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Article: Diagnosis and spectrum of melamine-related renal disease: Plausible mechanism of stone formation in humans

TitleDiagnosis and spectrum of melamine-related renal disease: Plausible mechanism of stone formation in humans
Authors
KeywordsCyanuric acid
Melamine
Melamine-associated renal stone disease
Issue Date2009
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/cca
Citation
Clinica Chimica Acta, 2009, v. 402 n. 1-2, p. 150-155 How to Cite?
AbstractBackground: An epidemic of urinary stones affecting children after consumption of melamine tainted milk is unfolding. We defined clinicopathological features of the disease for diagnosis, monitoring, and treatment of this group of patients. Methods: A clinicopathological study on exposed children with ultrasonographic evidence of urolithiasis was conducted. Melamine and cyanuric acid levels in the urine were determined by mass spectrometry. Results: Disease severity varied from acute renal failure with hydronephrosis to symptomatic or asymptomatic stones with or without abnormal urinalysis. All cases were aged < 3 y with > 50% cases having predisposing urinary metabolic risk factors for urolithiasis. Most of the stones were located in the renal pelvis and measured 2.5-18 mm by ultrasonography. We found a strong correlation between renal stone size and urinary melamine concentration. For stones < 10 mm, a 10 μg/mmol creatinine increase in urinary melamine concentration is associated with approximately 1 mm increase in the size of the stone. The high degree of correlation strongly suggests that melamine is related to stone formation in humans. Using ROC analysis, we propose that patients who have a persistent melamine level above the optimal cut-off value of 7.1 μg melamine/mmol creatinine in urine might have a significant exposure of melamine-tainted products. Unlike melamine, urinary cyanuric acid is not significantly different between cases and controls. Pathophysiological findings from feeding animals with melamine and cyanuric acid may not be directly applicable to humans. Conclusion: Both melamine and urine metabolic lithogenic factors are important for the formation of melamine-related stones. Apart from aiding with case screening and confirmation, the urine melamine level might as well be an indicator of residual melamine load in the body and thus is useful for following-up and monitoring of the confirmed cases. As the stones are small and can be passed out spontaneously, follow-up of these patients with urine melamine will be a convenient tool for monitoring the melamine load of the patients. © 2008 Elsevier B.V. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/58331
ISSN
2015 Impact Factor: 2.799
2015 SCImago Journal Rankings: 1.040
ISI Accession Number ID
Funding AgencyGrant Number
Pediatric Surgery Development Fund of The University of Hong Kong
Funding Information:

This work was supported by Pediatric Surgery Development Fund of The University of Hong Kong.

References

 

