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Investigation of Nephrolithiasis in Children with Tainted Chinese Dairy Product Consumption in Taiwan

Wang, I-Jen*†; Wu, Yu-Nian*; Wu, Wen-Chiuo*; Leonardi, Giovanni; Sung, Yen-Jen§; Lin, Shuei-Liong; Lin, Tien-Jen**; Wu, Kuen-Yuh††; Cheng, Wei-Chih‡‡; Chen, Pau-Chung††; Chan, Chang-Chuan††; Hwang, Kung-Chang*

doi: 10.1097/01.ede.0000362215.98114.94
Abstracts: ISEE 21st Annual Conference, Dublin, Ireland, August 25–29, 2009: Oral Presentations

*Department of Pediatrics, Taipei Hospital, Department of Health, Taipei, Taiwan; †Department of Health Risk Management, China Medical University, Taichung, Taiwan; ‡Health Protection Agency, Centre for Radiation, Chemical, and Environmental Hazards, Chemical Hazards & Poisons Division, Oxon, United Kingdom; §Institute of Cell Biology and Anatomy, National Yang Ming University, Taipei, Taiwan; ¶Taipei Hospital, Department of Health, Taipei, Taiwan; **Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; ††Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; and ‡‡Bureau of Food and Drug Analysis, Department of Health, Taipei, Taiwan.

Abstracts published in Epidemiology have been reviewed by the organizations of Epidemiology. Affliate Societies at whose meetings the abstracts have been accepted for presentation. These abstracts have not undergone review by the Editorial Board of Epidemiology.


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Little is known about the renal effects of melamine in humans. We evaluated risk factors, clinical manifestations, exposure patterns, and biomarkers for nephrolithiasis in children who consumed melamine-contaminated dairy products.

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From September 24 to October 31 in 2008, 1222 children whose parents were concerned that they may have consumed melamine-contaminated dairy products were investigated at Department of Health hospitals in Taiwan. The high exposure group was those who consumed China-brand dairy products with melamine levels >2.5 ppm. The low exposure group was those who consumed dairy products imported from China with melamine levels 0.05-2.5 ppm. Our control group was those who consumed dairy products without detected melamine levels <0.05 ppm. Clinical presentation, urinalysis, urine calcium, creatinine, and renal ultrasonography were evaluated. Urine melamine tests were checked for those with nephrolithiasis and age- and gender-matched controls selected from the study population.

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No hematuria, hypercalciuria, flank pain, or acute renal failure was noted in the high exposure group. Nine out of the 14 nephrolithiasis cases had a history of having resided in China and China-brand dairy product consumption. The age of children with nephrolithiasis in the high exposure group was younger than those without nephrolithiasis (P = 0.011). The duration of contaminated product consumption was longer in children with nephrolithiasis in the high exposure group than those without nephrolithiasis (P = 0.017). The risk of nephrolithiasis was found to increase with estimate melamine exposure levels (P for trend <0.001). Of the 10 nephrolithiasis cases that received urine melamine analysis, two had elevated levels. Comparatively, age- and gender-matched controls were all lower than the detection limit.

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Due to lack of symptoms and signs, we recommend renal ultrasonography for children with high melamine exposure. Urine melamine tests might be helpful in confirming the diagnosis of melamine related nephrolithiasis.

© 2009 Lippincott Williams & Wilkins, Inc.