Medullary Nephrocalcinosis in a Furosemide Abuser.

A 31-year-old woman with a long history of furosemide abuse presented with abdominal pain. She had been using furosemide (>200 mg per day) for at least the last 15 years. She initially used furosemide to maintain her urinary volume and later for weight loss. Her abdominal pain was caused by paralytic ileus due to hypokalemia (2.1 mEq/L). Although abdominal and pelvic CT revealed no intestinal obstruction, bilateral nephrocalcinosis was observed (Picture 1, 2). The pattern of nephrocalcinosis was diffuse throughout the medullary pyramids. Her estmated glomerular filtration rate (eGFR) was normal (119.4 mL/min./1.73 m2). Gout, hyper-parathyroidism and other etiologies may cause nephrocalcinosis (1); however, there was no clinical evidence of these conditions. No hypercalciuria was observed. Although the risk of developing nephrocalcinosis is higher in premature infants, it can be caused by the long-term abuse of furosemide in adults (2). She was discharged from hospital after undergoing medical treatment for ileus and hypokalemia.

Picture 1.

Picture 2.