the age of three months, nephrocalcinosis was more extensive and the serum Ca level was more than 12 mg/L with hypercalciuria. Parathyroid hormone (PTH), phosphorous (PO₄), ALP and thyroid function tests were all normal. Antenatal history revealed a hypothyroid mother who was maintained on L-thyroxin, calcium and vitamin D supplement during pregnancy. Her blood tests showed normal serum Ca, low PO₄ and elevated PTH. The baby was diagnosed to have hypercalciuria and hypercalcemia secondary to maternal hypophosphatemia (maternal vitamin D deficiency). Breast feeding was stopped and the baby was started on formula, whereby he showed remarkable improvement both for his blood chemistry as well as his hypercalciuria.
虽然已知母乳喂养的早产儿会出现高钙血症和高钙尿症，但据我们所知，此前足月婴儿中从未有过相关报道。我们报告了一名足月男婴，其在孕期因肾脏显影明亮而接受随访，出生后肾脏超声（US）检查显示扫描结果正常。实验室检查显示血清钙（Ca）、磷（PO₄）和碱性磷酸酶（ALP）均正常。该婴儿一直采用母乳喂养。两个月后的随访超声显示早期肾钙质沉着症，同时伴有高钙血症和高钙尿症；到三个月大时，肾钙质沉着症更为广泛，血清钙水平超过12mg/L且伴有高钙尿症。甲状旁腺激素（PTH）、磷（PO₄）、ALP和甲状腺功能检查均正常。产前病史显示，母亲患有甲状腺功能减退症，孕期一直服用左甲状腺素、钙剂和维生素D补充剂。她的血液检查显示血清钙正常、磷低且PTH升高。该婴儿被诊断为继发于母亲低磷血症（母亲维生素D缺乏）的高钙尿症和高钙血症。停止母乳喂养，开始用配方奶喂养，此后婴儿的血液生化指标和高钙尿症均有显著改善。