DC FieldValueLanguage
dc.contributor.authorLam, CWen_HK
dc.contributor.authorLan, Len_HK
dc.contributor.authorChe, Xen_HK
dc.contributor.authorTam, Sen_HK
dc.contributor.authorWong, SSYen_HK
dc.contributor.authorChen, Yen_HK
dc.contributor.authorJin, Jen_HK
dc.contributor.authorTao, SHen_HK
dc.contributor.authorTang, XMen_HK
dc.contributor.authorYuen, KYen_HK
dc.contributor.authorTam, PKHen_HK
dc.date.accessioned2010-05-31T03:28:26Z-
dc.date.available2010-05-31T03:28:26Z-
dc.date.issued2009en_HK
dc.identifier.citationClinica Chimica Acta, 2009, v. 402 n. 1-2, p. 150-155en_HK
dc.identifier.issn0009-8981en_HK
dc.identifier.urihttp://hdl.handle.net/10722/58331-
dc.description.abstractBackground: An epidemic of urinary stones affecting children after consumption of melamine tainted milk is unfolding. We defined clinicopathological features of the disease for diagnosis, monitoring, and treatment of this group of patients. Methods: A clinicopathological study on exposed children with ultrasonographic evidence of urolithiasis was conducted. Melamine and cyanuric acid levels in the urine were determined by mass spectrometry. Results: Disease severity varied from acute renal failure with hydronephrosis to symptomatic or asymptomatic stones with or without abnormal urinalysis. All cases were aged < 3 y with > 50% cases having predisposing urinary metabolic risk factors for urolithiasis. Most of the stones were located in the renal pelvis and measured 2.5-18 mm by ultrasonography. We found a strong correlation between renal stone size and urinary melamine concentration. For stones < 10 mm, a 10 μg/mmol creatinine increase in urinary melamine concentration is associated with approximately 1 mm increase in the size of the stone. The high degree of correlation strongly suggests that melamine is related to stone formation in humans. Using ROC analysis, we propose that patients who have a persistent melamine level above the optimal cut-off value of 7.1 μg melamine/mmol creatinine in urine might have a significant exposure of melamine-tainted products. Unlike melamine, urinary cyanuric acid is not significantly different between cases and controls. Pathophysiological findings from feeding animals with melamine and cyanuric acid may not be directly applicable to humans. Conclusion: Both melamine and urine metabolic lithogenic factors are important for the formation of melamine-related stones. Apart from aiding with case screening and confirmation, the urine melamine level might as well be an indicator of residual melamine load in the body and thus is useful for following-up and monitoring of the confirmed cases. As the stones are small and can be passed out spontaneously, follow-up of these patients with urine melamine will be a convenient tool for monitoring the melamine load of the patients. © 2008 Elsevier B.V. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/ccaen_HK
dc.relation.ispartofClinica Chimica Actaen_HK
dc.rightsClinica Chimica Acta. Copyright © Elsevier BV.en_HK
dc.subjectCyanuric aciden_HK
dc.subjectMelamineen_HK
dc.subjectMelamine-associated renal stone diseaseen_HK
dc.subject.meshChild, Preschoolen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInfanten_HK
dc.subject.meshKidney Calculi - epidemiology - metabolism - urineen_HK
dc.subject.meshMaleen_HK
dc.subject.meshTriazines - administration & dosage - metabolism - urineen_HK
dc.titleDiagnosis and spectrum of melamine-related renal disease: Plausible mechanism of stone formation in humansen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0009-8981&volume=402&spage=150&epage=155&date=2009&atitle=Diagnosis+and+spectrum+of+melamine-related+renal+disease:+plausible+mechanism+of+stone+formation+in+humansen_HK
dc.identifier.emailLam, CW:ching-wanlam@pathology.hku.hken_HK
dc.identifier.emailWong, SSY:samsonsy@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.emailTam, PKH:paultam@hkucc.hku.hken_HK
dc.identifier.authorityLam, CW=rp00260en_HK
dc.identifier.authorityWong, SSY=rp00395en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.identifier.authorityTam, PKH=rp00060en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/j.cca.2008.12.035en_HK
dc.identifier.pmid19171128-
dc.identifier.scopuseid_2-s2.0-60649086143en_HK
dc.identifier.hkuros155197en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-60649086143&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume402en_HK
dc.identifier.issue1-2en_HK
dc.identifier.spage150en_HK
dc.identifier.epage155en_HK
dc.identifier.isiWOS:000264618700027-
dc.publisher.placeNetherlandsen_HK
dc.identifier.scopusauthoridLam, CW=34570692600en_HK
dc.identifier.scopusauthoridLan, L=7005687228en_HK
dc.identifier.scopusauthoridChe, X=7005743182en_HK
dc.identifier.scopusauthoridTam, S=7202037323en_HK
dc.identifier.scopusauthoridWong, SSY=13310021400en_HK
dc.identifier.scopusauthoridChen, Y=13403088500en_HK
dc.identifier.scopusauthoridJin, J=55230685600en_HK
dc.identifier.scopusauthoridTao, SH=36092228000en_HK
dc.identifier.scopusauthoridTang, XM=7404101228en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK
dc.identifier.scopusauthoridTam, PKH=7202539421en_HK
dc.identifier.citeulike4116030-

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