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Nephrolithiasis during the first 6 months of life in exclusively breastfed infants

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Abstract

Background

We investigated etiology and prognosis of infantile nephrolithiasis, including whether lithogenic and anti-lithogenic content of breast milk affects its formation.

Methods

Thirty infants with nephrolithiasis and 30 healthy infants exclusively breastfed for the first 6 months of life were included in this prospective cohort case-control study. At entry, age, sex, and timing of birth of patients and controls were recorded. All patients were diagnosed and followed up periodically using ultrasonography. All infants received oral vitamin D (400 units/day). Lithogenic (calcium, oxalate, uric acid, phosphate) and anti-lithogenic (citrate, magnesium) components of maternal milk, serum calcium, phosphate, magnesium, 25-hydroxy vitamin D and parathormone, as well as spot urine calcium, uric acid, cystine, oxalate, magnesium, citrate/creatinine ratio, and calcium/citrate ratio were compared.

Results

Mean follow-up period was 56.1 ± 6.8 months. There was no difference concerning lithogenic and anti-lithogenic content of breast milk. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels (49.1 ± 19 vs. 26.7 ± 4 ng/ml, p < 0.001) were significantly higher and parathormone level significantly lower in patients. Random urine calcium/creatinine and calcium/citrate ratios were significantly higher in patient group (0.63 ± 0.40 vs. 0.42 ± 0.10 and 0.62 ± 0.12 vs. 0.41 ± 0.25 mg/mg, respectively, p < 0.01). Three patients were lost to follow-up after the first year. At last follow-up, calculi disappeared in 25/27 remaining patients without interventions or therapy.

Conclusions

Breast milk does not have an etiologic effect in infantile nephrolithiasis. Higher serum vitamin D levels may have roles in development of lower levels of PTH and higher levels of serum and urine calcium, leading to stone formation. The prognosis for infantile stones is excellent.

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Funding

This study was supported by the Pamukkale University Research Fund (Number 2015TPF041).

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Pamukkale University School of Medicine, Mavi Bina 1 Kat, Kinikli, 20070, Denizli, Turkey

    Neslihan Yılmaz & Selçuk Yüksel

  2. Department of Physiology, Pamukkale University School of Medicine, Denizli, Turkey

    Fatih Altıntaş

  3. Department of Radiology, Istinye University, Liv Hospital, Istanbul, Turkey

    Ali Koçyiğit

Authors
  1. Neslihan Yılmaz
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  2. Selçuk Yüksel
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  3. Fatih Altıntaş
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  4. Ali Koçyiğit
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Contributions

Dr. Yılmaz conceptualized and designed the study, drafted the initial manuscript, designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.

Prof Yüksel conceptualized and designed the study, drafted the initial manuscript, designed the data collection instruments, critically reviewed the manuscript for important intellectual content, and revised the manuscript.

Dr. Altıntaş and Prof Koçyiğit designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Selçuk Yüksel.

Ethics declarations

This study was approved by the Pamukkale University Ethics Committee (IRB number 60116787–020/59251).

Conflict of interest

The authors declare that they have no conflict of interest.

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Yılmaz, N., Yüksel, S., Altıntaş, F. et al. Nephrolithiasis during the first 6 months of life in exclusively breastfed infants. Pediatr Nephrol 36, 1227–1231 (2021). https://doi.org/10.1007/s00467-020-04815-w

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  • DOI: https://doi.org/10.1007/s00467-020-04815-w

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